Towards efficient motor imagery interventions after lower-limb amputation.

BACKGROUND: The therapeutic benefits of motor imagery (MI) are now well-established in different populations of persons suffering from central nervous system impairments. However, research on similar efficacy of MI interventions after amputation remains scarce, and experimental studies were primarily designed to explore the effects of MI after upper-limb amputations. OBJECTIVES: The present comparative study therefore aimed to assess the effects of MI on locomotion recovery following unilateral lower-limb amputation. METHODS: Nineteen participants were assigned either to a MI group (n = 9) or a control group (n = 10). In addition to the course of physical therapy, they respectively performed 10 min per day of locomotor MI training or neutral cognitive exercises, five days per week. Participants' locomotion functions were assessed through two functional tasks: 10 m walking and the Timed Up and Go Test. Force of the amputated limb and functional level score reflecting the required assistance for walking were also measured. Evaluations were scheduled at the arrival at the rehabilitation center (right after amputation), after prosthesis fitting (three weeks later), and at the end of the rehabilitation program. A retention test was also programed after 6 weeks. RESULTS: While there was no additional effect of MI on pain management, data revealed an early positive impact of MI for the 10 m walking task during the pre-prosthetic phase, and greater performance during the Timed Up and Go Test during the prosthetic phase. Also, a lower proportion of participants still needed a walking aid after MI training. Finally, the force of the amputated limb was greater at the end of rehabilitation for the MI group. CONCLUSION: Taken together, these data support the integration of MI within the course of physical therapy in persons suffering from lower-limb amputations.

Effects of motor imagery training on gait performance in individuals after stroke: a systematic review and meta-analysis.

PURPOSE: This review systematically explores and summarise the effects of motor imagery training (MIT) compared to conventional therapy on gait performance in individuals after stroke. MATERIALS AND METHODS: Randomised controlled trials (RCTs) were systematically searched in five electronic databases (PubMed, EMBASE, PsycINFO, OVID Nursing and CINAHL) from inception to 30 December 2022. Studies investigating MITs, targeted at individuals after stroke were eligible. Data were extracted related to study and intervention characteristics. RESULTS: Sixteen studies were included. Compared with 'routine methods of treatment or training', the meta-analyses showed that MIT was more effective in improving cadence immediately post intervention (SMD: 1.22, 95% CI: 0.59, 1.85, p = 0.0001, I2 = 25%) and at 1- or 2-months post intervention (SMD: 0.78, 95% CI: 0.35, 1.20, p = 0.0004, I2 = 46%). The results also showed that MIT improves the step length of the affected side and the unaffected side at 1- or 2-months post intervention. Separate meta-analyses were also conducted on different tests of walking endurance (assessed by the 6-Minute Walk Test) and functional mobility (assessed by the Timed-Up-and-Go test). CONCLUSIONS: MIT effectively improved gait performance. The findings in individuals after stroke remain inconclusive due to significant heterogeneity in included studies.

Restoring gait performance and daily functional abilities is an important goal of post-stroke rehabilitation.Motor imagery training (MIT) may be a promising method to improve gait restoration and is expected to provide another option for the effective rehabilitation of stroke patients.This review highlights the limited research on MIT and thus the limited evidence to guide clinical rehabilitation.In the stroke rehabilitation, clinical specialists may consider incorporating MIT into the treatment programme to improve patients' gait performance and ensure effective early lower limb rehabilitation.

Exploring Methodological Issues in Mental Practice for Upper-Extremity Function Following Stroke-Related Paralysis: A Scoping Review.

