Professional Documents
Culture Documents
PICO Question
Is mental imagery
combined with
occupational therapy
effective in promoting
upper extremity motor
function with clients
post stroke?
Clinical Relevance
Stroke is a leading cause of serious long-term
disability that impacts an individuals quality of life.
According to the CDC (2015), stroke costs the U.S.
an estimated $34 billion each year for the cost of
health care services, medications, & missed days of
work.
Upper extremity hemiparesis is one of the most
prevalent impairments caused by stroke as it
negatively impacts occupational performance in
valued activities.
(Page, Levine, Sisto, & Johnston, 2001)
Search Strategy
Electronic Databases
CINAHL, OT Search & AJOT
Key Words Searched
Occupational Therapy, Upper
Extremity/Limb Recovery and:
Mental Imagery
Mental Practice
Guided Imagery
Motor Imagery
Inclusion Criteria
Stroke
Peer Reviewed
Exclusion Criteria
Chronic pain management,
breast cancer, COPD, or any
other diagnosis/condition.
Non-peer reviewed
Summary of Evidence
Level of Evidence
Study Design/Methodology
of Selected Articles
Number of Articles
Found
II
Small-scale RCT
Non-randomized studies (with a
control group)
III
IV
Qualitative Study
Total:
Best Evidence
Article
Level of Evidence
Kim, S., & Lee, B. (2015). Motor imagery training improves upper
extremity performance in stroke patients. Journal of Physical
Therapy Science, 27(7), 2289-2291 3p.
Nilsen, D. M., Gillen, G., DiRusso, T., & Gordon, A. M. (2012). Effect of
imagery perspective on occupational performance after
stroke: A randomized controlled trial. American Journal of
Occupational Therapy, 66, 320329. http://dx.doi. Org/
10.5014/ajot.2012.003475
Page, S. J., Levine, P., Sisto, S., & Johnston, M. V. (2001). A
randomized efficacy and feasibility study of imagery in acute
stroke. Clinical Rehabilitation, 15(3), 233-240. doi:
10.1191/026921501672063235
II
II
Article #1
Meta-analysis on the Effect of Mental Imagery
on Motor Recovery of the Hemiplegic Upper
Extremity Function
Article #2
Motor Imagery Training Improves Upper
Extremity Performance in Stroke Patients
(Kim & Lee, 2015)
Exclusion Criteria
Control Group
Article #3
Effect of Imagery Perspective on
Occupational Performance After Stroke: A
Randomized Controlled Trial
(Nilsen, Gillen, Dirusso, & Gordon, 2012)
Article #4
A Randomized Efficacy and Feasibility
Study of Imagery in Acute Stroke
(Page, Levine, Sisto, & Johnston, 2001)
Testing Procedures
13 patients signed informed consent forms
2 separate pretesting sessions (1 week apart) with Fugl-Meyer &
Action Research Arm Test (ARA)
No intervention or research team contact between session
After second pretesting session, participants were randomly
assigned to either the therapy + imagery group or the therapy
only group
Computer generated random numbers table
Participants received therapy 1 hour, 3x/week for 6 weeks
Intervention Procedures
1 hour therapy sessions
30 minutes: upper extremity
30 minutes: lower extremity & gross arm
movements
All activities (transfers, balance/ambulation, ADL
training) performed bimanually
If necessary, performed with unaffected arm
supporting affected arm
Intervention Procedures
After therapy, patients assigned to experimental group
listened to 10 minute tape recorded imagery intervention read
by experienced male psychologist with expertise in imagery
2-3 minutes: Relaxation
Imagine self in warm, relaxing place (i.e. beach)
Progressive relaxation
- 2 minutes: Refocusing
Intervention Procedures
To maintain interest, 3 imagery scripts provided
for 6 weeks
Scripts focused on different functional
movements including: shoulder internal/external
rotation, pronation/supination, shoulder flexion,
and movement that facilitated grasp
Home Imagery Tapes: same as tape used in
therapy for that given week, 2 alternating
weekdays per week
Intervention Procedures
To ensure contact time was consistent,
patients in control group listened to 10 minute
tape containing information about stroke in
addition to listening to tape at home twice
per week
Instruments (Fugl Meyer & ACA) were
administered by blinded rater 1 week after
discharge
References
Kho, A. Y., Liu, K. Y., & Chung, R. K. (2014). Meta-analysis on the effect of mental imagery on motor recovery of the
hemiplegic upper extremity function. Australian Occupational Therapy Journal, 61(2), 38-48 11p. Doi:
10.1111/1440-1630.12084
Kim, S., & Lee, B. (2015). Motor imagery training improves upper extremity performance in stroke patients. Journal
of Physical Therapy Science, 27(7), 2289-2291 3p.
Nilsen, D. M., Gillen, G., DiRusso, T., & Gordon, A. M. (2012). Effect of imagery perspective on occupational
performance after stroke: A randomized controlled trial. American Journal of Occupational Therapy, 66,
320329. http://dx.doi. Org/10.5014/ajot.2012.003475
Nilsen, D. M., Gillen, G., & Gordon, A. M. (2010). Use of mental practice to improve upper-limb recovery after
stroke: A systematic review. American Journal Of Occupational Therapy, 64(5), 695-708 14p. doi:10.5014/ajot.
2010.09034
Page, S. J., Levine, P., Sisto, S., & Johnston, M. V. (2001). A randomized efficacy and feasibility study of imagery in
acute stroke. Clinical Rehabilitation, 15(3), 233-240. doi:10.1191/026921501672063235
Stroke Facts. (2015, March 24). Retrieved October 25, 2015, from
http://www.cdc.gov/stroke/facts.htm
Additional Resources
Nilsen, D. M., Gillen, G., Geller, D., Hreha, K., Osei, E., & Saleem, G. T. (2015). Effectiveness of interventions to
improve occupational performance of people with motor impairments after stroke: An evidence-based
review. American Journal of Occupational Therapy, 69, 6901180030
http://dx.doi.org/10.5014/ajot.2015.011965
Page, S. J., Levine, P., & Hill, V. (2015). Mental practicetriggered electrical stimulation in chronic, moderate,
upper- extremity hemiparesis after stroke. American Journal of Occupational Therapy, 69, 6901290050.
http://dx.doi.org/ 10.5014/ajot.2015.014902
Wu, A. J., Radel, J., & Hanna-Pladdy, B. (2011). Improved function after combined physical and mental
practice after stroke: A case of hemiparesis and apraxia. American Journal Of Occupational Therapy,
65(2), 161-168 8p. doi:10.5014/ajot.2011.000786