The Application of a Mental Practice Protocol in the Acute Inpatient Rehabilitation Setting

Adventist HealthCare18 enrolled

Overview

The purpose of this randomized controlled trial is to compare the effect of audio-guided mental practice (MP) and video-guided MP on the impairment and functional abilities of upper extremity (UE) hemiparesis following a stroke. Participants are recruited from Adventist Healthcare Rehabilitation Hospital. All participants must be less than one-month post-stroke with moderate UE hemiparesis. Eligible participants are randomly assigned to an experimental group, (MP or repetitive-task practice (RTP)), or the control group. The MP groups will perform either audio-guided MP or video-guided MP, five days a week, with 20 repetitions of the following tasks: wiping a table, picking up a cup, brushing hair, and turning the pages of a book. The RTP group physically performed the same tasks. The control group received traditional stroke rehabilitation. The investigators hypothesize that video MP will have greater improvements in UE impairments and functional abilities than audio MP, RTP, and/or traditional therapy.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

NONE

Enrollment

Conditions

Stroke Upper Extremity Paresis

Interventions

Mental PracticeOTHER

MP is the cognitive rehearsal of a motor task without physical movement, with the intent to improve motor performance. Mental practice can be completed via audio or video recording, visual prompts, written instructions, self-initiated or recorded pictures.

Repetitive-Task PracticeOTHER

Repetitive-Task Practice is the repetitive rehearsal of a motor task with the intent to improve motor performance.

Traditional TherapyOTHER

Traditional therapy includes traditional interventions completed in occupational therapy for patients following a stroke. These interventions include but are not limited to, range of motion, weight-bearing, massage, modalities, self-care training, and transfer training.

Eligibility

Sex: ALLMin age: 18 YearsMax age: 80 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Primary diagnosis of stroke * Less than one-month post-stroke * Hemiparesis of one upper extremity * Moderate upper extremity impairment Exclusion Criteria: * History of prior stroke * Comorbidities (severe neurological, orthopedic, rheumatoid, or cardiac impairments) * Severe spasticity * Severe cognitive impairments * Inability to perform mental imagery * Severe aphasia based on speech therapist evaluation * Low English proficiency * Severe pain

Outcomes

Primary Outcomes

Fugl Meyer Assessment-Upper Extremity Portion (FMA-UE) (Measuring pre/post intervention change)

The Fugl Meyer Assessment-upper extremity(FMA-UE) portion will be administered to measure the impairment of the upper extremity. Upper extremity movements are rated on 3-point ordinal scale where 0= unable to perform, 1= performs partially, 2= performs fully. Cumulative scores range from 0-66 where a lower score indicates increased impairment.

Time frame: Within 3 days of admission and within 3 days prior to discharge

Wolf Motor Function Test (WMFT) (Measuring pre/post intervention change)

The Wolf Motor Function Test (WMFT) is used to measure the functional abilities of the UE. 15 tasks are performed including six timed joint-segment movements and eight timed integrative functional movements. Tasks are rated on a 6-point ordinal scale where 0= does not attempt to 5=movement appears to be normal. Timed and functional ability scores are calculated to indicate the functional abilities of the UE.