Mental Practice in Chronic, Stroke-Induced Hemiparesis

Summary

Principal Investigator: Stephen Page
Affiliation: University of Cincinnati
Country: USA
Abstract: DESCRIPTION (provided by applicant): Despite increasing stroke incidence and prevalence, conventional affected arm rehabilitation offers negligible efficacy. Newer approaches emphasize repetitive, task-specific practice (RTP) with the affected arm. While these approaches are promising, they often require particular equipment to administer, can be intensive and/or taxing for the patient and therapist, and/or can be invasive. Strategies inherent in many of the above approaches are also not reimbursed by insurance plans. Thus, there remains a need for easily implemented, inexpensive, non-invasive RTP approaches for hemiparesis. Mental practice (MP) is a complementary/alternative medicine (CAM) mind-body technique in which physical skills can be rehearsed in an inexpensive, repetitive manner. This lab was the first to show that addition of MP to RTP yields significantly larger affected arm motor outcomes than conventional motor therapy in stroke. The PI's subsequent research confirmed that MP improves affected arm kinematics, and increases affected arm use and function, with this work culminating in a positive MP trial. The PI's recent work has also determined optimal MP duration at which the largest motor changes are exhibited. The next logical step is to determine MP efficacy in a Phase IIb, multicenter trial. This two-center study will randomize [100] chronic stroke patients to either: (a) MP sessions combined with RTP training;or (b) RTP training only. This will address the objective of this application, which is to determine the impact of a RTP regimen including MP in chronic stroke. Outcomes include functional limitation (primary endpoint), impairment, activity restriction in the lab and community, quality of life, and fMRI. The central hypothesis is that participation in MP + RTP will reduce functional limitation. We will test our central hypothesis and accomplish our objective by pursuing the following specific aims: (1) Determine efficacy of MP + RTP as compared to RTP on affected arm functional limitation;(2) Determine the impact of MP + RTP on affected arm outcomes;(3) Determin MP + RTP effects on cortical organization using fMRI. PUBLIC HEALTH RELEVANCE Stroke is the leading cause of disability in the United States, producing motor impairments that compromise performance of valued activities. Hemiparesis is particularly disabling, is the primary impairment underlying stroke-related disability, and the most frequent impairment treated by therapists in the United States. This study will test efficacy of a promising technique in reducing disability and increasing function, thereby improving outcomes and health, and reducing care costs, for community dwelling patients with stroke-induced hemiparesis.
Funding Period: ----------------2009 - ---------------2014-
more information: NIH RePORT

Top Publications

  1. pmc Psychometric properties and administration of the wrist/hand subscales of the Fugl-Meyer Assessment in minimally impaired upper extremity hemiparesis in stroke
    Stephen J Page
    Neuromotor Recovery and Rehabilitation Laboratory, School of Health and Rehabilitation Sciences, Ohio State University Medical Center, Columbus, OH 43210, USA
    Arch Phys Med Rehabil 93:2373-6.e5. 2012
  2. pmc Size doesn't matter: cortical stroke lesion volume is not associated with upper extremity motor impairment and function in mild, chronic hemiparesis
    Stephen J Page
    School of Health and Rehabilitation Sciences, The Ohio State University Medical Center, Columbus, OH 43210, USA
    Arch Phys Med Rehabil 94:817-21. 2013
  3. doi What are the "ingredients" of modified constraint-induced therapy? An evidence-based review, recipe, and recommendations
    Stephen J Page
    Neuromotor Recovery and Rehabilitation Laboratory REHABLAB, School of Health and Rehabilitation Sciences, The Ohio State University Medical Center, Columbus, OH 43210, USA
    Restor Neurol Neurosci 31:299-309. 2013
  4. pmc Minimal depression: how does it relate to upper-extremity impairment and function in stroke?
    Lindy L Weaver
    School of Health and Rehabilitation Sciences, The Ohio State University Wexner Medical Center, Columbus, OH, USA
    Am J Occup Ther 67:550-5. 2013
  5. pmc Longer versus shorter mental practice sessions for affected upper extremity movement after stroke: a randomized controlled trial
    Stephen J Page
    Departments of Rehabilitation Sciences, Physical Medicine and Rehabilitation, Neurosciences, and Neurology, University of Cincinnati Academic Medical Center UCAMC, Cincinnati, OH, USA
    Clin Rehabil 25:627-37. 2011
  6. pmc Optimizing terminology for stroke motor rehabilitation: recommendations from the American Congress of Rehabilitation Medicine Stroke Movement Interventions Subcommittee
    Stephen J Page
    School of Allied Medical Professions, and the Neuromotor Recovery and Rehabilitation Laboratory the RehabLab at the School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University Medical Center, Columbus, OH 43210, USA
    Arch Phys Med Rehabil 93:1395-9. 2012