In this scoping review, we aimed to comprehensively clarify the methodology of Mental practice (MP) by systematically mapping studies documenting the application of MP to post-stroke paralytic upper-extremity function. Specifically, when is an MP intervention most commonly applied after stroke onset? What is the corresponding MP load (intervention time, number of intervention days, and intervention period)? What are the most common methods of Motor Imagery (MI) recall and MI tasks used during the application of MP? Is MP often used in conjunction with individual rehabilitation? What are the paralyzed side's upper-limb and cognitive function levels at the start of an MP intervention? The research questions were identified according to PRISMA-ScR. The PubMed, Scopus, Medline, and Cochrane Library databases were used to screen articles published until 19 July 2022. In total, 694 English-language articles were identified, of which 61 were finally included. Most of the studies were conducted in the chronic phase after stroke onset, with limited interventions in the acute or subacute phase. The most common intervention time was ≤30 min and intervention frequency was 5 times/week in MP. An audio guide was most commonly used to recall MI during MP, and 50 studies examined the effects of MP in combination with individual rehabilitation. The Fugl-Meyer Assessment mean for the 38 studies, determined using the Fugl-Meyer Assessment, was 30.3 ± 11.5. Additional research with the aim of unifying the widely varying MP methodologies identified herein is warranted.

Unraveling Transformative Effects after tDCS and BCI Intervention in Chronic Post-Stroke Patient Rehabilitation-An Alternative Treatment Design Study.

Stroke is a debilitating clinical condition resulting from a brain infarction or hemorrhage that poses significant challenges for motor function restoration. Previous studies have shown the potential of applying transcranial direct current stimulation (tDCS) to improve neuroplasticity in patients with neurological diseases or disorders. By modulating the cortical excitability, tDCS can enhance the effects of conventional therapies. While upper-limb recovery has been extensively studied, research on lower limbs is still limited, despite their important role in locomotion, independence, and good quality of life. As the life and social costs due to neuromuscular disability are significant, the relatively low cost, safety, and portability of tDCS devices, combined with low-cost robotic systems, can optimize therapy and reduce rehabilitation costs, increasing access to cutting-edge technologies for neuromuscular rehabilitation. This study explores a novel approach by utilizing the following processes in sequence: tDCS, a motor imagery (MI)-based brain-computer interface (BCI) with virtual reality (VR), and a motorized pedal end-effector. These are applied to enhance the brain plasticity and accelerate the motor recovery of post-stroke patients. The results are particularly relevant for post-stroke patients with severe lower-limb impairments, as the system proposed here provides motor training in a real-time closed-loop design, promoting cortical excitability around the foot area (Cz) while the patient directly commands with his/her brain signals the motorized pedal. This strategy has the potential to significantly improve rehabilitation outcomes. The study design follows an alternating treatment design (ATD), which involves a double-blind approach to measure improvements in both physical function and brain activity in post-stroke patients. The results indicate positive trends in the motor function, coordination, and speed of the affected limb, as well as sensory improvements. The analysis of event-related desynchronization (ERD) from EEG signals reveals significant modulations in Mu, low beta, and high beta rhythms. Although this study does not provide conclusive evidence for the superiority of adjuvant mental practice training over conventional therapy alone, it highlights the need for larger-scale investigations.

Motor learning without physical practice: The effects of combined action observation and motor imagery practice on cup-stacking speed.

In this study we explored training effects for combined action observation and motor imagery (AO + MI) instructions on a complex cup-stacking task, without physical practice. Using a Graeco-Latin Square design, we randomly assigned twenty-six participants into four groups. This counterbalanced the within-participant factor of practice condition (AO + MI, AO, MI, Control) across four cup-stacking tasks, which varied in their complexity. On each of the three consecutive practice days participants experienced twenty trials under each of the three mental practice conditions. On each trial, a first-person perspective video depicted bilateral cup-stacking performed by an experienced model. During AO, participants passively observed this action, responding only to occasional colour cues. For AO + MI, participants imagined performing the observed action and synchronised their concurrent MI with the display. For MI, a sequence of pictures cued imagery of each stage of the task. Analyses revealed a significant main effect of practice condition both at the 'surprise' post-test (Day 3) and at the one-week retention test. At both time points movement execution times were significantly shorter for AO + MI compared with AO, MI and the Control. Execution times were also shorter overall at the retention compared with the post-test. These results demonstrate that a complex novel motor task can be acquired without physical training. Practitioners can therefore use AO + MI practice to supplement physical practice and optimise skill learning.

