Mental practice: applying motor PRACTICE and neuroplasticity principles to increase upper extremity function.

Abstract

The vast majority of stroke survivors exhibit residual impairments,1,2 with most reporting-associated quality of life decrements.3,4 The prevalence of these poststroke motor deficits and the overall burden of stroke are likely to rise exponentially attributable to an aging population and increases in the prevalence of many risk factors (eg, obesity, diabetes mellitus, smoking).5,6 In light of these trends, several promising motor interventions have been introduced, with many targeting upper extremity (UE) hemiparesis, given its widely appreciated impact. Yet, although several of these approaches appear efficacious, few therapeutic approaches showing promise in animal or early human trials are fully translated to regular clinical practice.7 Consistently, many contemporary motor rehabilitation strategies require high duration contact time8 and costly equipment,9 preventing their widespread clinical application, except among specialized rehabilitation and academic medical centers. Mental practice involves repetitive cognitive rehearsal of physical movements in the absence of physical, voluntary attempts. From a practical perspective, mental practice constitutes an attractive alternative to other rehabilitative approaches because it does not require physical rehearsal, can be performed without direct supervision, and requires minimal expense and equipment, facilitating ease of use. The brain’s ability to respond to repetitive, learning-based strategies even years after injury and well into adulthood also makes mental practice a favorable match for stroke, which tends to be a disease of the aged and because survivors frequently exhibit residual impairments for years postictus. We speculated that repetitive mental practice use, shown to trigger the same neural areas and musculature as physical practice of the same tasks,10–14 would cause substantive neural and motor changes in stroke survivors with UE deficits. Although used for decades in sport and exercise settings, this laboratory was the first to apply mental practice to increase learning …