Scientific Experts

Detail Information

Publications8

  1. pmc Psychometric properties and administration of the wrist/hand subscales of the Fugl-Meyer Assessment in minimally impaired upper extremity hemiparesis in stroke
    Stephen J Page
    Neuromotor Recovery and Rehabilitation Laboratory, School of Health and Rehabilitation Sciences, Ohio State University Medical Center, Columbus, OH 43210, USA
    Arch Phys Med Rehabil 93:2373-6.e5. 2012
    ..A standardized approach to UE test administration is critical to accurate score interpretation across patients and trials. Thus, the article also provides instructions and pictures for w/h UE FM administration and scoring...
  2. pmc Size doesn't matter: cortical stroke lesion volume is not associated with upper extremity motor impairment and function in mild, chronic hemiparesis
    Stephen J Page
    School of Health and Rehabilitation Sciences, The Ohio State University Medical Center, Columbus, OH 43210, USA
    Arch Phys Med Rehabil 94:817-21. 2013
    ....
  3. doi What are the "ingredients" of modified constraint-induced therapy? An evidence-based review, recipe, and recommendations
    Stephen J Page
    Neuromotor Recovery and Rehabilitation Laboratory REHABLAB, School of Health and Rehabilitation Sciences, The Ohio State University Medical Center, Columbus, OH 43210, USA
    Restor Neurol Neurosci 31:299-309. 2013
    ..It is expected that a more complete understanding of the components comprising this promising approach will overcome knowledge barriers associated with its appropriate use, and encourage better patient management in clinical practice...
  4. pmc Minimal depression: how does it relate to upper-extremity impairment and function in stroke?
    Lindy L Weaver
    School of Health and Rehabilitation Sciences, The Ohio State University Wexner Medical Center, Columbus, OH, USA
    Am J Occup Ther 67:550-5. 2013
    ..Given the proliferation of UE therapies targeting this group, this information is important for effective therapy planning and implementation. ..
  5. pmc Longer versus shorter mental practice sessions for affected upper extremity movement after stroke: a randomized controlled trial
    Stephen J Page
    Departments of Rehabilitation Sciences, Physical Medicine and Rehabilitation, Neurosciences, and Neurology, University of Cincinnati Academic Medical Center UCAMC, Cincinnati, OH, USA
    Clin Rehabil 25:627-37. 2011
    ..To evaluate and compare efficacy of 20-, 40-, and 60-minute mental practice sessions on affected upper extremity impairment and functional limitation...
  6. pmc Optimizing terminology for stroke motor rehabilitation: recommendations from the American Congress of Rehabilitation Medicine Stroke Movement Interventions Subcommittee
    Stephen J Page
    School of Allied Medical Professions, and the Neuromotor Recovery and Rehabilitation Laboratory the RehabLab at the School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University Medical Center, Columbus, OH 43210, USA
    Arch Phys Med Rehabil 93:1395-9. 2012
    ..In developing these guidelines, conceptual frameworks used in the pharmaceutical, exercise, and rehabilitative therapy realms were used. Implications of these definitions for research and clinical practice are also discussed...