Motor Imagery and Mental Practice in the Subacute and Chronic Phases in Upper Limb Rehabilitation after Stroke: A Systematic Review

Table 1

Summary of the characteristics of the studies analysed.

Study	Aim	Sample characteristics	Procedure	Outcome variables	Results
[24]	Design: CT not randomized; To investigate the effect of MI training with sensory feedback on sensory-motor function of the upper extremity in patients with chronic stroke	Stage: chronic; : 30; (IG): 15; (CG): 15	IG: 45- rehabilitation; CG: conventional rehabilitation; Assessment: baseline, posttreatment	BBT; PPT; ROM; MAS; 2PD; NSA; SIS; FMA-UE	Significant differences in ROM shoulder ABD and elbow EXT (); Improvement of BBT (), FM-UE (), speed and motor coordination ()
[25]	Design: RCT; To investigate whether MI training has a positive influence on upper extremity performance in stroke patients	Stage: chronic	4 wk; IG: CG: Assessment: baseline, posttreatment	FMA-UE; WMFT	FMA-UE: improve 8.17 pt in IG; WMFT: improve 6.25 pt in IG
[26]	Design: RCT; Evaluated motor function of the upper extremity and investigated neural plastic changes before and after treatment using diffusion tensor imaging and transcranial magnetic stimulation	Stage: subacute; : 20; (IG): 10; (CG): 10	IG: 45 min traditional rehabilitation; CG: 45 min traditional rehabilitation; Assessment: baseline, posttreatment	FMA-UE; ARAT; TMS	Better score in ARAT for IG (6.48); Significant improvement in FMA-UE for IG (4.7)
[27]	Design: RCT; To evaluate whether combining MP with physical practice training enhances hand function in patients with stroke	Stage: subacute; : 20; (IG): 10; (CG): 10	IG: 45 min with 5 min rest between 2 ss PM-IM; CG: 45 min Bobath; Assessment: baseline, posttreatment	ARAT; fMRI; Activated voxels of SMC	Significant difference in both groups for ARAT (); Significant improvement between pre- and posttreatment (); Increase in ARAT of 12.65 for IG and 5.20 for CG
[28]	Design: RCT; To investigate the adjuvant effects of MP using an inverse video of the unaffected limb in subacute stroke patients with severe motor impairment on motor improvement, functional outcomes, and activities of daily living	Stage: subacute	IG: MP inverse video of the unaffected limb; CG: 30 min rehabilitation; Assessment: baseline, 4 wk	FMA-UE; MFT; FIM	No significant differences in all outcomes between groups; Significant differences in FMA-UE and FIM posttreatment in both groups
[29]	Design: RCT; To determine whether the imagery perspective used during MP differentially influenced performance outcomes after stroke	Stage: chronic	IGint: internal perception; IGext: external perception; CG: imagery training; Assessment: baseline and posttreatment	FMA-UE; JTTHF; COPM	Significant improvement in IGint and IGext; Significant improvement in all the groups for COPM (); Improvement in FMA for all groups, but only significant for IGint ( 5 9.6, SEM 5 1.03) and IGext ( 5 10.6, SEM 5 2.94); For self-perception of performance, COPM mean improve (): CG 12.3 (SEM 5 3.86), IGint 13.2 (SEM 5 3.09), IGext 15.6 (SEM 5 3.79)
[30]	Design: RCT; To investigate the effects of adjuvant MP on affected upper limb function following a stroke using three-dimensional (3D) motion analysis	Stage: subacute	IGa: rehabilitation therapy; 3 wk conventional rehabilitation therapy; IGb: 3 wk conventional rehabilitation therapy; rehabilitation therapy; MP: /wk; Assessment: baseline, posttreatment, 3 wk, 6 wk	3D motion analysis; FMA-UE; MAL-30	No significant differences between groups during assessment of effect and treatment period; No significant differences in comparisons between groups analyzing 3D movement and comparisons between groups on rating scales
[31]	Design: RCT; Compared efficacy of a “massed” MP regimen versus a “distributed” MP regimen on upper extremity motor impairment and functional limitation	Stage: chronic; : 27; IGm: 13; IGd: 14	IGm: 30 min exercise + 5 min; IGd: 30 min exercise + 5 min more phases at home; Assessment: baseline, 10 wk and 3 m	FMA-UE; ARAT	IGd more significant improvement than IGm () at 10 wk; Significant difference in ARAT at 3 m for IGd
[32]	Design: RCT; To investigate the role of MP in functional recovery of upper limbs in stroke patients	Stage: subacute	IGa: IGb: conventional neurorehabilitation protocol; Assessment: baseline, posttreatment, 3 wk, 6 wk	MI; AFT	No significant differences posttreatment; Significant differences between groups at 3 wks; Difference was minimal at 6 wks
[33]	Design: RCT; To evaluate the effectiveness of a task-oriented MP approach as an addition to regular arm-hand therapy in patients with subacute stroke	Stage: subacute	Training: IG: conventional instruction video; CG: program; Assessment: baseline, posttreatment, 3 follow-ups for 1 year and 12 months	FMA-UE; FAT; WMFT; Accelerometry	Improvement on FMA-UE and WMFT in both groups; Significant improvement on FAT test posttreatment and maintain during 12 months on IG; No significant differences between groups on training effect
[34]	Design: RCT; To identify the targets for MI in stroke rehabilitation from a voxel-based whole brain analysis of resting-state functional magnetic resonance imaging	Stage: chronic; (IG): 17; (CG): 17	IG: rehabilitation; CG: 30 min stroke education conventional rehabilitation; Assessment: baseline, posttreatment	FMA-UE; mBI; MRI	Significant improvement for IG in FMA-UE (CG: , IG: , ); Positive correlation between slow-5 band in the ipsilesional IPL and FM-UE; Different alternative for functional connectivity in IG for ipsilesional IPL that correlated positively with FM-UL; MI rehabilitation efficiency was associated with an increased slow-5 band and impaired functional connectivity in ipsilesional IPL

2PT: 2-Point Test; ADL: activities of daily living; AFT: Arm Functional Test; ARAT: Action Research Arm Test; AO: Action-Observation; BBT: Box and Blocks Test; CG: control group; COPM: Canadian Occupational Performance Measure; d: days; CT: clinical trial; FAT: Frenchay Arm Test; FMA-UE: Fugl-Meyer Assessment Upper Extremity; FIM: Functional Independence Measure; fMRI: functional magnetic resonance imaging; MRI: magnetic resonance imaging; IG: Intervention Group; JTHFT: Jebsen and Taylor Hand Function Test; MAL: Motor Activity Log; MAL AOU: Motor Activity Log Amount of Use; MAL QOM: Motor Activity Log Quality of Movement; m: month; MAS: Modified Ashworth Scale; mBI: modified Barthel Index; MCID: Minimal Clinically Important Difference; MFT: Motor Function Test; MI: motor imagery; min: minutes; MP: mental practice; : number; NSA: Nottingham Sensory Assessment; PG: Placebo Group; PPT: Purde-Pegboard Test; pt: points; RCT: randomized clinical trial; ROM: Range Of Movement; SIS: Stroke Impact Scale; ss: sessions; : time; TMS: Transcraneal Magnetic Stimulation; WMFT: Wolf Motor Function Test; wk: weeks.