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Added Value of Mental Practice Combined with a Small Amount of Physical Practice on the Relearning of Rising and Sitting Post-Stroke: A Pilot Study

Malouin, Francine PhD; Richards, Carol L. PT, PhD; Durand, Anne PT, PhD; Doyon, Julien PhD

Journal of Neurologic Physical Therapy: December 2009 - Volume 33 - Issue 4 - pp 195-202
doi: 10.1097/NPT.0b013e3181c2112b

Background and Purpose: The additional effects of combining mental practice with a small amount of physical practice on the relearning of a motor task post-stroke are unknown. This study investigated the added value of mental practice on the relearning of rising up from a chair and sitting down when combined with a small amount of physical practice.

Methods: Twelve individuals with chronic stroke were randomly assigned to one of three groups: a group that combined mental practice with physical practice (MP), a group that combined physical practice with cognitive training (Cog) and a group without training (NOT.). Training was provided three times per week for four weeks, and participants were assessed at baseline, after training, and three weeks later. The vertical forces were recorded under each foot, and the vertical impulse was calculated for five trials and converted in percent of body weight.

Results: The MP and Cog groups received the same amount of physical training. Significant gains (P < 0.04) in limb loading found only in the MP group were retained. Larger (P < 0.03) change scores in limb loading for rising up from a chair and sitting down were found in the MP group (median = rising up: 18.4%; sitting down: 12.2%) compared with Cog group (median = rising up: −6.8%; sitting down: 5.4%) and a group without training (median = rising up: 6.2%; sitting down: 5.4%).

Conclusion: Combining series of mental repetitions (∼1100 repetitions) with minimal physical repetitions (∼120 repetitions) yielded significant gains and retention of those gains. These preliminary results provide some support to the added value of combining mental repetitions with a small number of physical repetitions to promote the relearning of motor strategies post-stroke and warrant further investigation in clinical trials.

Department of Rehabilitation (F.M., C.L.R.), Laval University and Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS); Institut de Réadaptation en Déficience Physique de Québec (A.D.), Quebec City, Quebec, Canada, Quebec City; and Department of Psychology (J.D.), Functional Neuroimaging Unit, University of Montreal Geriatric Institute, University of Montreal, Montreal, Quebec, Canada.

Supported by Quebec Provincial Rehabilitation Research Network (FRSQ) and the Canadian Institutes of Health Research.

Address correspondence to: Francine Malouin, E-mail:

© 2009 Neurology Section, APTA