Longer versus shorter mental practice sessions for affected upper extremity movement after stroke: a randomized controlled trial

Objective: To evaluate and compare efficacy of 20-, 40-, and 60-minute mental practice sessions on affected upper extremity impairment and functional limitation. Design: Randomized controlled study with multiple baseline design. Subjects: Twenty-nine subjects with chronic stroke and exhibiting stable, mild hemiparesis. Interventions: Subjects were given 30-minute rehabilitative sessions 3 days/week for 10 weeks, emphasizing affected upper extremity use during valued activities. Directly after these sessions, randomly selected subjects were given audiotaped mental practice for 20, 40, or 60 minutes. Subjects assigned to a control group received the same therapy as the mental practice groups, and an audiotaped sham intervention directly after therapy sessions. Main outcome measures: Fugl-Meyer (FM) motor assessment and Action Research Arm Test (ARAT). Results: No pre-existing differences were found between groups on any demographic variable or movement scale. On the FM, mental practice duration significantly predicted pretesting to post change (P = 0.05), with increasing duration related to larger FM score increases (5.4 point score increase for the 60-minute duration group). On the ARAT, a non-significant trend was seen (P = 0.78), favoring the 20-minute dosing condition (4.5 point increase). Importantly, regardless of dosing condition, subjects administered mental practice exhibited markedly larger score changes on both the FM and ARAT than subjects not receiving mental practice. Conclusions: Sixty minutes of mental practice appears to most significantly reduce affected arm impairment. However, no clear change pattern was seen in affected arm functional limitation according to mental practice duration. Results suggest that a stroke rehabilitative regimen augmented by mental practice renders a greater functional impact than therapy only.