Defining and measuring motor imagery in children: mini review.

Motor imagery (MI) is the ability to engage in the mental representation of a task consciously or automatically without generating a voluntary movement. While the construct of MI and its various dimensions have been comprehensively studied in adults, research remains limited in children. Children as young as 5 years old can engage in MI, and this engagement is crucial to their motor development and skill acquisition. Further, the degree of skill achievement is directly linked to MI responsiveness. Clinicians and researchers often measure MI responsiveness in children to facilitate skill development and retention. However, few measures exist that can appropriately assess MI responsiveness in children. To date, a focused review examining the MI dimensions in children as well as comparing the characteristics of MI measures in children is lacking, and thus a research gap exists. This paper examines past and current research describing MI ability in children from the theoretical, developmental, and neurological lens and systematically analyzes the properties of three widely used operations - the movement imagery questionnaire in children (MIQ-C), the Florida praxis imaginary questionnaire (FPIQ-C), and the mental chronometry paradigm (MCP) - to measure MI and its dimensions in children.

Progressive muscle relaxation, meditation, and mental practice-based interventions for the treatment of tremor after traumatic brain injury.

BACKGROUND AND PURPOSE: Individuals post traumatic brain injury (TBI) are likely to experience cognitive, sensory, and motor impairments. Tremor is a common movement disorder that can affect this patient population. The purpose of this case report was to describe the effects that progressive muscle relaxation, meditation, and mental practice-based interventions have on the treatment of chronic right upper extremity tremor in a patient post-TBI. CASE DESCRIPTION: A 47-year-old male with a traumatic brain injury presented with a resting and postural tremor of the right wrist flexors and deficits in cognition, sensation, proprioception, balance, and motor function. The patient's primary goal for therapy was to decrease the tremor to improve his quality of life and ability to perform activities of daily living. METHODS: Progressive muscle relaxation, breath-focused meditation, and mental practice-based intervention were administered to the patient. Active range of motion activities occurred during weekly in-person sessions and daily practice occurred at home. RESULTS: The patient demonstrated improvements in quality of life, self-ratings of tremor severity, ratings of tremor impact on ADL's, gross motor object manipulation, frequency of tremor via surface electromyography, and visual inspection of a spirograph. CONCLUSION: A combination of progressive muscle relaxation, meditation, and mental practice-based interventions appeared to positively impact tremor across physical and psychosocial domains in a patient with a chronic tremor. Further investigation is needed to verify these findings.

Inter-task transfer of force gains is facilitated by motor imagery.

Introduction: There is compelling evidence that motor imagery (MI) contributes to improve muscle strength. While strong effects have been observed for finger muscles, only few experiments with moderate benefits were conducted within applied settings targeting large upper or lower limb muscles. The aim of the present study was therefore to extend the investigation of embedded MI practice designed to improve maximal voluntary strength on a multi-joint dynamic exercise involving the lower limbs. Additionally, we tested whether targeting the content of MI on another movement than that physically performed and involving the same body parts might promote inter-task transfer of strength gains. Methods: A total of 75 participants were randomly assigned into three groups who underwent a physical training on back squat. During inter-trial recovery periods, a first MI group (n = 25) mentally rehearsed the back squat, while a second MI group (n = 25) performed MI of a different movement involving the lower limbs (deadlift). Participants from the control group (n = 25) completed a neutral cognitive task during equivalent time. Strength and power gains were assessed ecologically using a velocity transducer device at 4 different time periods. Results: Data first revealed that participants who engaged in MI of the back squat improved their back squat performance (p < 0.03 and p < 0.01, respectively), more than the control group (p < 0.05), hence supporting the positive effects of MI on strength. Data further supported the inter-task transfer of strength gains when MI targeted a movement that was not physically trained (p = 0.05). Discussion: These findings provide experimental support for the use of MI during physical training sessions to improve and transfer force development.

