Mental-practice-in-OT-Stroke-LLL event-London region. freeman.pp.ppt

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  • 1.
    • The Use of Mental Practice in Occupational Therapy for Stroke Patients
    • Sarah Freeman
    • [email_address]
    Mental Practice
  • 2.
    • Definition of mental practice
    • Types of mental imagery
    • The effectiveness of mental practice
    • The use of mental practice in stroke rehabilitation and in occupational therapy
    • Areas for further research
    Objectives
  • 3. What is mental practice?
    • ‘ the symbolic rehearsal of a physical activity in the absence of any gross muscular movements’ (Richardson, 1967)
    • Mental practice is achieved through the use of mental imagery
    • The effects of mental and physical practice are functionally similar
  • 4. Types of mental imagery
    • Visual
      • eg Imagining the movement of a visual form
    • Motor
      • eg imagining your own hand moving
    • Kinaesthetic
      • eg imagining the feeling of your hand moving
  • 5.
    • Internal Imagery- an internal recreation of the task:
    • Effective for planning a task
    • External Imagery- an outside perspective of performance:
    • More effective for learning & subsequent retention
    Types of mental imagery
  • 6. The effectiveness of mental practice
    • Combined with physical practice,
    • mental practice:
    • improves performance to the same, or a higher extent than physical practice alone
    • increases the rate of skill acquisition
    • may facilitate greater performance than that of a control condition of no input
  • 7. Stroke rehabilitation approaches
    • All approaches involve the process of re-learning
    • Eg:
      • Neurodevelopmental treatment (Bobath)
      • Motor re-learning (Carr & Shepherd)
      • Task- oriented approaches
      • Compensatory
  • 8. Mental practice theories
    • It is debated whether mental practice relies on motor, cognitive or motivational processes
      • Mental practice is more effective when learning simple tasks
      • Imagery abilities may vary
      • Tasks learned must be meaningful & prior experience of the activity is necessary
  • 9. How mental imagery can promote functional independence through relearning
  • 10. Mental practice used in occupational therapy
    • Page, Levine & Leonard (2005)
    • Investigated the efficacy of mental practice in increasing the function & use of the affected upper limb of 11 stroke patients.
    • Randomized, controlled pre-post case series study
    • Tasks were reaching & grasping a cup, turning pages & using a pen.
  • 11. Mental practice used in occupational therapy
    • Page, Levine & Leonard (2005)
    • Results showed:
      • Increased affected limb use and function
      • Skills had been generalized to other ADLs after intervention
  • 12. Mental practice used in occupational therapy
    • Smania, et al. (1997)
    • Studied the effectiveness of visuomotor imagery practice in rehabilitation of unilateral neglect
    • Before / after trial on 2 participants
    • Mental imagery included imagining patients at home, geographical areas, reverse spelling & mental representation.
  • 13. Mental practice used in occupational therapy
    • Smania, et al. (1997)
    • Outcomes assessed using functional tests & neuropsychological tests
    • Visuomotor imagery training found to improve performance deficits related to neglect
  • 14. Mental practice used in occupational therapy
    • Liu et al., (2004)
    • Studied the efficacy of mental imagery at promoting relearning for people after a stroke
    • Prospective, randomized controlled trial, of 46 stroke inpatients aged over 60 years.
    • MP Protocol used picture cards, visualizing performance and watching videotaped performance
  • 15. Mental practice used in occupational therapy
    • Liu et al., (2004)
    • Outcome measures used were the performance of 15 trained and 5 untrained daily living tasks
    • Patients who engaged in mental practice improved their attention & sequencing ability
    • Increased their relearning of familiar and new tasks
  • 16. Benefits of using mental practice
      • Increases affected limb use and function
      • Can improve cognitive skills (eg attention, sequencing)
      • Creates opportunities for clients to problem-solve
      • Uses a client-centred approach
      • Time / cost -effective
  • 17. Areas for further research
    • Establishing guidelines and protocols
    • Motivational aspects of relearning through mental practice
    • Long-term occupational benefits
  • 18.
    • Sarah Freeman
    • [email_address]
    Mental Practice
  • 19. References
    • Bell, A. & Murray, B (2004) Improvement in Upper Limb Motor Performance following Stroke: the Use of Mental Practice. British Journal of Occupational Therapy 67 (11): 501-507.
    • Kosslyn,S.M. (1994) Image and brain : the resolution of the imagery debate. Cambridge, Mass. ; London : MIT Press
    • Liu, K. P., Chan, C. C., Lee, T., Hui-Chan, C. W. (2004) Mental Imagery for Promoting Relearning for People After Stroke: A Randomized Controlled Trial. Archives of Physical Medical Rehabilitation 85:1403-8.
    • Page, S. Levine, P. Leonard, A. (2005) Effects of Mental Practice on Affected Limb Use and Function in Chronic Stroke. Archives of Physical & Medical Rehabilitation 86 399-402.
    • Richardson, A (1967) Mental Practice: a review and discussion (part 1). Research Quarterly (38): 95-107
    • Smania, N., Bazoli, .F, Piva, D., Guidetti, G. (1997) Visuomotor imagery and rehabilitation of neglect. Archives of Physical & Medical Rehabilitation, 78:430-6.
    • Van Leeuwen, R., Inglis, J.T. (1998) Mental practice and imagery: a potential in stroke rehabilitation. Physical Therapy Reviews 3 :47-52.