The feasibility of a mental practice protocol for severe upper extremity hemiparesis

Objective: To increase the efficacy of mental practice (MP) with severe upper extremity (UE) hemiparesis following a stroke and examine the feasibility of following a MP protocol in the acute inpatient rehabilitation setting. Design: single-group, pretest-posttest Setting: acute inpatient rehabilitation Subjects: 11 patients, less than 1-month post-stroke with severe UE hemiparesis and 17 occupational therapists working in acute inpatient rehabilitation Intervention: Patients completed a MP protocol of MP 5 days/week for 2 weeks of wiping a table and picking up a cup. Outcome Measures: Wolf Motor Function Test (WMFT) and Fugl Meyer Assessment-UE (FMA-UE) assessed UE functional abilities and impairments. The Acceptability of Intervention Measure (AIM), the Intervention Appropriateness Measure (IAM), and the Feasibility of Intervention Measure (FIM) measured perceptions of MP. Results: Wilcoxon signed-rank test demonstrated completing MP showed a statistically significant difference in FMA-UE scores from pretest (Mdn = 7.00, M = 8.36, SD =5.46) to posttest (Mdn = 13.00, M = 16.27, SD =11.11), n = 11, Z= 2.70, p= .007, r = .57. There was no statistically significant change in WMFT time scores from pretest (Mdn = 120.00, M = 114.48, SD = 18.32) to posttest (Mdn = 120; M = 81.25, SD = 54.72), Z = 1.82, p =.068, r = .39. There was a statistically significant change in WMFT-FAS from pretest (Mdn = 1.00, M = .91, SD = .831) to posttest (Mdn = 1.00, M = 1.55, SD = 1.29), Z = 2.07, p =.041, r = .44. MP improved UE impairments with less effect on UE functional abilities. Mean AIM scores demonstrated 72.7% of patient responses and 70.6% of therapist responses were agreeable to the acceptability of MP as a treatment. Mean IAM and FIM scores for therapists and patients demonstrate >80% of patient responses were agreeable to MP as an appropriate and feasible intervention. Conclusions: Although there is less acceptability of patients and therapist toward MP as an intervention, MP is a feasible and effective treatment for acute UE hemiparesis following a stroke.