A Quantitative Investigation of Mental Fatigue Elicited during Motor Imagery Practice: Selective Effects on Maximal Force Performance and Imagery Ability.

In the present study, we examined the development of mental fatigue during the kinesthetic motor imagery (MI) of isometric force contractions performed with the dominant upper limb. Participants (n = 24) underwent four blocks of 20 MI trials of isometric contractions at 20% of the maximal voluntary contraction threshold (20% MVCMI) and 20 MI trials of maximal isometric contractions (100% MVCMI). Mental fatigue was assessed after each block using a visual analogue scale (VAS). We assessed maximal isometric force before, during and after MI sessions. We also assessed MI ability from self-report ratings and skin conductance recordings. Results showed a logarithmic pattern of increase in mental fatigue over the course of MI, which was superior during 100% MVCMI. Unexpectedly, maximal force improved during 100% MVCMI between the 1st and 2nd evaluations but remained unchanged during 20% MVCMI. MI ease and vividness improved during 100% MVCMI, with a positive association between phasic skin conductance and VAS mental fatigue scores. Conversely, subjective measures revealed decreased MI ability during 20% MVCMI. Mental fatigue did not hamper the priming effects of MI on maximal force performance, nor MI's ability for tasks involving high physical demands. By contrast, mental fatigue impaired MI vividness and elicited boredom effects in the case of motor tasks with low physical demands.

Bilateral transfer of motor performance as a function of motor imagery training: a systematic review and meta-analysis.

Objective: The objective of this review was to evaluate the efficacy of mental imagery training (MIT) in promoting bilateral transfer (BT) of motor performance for healthy subjects. Data sources: We searched 6 online-databases (Jul-Dec 2022) using terms: "mental practice," "motor imagery training," "motor imagery practice," "mental training," "movement imagery," "cognitive training," "bilateral transfer," "interlimb transfer," "cross education," "motor learning," "strength," "force" and "motor performance." Study selection and data extraction: We selected randomized-controlled studies that examined the effect of MIT on BT. Two reviewers independently determined if each study met the inclusion criteria for the review. Disagreements were resolved through discussion and, if necessary, by a third reviewer. A total of 9 articles out of 728 initially identified studies were chosen for the meta-analysis. Data synthesis: The meta-analysis included 14 studies for the comparison between MIT and no-exercise control (CTR) and 15 studies for the comparison between MIT and physical training (PT). Results: MIT showed significant benefit in inducing BT compared to CTR (ES = 0.78, 95% CI = 0.57-0.98). The effect of MIT on BT was similar to that of PT (ES = -0.02, 95% CI = -0.15-0.17). Subgroup analyses showed that internal MIT (IMIT) was more effective (ES = 2.17, 95% CI = 1.57-2.76) than external MIT (EMIT) (ES = 0.95, 95% CI = 0.74-1.17), and mixed-task (ES = 1.68, 95% CI = 1.26-2.11) was more effective than mirror-task (ES = 0.46, 95% CI = 0.14-0.78) and normal-task (ES = 0.56, 95% CI = 0.23-0.90). No significant difference was found between transfer from dominant limb (DL) to non-dominant limb (NDL) (ES = 0.67, 95% CI = 0.37-0.97) and NDL to DL (ES = 0.87, 95% CI = 0.59-1.15). Conclusion: This review concludes that MIT can serve as a valuable alternative or supplement to PT in facilitating BT effects. Notably, IMIT is preferable to EMIT, and interventions incorporating tasks that have access to both intrinsic and extrinsic coordinates (mixed-task) are preferred over those that involve only one of the two coordinates (mirror-task or normal-task). These findings have implications for rehabilitation of patients such as stroke survivors.

