Mental Practice in Post-stroke Subjects

Study Overview
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Brief Summary
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Among the limitations caused by cerebrovascular accident (CVA), the upper limb (MS) undergoes changes that limit the individual in his ability to maintain an active social life. Mental Practice (MP) consists of the internal reproduction of an event, which is repeated extensively in order to learn or improve an already known skill. The objective of the study is evaluate the effects of the physical practice associated with PM, on paretic MS. Subjects with unilateral stroke over 6 months, age> 18 years and who were able to hold objects will be selected. Subjects with painful conditions that affected exercise performance,> 3 spasticity by Ashworth, and cognitive deficit suggested by the Mini Mental State Examination will be excluded.

Detailed Description
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There are 3 study protocols. The MP protocol 1 comprise 4 steps: 1) 5 minutes of global relaxation; 2) Video therapy, being 2 minutes / task (4 distinct tasks: stacking cubes, opposition of fingers with precision gripping, passing water from one glass to another, sequencing of bottles); 3) MP: think about the tasks assisted in the video for 5 minutes / task. 4) Physical Practice: reproduce through the motor execution, the activities assisted in the video (5 minutes / task). The MP protocol 2 was the same, changing the order: first physical practice and after MP. For the protocol 3 without PM, step 3 was suppressed, remaining the remaining steps. There were 15 sessions, 2x / week, for 1 hour. The Fugl-Meyer (FM) Scales, Ashworth Modified Scale (EMA), Functional Independence Measurement (MIF), Action Research Arm Test (ARAt), Box and block task (BBT) and Theory of mind battery (ToM) will be applied before and after the sessions, and in 3 months follow-up.

Official Title
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Influence of Mental Practice on Manual Dexterity Associated Before and After Physical Practice in Patients With Stroke Sequelae

Conditions
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Stroke Sequelae, Stroke

Intervention / Treatment
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* Other: Physical practice
* Other: Mental practice
* Other: Videotherapy


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Clinical diagnosis of stroke, ischemic or hemorrhagic, for more than 6 months, age above 18 years, unilateral involvement and are able to hold objects Exclusion Criteria: Painful conditions that affect the ability to perform the proposed exercises, spasticity greater than 3 by the Ashworth Scale and cognitive deficits that will be evaluated by the Mini Mental State Examination (MMSE)

Ages Eligible for Study
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Minimum Age: 18 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: Quadruple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Group 1<br>Post-stroke participants receive the mental practice before the physical practice. The activities will be presented in a videotherapy way. | Other: Physical practice<br>* Physical Practice: reproduce through the motor execution (4 distinct tasks: stacking cubes, opposition of fingers with precision gripping, passing water from one glass to another, sequencing of bottles), the activities assisted in the video (5 minutes / task).<br>Other: Mental practice<br>* Mental practice: think about the tasks watched in the videotherapy (4 distinct tasks: stacking cubes, opposition of fingers with precision gripping, passing water from one glass to another, sequencing of bottles) for 5 minutes / task.<br>Other: Videotherapy<br>* Videotherapy, being 2 minutes per task (4 distinct tasks: stacking cubes, opposition of fingers with precision gripping, passing water from one glass to another, sequencing of bottles)<br>|
| Experimental: Group 2<br>Post-stroke participants receive the mental practice after the physical practice. The activities will be presented in a videotherapy way. | Other: Physical practice<br>* Physical Practice: reproduce through the motor execution (4 distinct tasks: stacking cubes, opposition of fingers with precision gripping, passing water from one glass to another, sequencing of bottles), the activities assisted in the video (5 minutes / task).<br>Other: Mental practice<br>* Mental practice: think about the tasks watched in the videotherapy (4 distinct tasks: stacking cubes, opposition of fingers with precision gripping, passing water from one glass to another, sequencing of bottles) for 5 minutes / task.<br>Other: Videotherapy<br>* Videotherapy, being 2 minutes per task (4 distinct tasks: stacking cubes, opposition of fingers with precision gripping, passing water from one glass to another, sequencing of bottles)<br>|
| Active Comparator: Group 3<br>Post-stroke participants receive only physical practice. The activities will be presented in a videotherapy way. | Other: Physical practice<br>* Physical Practice: reproduce through the motor execution (4 distinct tasks: stacking cubes, opposition of fingers with precision gripping, passing water from one glass to another, sequencing of bottles), the activities assisted in the video (5 minutes / task).<br>Other: Videotherapy<br>* Videotherapy, being 2 minutes per task (4 distinct tasks: stacking cubes, opposition of fingers with precision gripping, passing water from one glass to another, sequencing of bottles)<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Fugl-Meyer Scale | Sensory-motor impairment of upper limb | Change from baseline sensory-motor impairmente at 8 weeks and 3 months (follow-up). | 
| surface electromyography | Short radial extensor of the carpus and superficial flexor of the fingers | change from baseline muscle activity at 8 weeks and 3 months (follow-up) | 
| Functional independence measure (FIM) | assess the dependence of others for activities of daily living | change from baseline functional independence at 8 weeks and 3 months (follow-up) | 
| Action Research Arm Test (ARAT) | functional test of upper limb | change from baseline dexterity at 8 weeks and 3 months (follow-up) | 
| Box and Block test (BBT) | manual dexterity | change from baseline dexterity at 8 weeks and 3 months (follow-up) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Movement Imagery Questionnaire-Revised second version (MIQ-RS) | evaluate the ability to imagine thick movements related to the upper and include movements referring to the ADLs. | change from baseline ability to imagine at 8 weeks | 
| Kinesthetic and Visual Imagery Questionnaire (KVIQ - 10) | assessing visual and kinesthetic motor imagery | change from baseline capacity of imagination at 8 weeks | 
| Mini-mental State Examination | evaluation of cognition | baseline | 
| Theory of Mind Task Battery (ToM) | evaluation of mental function | change from mental function baseline at 8 weeks | 
| Modified ashworth scale (MAS) | evaluation of muscle tone of upper limb | change fom baseline muscle tone at 8 weeks and 3 months (follow-up) |