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

Study Overview
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Brief Summary
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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.

Official Title
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The Application of a Mental Practice Protocol to Increase the Functional Recovery of the Hemiparetic Upper Extremity in the Acute Inpatient Rehabilitation Setting

Conditions
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Stroke, Upper Extremity Paresis

Intervention / Treatment
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* Other: Mental Practice
* Other: Repetitive-Task Practice
* Other: Traditional Therapy


Participation Criteria
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Eligibility Criteria
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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

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 80 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Audio MP<br>Participants of the audio mental practice (MP) group will complete MP via audio-guided multisensory cues of one of four tasks: (1) wiping a table (2) picking up a cup (3) brushing hair and/or (4) turning the page of a book. The assigned motor task is based upon the functional abilities of the patient. MP will be performed followed by physical practice of the same task with a research therapist 3x/week and independent MP 2 days/week. Each audio recording consists of 20 repetitions of the task. | Other: Mental Practice<br>* 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.<br>* Other names: Motor Imagery;|
| Experimental: Video MP<br>Participants of the video mental practice (MP) group will complete MP via video-guided multisensory cues of one of four tasks: (1) wiping a table (2) picking up a cup (3) brushing hair and/or (4) turning the page of a book. The assigned motor task is based upon the functional abilities of the patient. MP will be performed followed by physical practice of the same task with a research therapist 3x/week and independent MP 2 days/week. Each audio recording consists of 20 repetitions of the task. | Other: Mental Practice<br>* 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.<br>* Other names: Motor Imagery;|
| Experimental: Repetitive-Task Practice<br>Participants of the repetitive-task practice group will complete repetitive practice of one of four tasks: (1) wiping a table (2) picking up a cup (3) brushing hair and/or (4) turning the page of a book. The assigned motor task is based upon the functional abilities of the patient. MP will be performed followed by physical practice of the same task with a research therapist 3x/week and independent MP 2 days/week. Each participant completed at least 20 repetitions of the task. | Other: Repetitive-Task Practice<br>* Repetitive-Task Practice is the repetitive rehearsal of a motor task with the intent to improve motor performance.<br>* Other names: Repetitive-Task Specific Practice;|
| Active Comparator: Traditional Therapy<br>The control group received traditional occupational therapy stroke rehabilitation. | Other: Traditional Therapy<br>* 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.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| 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. | 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. | Within 3 days of admission and within 3 days prior to discharge | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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mental practice, stroke, upper extremity, hemiparesis, rehabilitation interventions