Validation of the Slovenian Version of the Movement Imagery Questionnaire for Children (MIQ-C): A Measurement Tool to Assess the Imagery Ability of Motor Tasks in Children.

Purpose: The ability to perform motor imagery has been shown to influence individual athletic performance and rehabilitation. Recent evidence supports its potential as a training tool to improve motor skills in children. Although there is a standardized assessment of the imagery abilities in Slovenian-speaking adults, there is currently no validated instrument for use with Slovenian children. Therefore, the aim of the present study was to conduct a linguistic validation study of the movement imagery questionnaire for children (MIQ-C). Methods: A total of 100 healthy children (mean age 10.3±1.3 years; 50 female) were assessed with a Slovenian version of the MIQ-C at Day 1 and Day 8. Inter-day agreement was examined using intraclass correlation coefficients (ICC). Construct validity and internal consistency were assessed using a Cronbach's alpha coefficient and exploratory - confirmatory factor analysis, respectively. Results: The test-retest ICC were very high for all three scales examined (ICCKI=0.90; ICCIVI=0.92; ICCEVI=0.90). Excellent internal consistency (up to 0.90) was found for kinaesthetic and both visual imageries. Confirmatory analysis confirmed a three-factorial structure of the MIQ-C. Conclusions: The Slovenian version of the MIQ-C proved to be highly reliable and valid in assessing children's motor imagery abilities, and as such for use with Slovene-speaking children. Moreover, this standardized instrument can be a helpful tool in training and rehabilitation practice with children aged 7-12 years.

Timing-specific patterns of cerebral activations during motor imagery: A case study of the expert brain signature.

Brain activations elicited during motor imagery (MI) in experts are typically reduced compared to novices, which is interpreted as a neurophysiological correlate of increased neural efficiency. However, the modulatory effects of MI speed on expertise-related differences in brain activation remains largely unknown. In the present pilot study, we compared the magnetoencephalographic (MEG) correlates of MI in an Olympic medallist and an amateur athlete under conditions of slow, real-time and fast MI. Data revealed event-related changes in the time course of alpha (8-12 Hz) power of MEG oscillations, for all timing conditions. We found that slow MI was associated with a corollary increase in neural synchronization, in both participants. Sensor-level and source-level analyses however disclosed differences between the two expertise levels. The Olympic medallist achieved greater activation of cortical sensorimotor networks than the amateur athlete, particularly during fast MI. Fast MI elicited the strongest event-related desynchronization of alpha oscillations, which was generated from cortical sensorimotor sources in the Olympic medallist, but not in the amateur athlete. Taken together, data suggest that fast MI is a particularly demanding form of motor cognition, putting a specific emphasis on cortical sensorimotor networks to achieve the formation of accurate motor representations under demanding timing constraints.

Enhancing upper-limb neurorehabilitation in chronic stroke survivors using combined action observation and motor imagery therapy.

Introduction: For people who have had a stroke, recovering upper-limb function is a barrier to independence. When movement is difficult, mental practice can be used to complement physical therapy. In this within-participants study we investigated the effects of combined action observation and motor imagery (AO + MI) therapy on upper-limb recovery in chronic stroke survivors. Methods: A Graeco-Latin Square design was used to counterbalance four mental practice conditions (AO + MI, AO, MI, Control) across four cup-stacking tasks of increasing complexity. Once a week, for five consecutive weeks, participants (n = 10) performed 16 mental practice trials under each condition. Each trial displayed a 1st person perspective of a cup-stacking task performed by an experienced model. For AO, participants watched each video and responded to an occasional color cue. For MI, participants imagined the effort and sensation of performing the action; cued by a series of still-images. For combined AO + MI, participants observed a video of the action while they simultaneously imagined performing the same action in real-time. At three time points (baseline; post-test; two-week retention test) participants physically executed the three mentally practiced cup-stacking tasks, plus a fourth unpractised sequence (Control), as quickly and accurately as possible. Results: Mean movement execution times were significantly reduced overall in the post-test and the retention test compared to baseline. At retention, movement execution times were significantly shorter for combined AO + MI compared to both MI and the Control. Individual participants reported clinically important changes in quality of life (Stroke Impact Scale) and positive qualitative experiences of AO + MI (social validation). Discussion: These results indicate that when physical practice is unsuitable, combined AO + MI therapy could offer an effective adjunct for neurorehabilitation in chronic stroke survivors.

