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PHYS THER
Vol. 82, No. 1, January 2002, pp. 93-94
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Letters and Responses

Mental Practice


To the Editor:

I would like to comment on the Case Report by Page et al titled "Mental Practice Combined With Physical Practice for Upper-Limb Motor Deficit in Subacute Stroke" (August 2001).

I believe in the value of mental practice in treatment, and it is very important to bring up this subject when discussing the management of a person with hemiplegia. In this report, the patient was managed using mental practice and physical therapy. In my opinion, the importance of mental practice in this case would have been proven if the patient had been managed using mental practice only. The fact that the patient received both mental practice and physical therapy makes it impossible to determine whether one intervention or the other (or both) led to the improvement seen.

The condition of a person 5 months after a stroke will be different from that person's condition only 1 month after the stroke. Therefore, even though physical therapy might not have helped at the earlier stage poststroke, it might have been effective at the later stage.

Elia PanturinPT, MEd

Lecturer
Tel Aviv University
Tel Aviv, Israel
Senior Instructor
International Bobath Instructors Training Association

 

Author Response:


We thank Ms Panturin for her interest in our study. We agree that it would be interesting to test the efficacy of a "mental practice only" protocol on skill reacquisition in people with hemiparesis. However, the greatest increases are exhibited when mental practice is combined with physical practice,1,2 particularly in an alternating fashion,3,4 as is provided in our protocol. In contrast, considerably smaller gains have been realized from protocols implementing mental practice only. There are also data suggesting that as learners become more experienced with the physical properties of the task, mental practice becomes more effective.5 This seems reasonable, as an individual with low physical familiarity with a complex activity of daily living would probably have difficulty mentally rehearsing the skill. For these reasons, we selected a protocol combining physical practice (ie, therapy) with mental practice.

We also agree with Ms Panturin that the condition of an individual 5 months after stroke is substantially different from that of an individual 1 month after stroke. However, the research is clear that, as patients move further past neurologic insult, their potential to respond to traditional therapy regimens is diminished6 (although gains have been seen in response to novel regimens7 or regimens altering intensity levels8). The fact that our patient was highly accustomed to the therapy to which he was being exposed and the fact that he was at a later stage, therefore, make it less likely that therapy was "effective at the later stage" and less likely that the improvement exhibited was due to therapy.

Stephen J Page

Clinical Research Scientist
Outcomes Research Department
Kessler Medical Rehabilitation Research and Education Corporation
1199 Pleasant Valley Way
West Orange, NJ 07052
(spage{at}kmrrec.org)
Assistant Professor of Physical Medicine and Rehabilitation
The University of Medicine and Dentistry/New Jersey Medical School
Newark, NJ

Peter Levine

Research Assistant
Kessler Medical Rehabilitation Research and Education Corporation

Sue Ann Sisto

Director
Human Performance and Movement
Analysis Laboratory
Kessler Medical Rehabilitation Research and Education Corporation
Assistant Professor of Physical Medicine and Rehabilitation
The University of Medicine and Dentistry/New Jersey Medical School

Mark V Johnston

Director
Outcomes Research Department
Kessler Medical Rehabilitation Research and Education Corporation
Associate Professor of Physical Medicine and Rehabilitation
The University of Medicine and Dentistry/New Jersey Medical School

References

  1. Hird JS, Landers DM, Thomas JR, Horan JJ. Physical practice is superior to mental practice in enhancing cognitive and motor task performance. J Sport Exerc Psych.1991; 13:281–293.[ISI][Medline]
  2. McBride E, Rothstein A. Mental and physical practice and the learning and retention of open and closed motor skills. Percept Mot Skills.1979; 49:359–365.[Abstract/Free Full Text]
  3. Etnier J, Landers DM. The influence of procedural variables on the efficacy of mental practice. Sport Psychol.1996; 10:48–57.
  4. Gabriele T, Hall CR, Lee TD. Cognition in motor learning: imagery effects on contextual interference. Human Movement Science.1989; 8:227–245.
  5. MacKay DG. The problem of rehearsal or mental practice. J Mot Behav.1981; 13:274–285.[ISI][Medline]
  6. Jorgenson HS, Nakayama H, Raaschou H, et al. Outcome and time course of recovery in stroke, part II: time course of recovery, the Copenhangen stroke study. Arch Phys Med Rehabil.1995; 76:406–412.[ISI][Medline]
  7. Page SJ. Imagery improves motor function in chronic stroke patients with hemiplegia: a pilot study. Occup Ther J Res.2000; 20:200–215.
  8. Van der Lee JH, Wagenaar RC, Lankhorst GJ, et al Forced use of the upper extremity in chronic stroke patients: results from a single-blind randomized clinical trial. Stroke.1999; 30:2369–2375.[Abstract/Free Full Text]




This Article
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