Graded motor imagery training as a home exercise program for upper limb motor function in patients with chronic stroke: A randomized controlled trial.

PURPOSE: Although several types of occupational therapy for motor recovery of the upper limb in patients with chronic stroke have been investigated, most treatments are performed in a hospital or clinic setting. We investigated the effect of graded motor imagery (GMI) training, as a home exercise program, on upper limb motor recovery and activities of daily living (ADL) in patients with stroke. METHODS: This prospective randomized controlled trial recruited 42 subjects with chronic stroke. The intervention group received instruction regarding the GMI program and performed it at home over 8 weeks (30 minutes a day). The primary outcome measure was the change in motor function between baseline and 8 weeks, assessed the Manual Function Test (MFT) and Fugl-Meyer Assessment (FMA). The secondary outcome measure was the change in ADL, assessed with the Modified Barthel Index (MBI). RESULTS: Of the 42 subjects, 37 completed the 8-week program (17 in the GMI group and 20 controls). All subjects showed significant improvements in the MFT, FMA, and MBI over time (P < .05). However, the improvements in the total scores for the MFT, FMA, and MBI did not differ between the GMI and control groups. The MFT arm motion score for the GMI group was significantly better than that of the controls (P < .05). CONCLUSIONS: The GMI program may be useful for improving upper extremity function as an adjunct to conventional rehabilitation for patients with chronic stroke.

Is the modified Mann Assessment of Swallowing Ability useful for assessing dysphagia in patients with mild to moderate dementia?

Dysphagia is an important causative factor of aspiration pneumonia among the elderly, particularly in patients with dementia. The modified Mann Assessment of Swallowing Ability (mMASA) is commonly used as a physician-administered screening protocol for assessing dysphagia due to its merits as a clinical test that does not involve special equipment or radiation exposure. The present study investigated whether the mMASA would reflect the dysphagia state as estimated by videofluoroscopic swallowing study (VFSS) findings and cognitive function in patients with dementia. This study included 25 subjects with mild to moderate dementia. In all subjects, swallowing function was evaluated with the mMASA and VFSS and cognitive function was evaluated using the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Global Deterioration Scale (GDS), and Clinical Dementia Rating (CDR) scales. The Spearman correlation and linear regression tests were conducted with the mMASA values and other tests for swallowing and cognition. The mMASA values were correlated with the Penetration-Aspiration Scale (PAS) of the VFSS as well as scores on the MMSE, MoCA, GDS, and CDR. In addition, the Judgment and Problem Solving and Community Affairs subscales of the CDR were correlated with mMASA values. The assessments of dysphagia using the mMASA were consistent with the VFSS findings and were reflected by cognitive function. Taken together, the present findings suggest that the mMASA would be useful for the routine evaluation of swallowing function in patients with mild to moderate dementia for the detection of dysphagia.