[Modern view on upper limb physical rehabilitation after stroke. Literature review]. / Sovremennyi podkhod k fizicheskoi reabilitatsii funktsii verkhnei konechnosti posle insul'ta. Obzor literatury.

Stroke is the world's second leading cause of death and the first cause of disability among all diseases. The most common complication of a stroke is a violation of the motor function of the limbs, which significantly worsens the quality of life and the level of self-care and independence of patients. Restoring the function of the upper limb is one of the priority tasks of rehabilitation after a stroke. A large number of factors, such as the location and size of the primary brain lesion, the presence of complications in the form of spasticity, impaired skin and proprioceptive sensitivity, and comorbidities, determine the patient's rehabilitation potential and the prognosis of ongoing rehabilitation measures. Of particular note are the timing of the start of rehabilitation measures, the duration and regularity of the treatment methods. A number of authors propose scales for assessing the rehabilitation prognosis, as well as algorithms for compiling rehabilitation programs for restoring the function of the upper limb. A fairly large number of rehabilitation methods and their combinations have been proposed, including special methods of kinesitherapy, robotic mechanotherapy with biofeedback, the use of physiotherapeutic factors, manual and reflex effects, as well as ready-made programs that include sequential and combined use of various methods. Dozens of studies have been devoted to comparative analysis and evaluation of the effectiveness of these methods. The purpose of this work is to review current research on a given topic and draw up our own conclusion on the appropriateness of using and combining these methods at various stages of rehabilitation in stroke patients.

Mental training in dentistry: A scoping review.

INTRODUCTION: Clinical motor skills are essential to train dental students. There is evidence that imagery serves to acquire and improve motor skills, but there is scarce information on its application in dental education. In order to broadly map the available evidence and to detect knowledge gaps in the mental training used to develop motor skills in dentistry, a scoping review was conducted. MATERIALS AND METHODS: A structured search was conducted to identify relevant references from the Web of Science, Scopus and MEDLINE/PubMed databases for studies addressing mental training methods applied to develop motor skills in dentistry. RESULTS: A total of 758 articles were screened and four were selected, all of which were randomized clinical trials. Three studies investigated the effectiveness of visual imagery, and one investigated kinesthetic imagery. The research theme identified was motor skill acquisition. CONCLUSION: The reviewed studies indicate the usefulness of mental training for skill acquisition in dentistry. To improve the generalizability of the results, further research with standardized mental training on motor skills in dentistry is needed.

Effects of mental practice on pain, functionality, and quality of life in individuals with chronic neck pain: A systematic review.

PURPOSE: There are conflicting reports in the literature regarding the effectiveness of motor imagery (MI) and action observation (AO) in individuals with chronic non-specific neck pain (CNSNP). This study sought to systematically investigate whether mental practice has any impact on pain, functionality and quality-of-life in individuals with CNSNP. METHODS: This is a systematic review. Randomized controlled trials (RCTs) that explored the effects of mental practice on pain, functionality and quality-of-life in individuals with CNSNP were searched using databases PubMed, Cochrane library, Medline via Ovid, Scopus, and PEDro from inception to July 2022. Two reviewers independently extracted data and evaluated the quality of the studies utilizing the PEDro scale. RESULTS: Six high-quality RCTs with 128 participants with CNSNP in the MI and AO groups, and 93 participants with CNSNP in the control group, were included in this review. Both AO and MI were effective in improving pain response and cervical joint position sense. However, AO was more efficient than MI and its effects were retained longer. Improvements in the visual analogue scale and neck disability index were retained when MI training lasted for 6 weeks. The pain and general health sub-parameters of the short form-36 health survey improved after MI training. CONCLUSION: Mental practice, particularly AO, can improve neck pain intensity, joint position sense, functional disability, and some aspects of quality-of-life in individuals with CNSNP. These improvements dissipated over time. Although mental practice can be an alternative to exercise when pain exists, it can be more efficient when prescribed with simple movements and exercises. REGISTRATION: The protocol of this review was registered with PROSPERO (CRD42022330240) Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022330240.

Mental practice for laparoscopic salpingectomy.

Mental practice (MP) is a method of enhancing surgical training by rehearsal of a task without physical action. The primary objective of the study was to develop and validate a MP tool for laparoscopic salpingectomy (LS). An imagery script for LS was developed and used to facilitate a structured MP session for trainees in Obstetrics and Gynaecology and expert gynaecologists across three teaching hospitals in the UK. A virtual platform was used for one trainee group to assess its feasibility compared to a face-to-face approach. Pre- and post-session assessments were conducted to evaluate the impact of the script on motivation, confidence, preparedness and quality of imagery and demonstrated a significant improvement in global imagery scores for both novice groups. The expert group scored significantly higher than the face-to-face novice group on all items both before and after MP, indicating construct validity. There were no significant differences demonstrated between the two novice groups, thus demonstrating the virtual platform to be a non-inferior approach - an important consideration in the current COVID era.

Effectiveness of synchronous action observation and mental practice on upper extremity motor recovery after stroke.

The purpose of this quasi-experimental pretest-posttest control group study was to examine the effect of group synchronous action observation/mental practice intervention compared to usual rehabilitation care on upper extremity motor recovery after stroke. The intervention group (n = 25) received usual care, consisting of a minimum of 3 hours of rehabilitation services per day, 5 days a week, plus group synchronous action observation/mental practice sessions 3 times per week and the control group (n = 26) received usual care. Outcome measures included the Kinesthetic and Visual Imagery Questionnaire Short Version (KVIQ-10), the Fugl-Meyer Assessment (FMA-UE) of affected upper extremity motor function only and The Box and Block Test (BBT). Although there were no statistically significant differences in upper extremity motor function between the two groups, a subgroup analysis of the intervention group identified statistically significant (FMA-UE: p < .001; BBT: p = .04) and Minimally Important Clinical Differences on upper extremity motor recovery between patients with behaviors demonstrating more versus less commitment to the intervention. Group synchronous action observation/mental practice is a promising intervention for patients demonstrating commitment to actively participating in the intervention to improve outcomes on upper extremity motor recovery after stroke.

Can mental practice adjunct in the recovery of motor function in the upper limbs after stroke? A systematic review and meta-analysis.

BACKGROUND: Studies indicate that mental practice can be an adjuvant rehabilitation, improving motor functions. AIM: To synthesize the evidence on the intervention with the mental practice for the rehabilitation of the upper limb after stroke in the context of a dependent task. METHODS: The review was registered on the PROSPERO with protocol number: CRD42020166624. We searched the PubMed, Medline, Embase, Central, PEDro, and Web of Science from randomized clinical trials from 1975 to 2022. A literature review was conducted with 13 studies that synthesized findings on mental practice such as adjuvant rehabilitation in the recovery of the upper limb after stroke based on Fugl-Meyer Assessment (FMA) Motor and action research arm test (ARAT) scores. RESULTS: The sample size was 232 were part of the intervention group and 180 of the control group. The findings no showed results in favor of mental practice after stroke accordingly to ARAT and FMA Motor scores (P > 0.05). CONCLUSION: Current evidence does not support the use of the mental practice to increase the recovery of the upper limb after stroke, although the evidence is conflicting for some aspects of the technique.