Mental Practice With Motor Imagery Does Not Help In Stroke Recovery

This was depressing, I am basing a lot of my therapy on mental imagery since I have a huge dead spot to relocate.
But this series from 2010 says it is effective.
http://commons.pacificu.edu/cgi/viewcontent.cgi?article=1021&context=otpf&sei-redir=1#search="The+Effectiveness+of+Mental+Imagery+on+the"
http://www.sciguru.com/newsitem/8319/Mental-Practice-With-Motor-Imagery-Does-Not-Help-In-Stroke-Recovery/
Until researchers actually give us a damage diagnosis broken down by penumbra vs. dead area, none of these studies are reproducible or valid.

April 28th, 2011

A new clinical study shows that mental practice with motor imagery is not beneficial in stroke recovery. Motor imagery has been believed to be an effective neuro-rehabilitation technique.
Motor imagery is a mental process by which a subject simulates a given action. Several studies have demonstrated that mental simulation of movement activates the same brain areas that are activated when these movements are actually executed. The current study is based upon these findings and the argument that if mental simulation of the physical activity can activate specific brain areas, then "we can 'jog' the brain" in the absence of actual bodily movement. In addition, it is also known that brain plasticity plays an important role in recovery following brain injury. The researchers, in this study, evaluated the therapeutic benefit of mental practice with motor imagery for upper limb motor weakness in stroke patients.



Image Credit: NINDS, NIH
These MRI images show ischemic stroke and recovery


Stroke is caused by the interruption of the blood supply to parts of the brain and the symptoms depend on what part of the brain is damaged. This can be due to blockage of blood vessels causing reduced or no blood flow, or hemorrhage (blood loss). A stroke can cause permanent neurological damage; a very severe stroke can cause death.

The article published in the April 22 online edition of the peer-reviewed scholarly journal Brain reports the finding of a single-blind randomized controlled trial in which a large sample of unselected stroke patients within six months following stroke undertook a program of either four weeks of motor imagery training, or a control training program.

Patients underwent 45-minute training sessions three days a week for four weeks. The participants in the test group were directed to imagine a variety of different hand movements such as opening and closing, reaching, grasping, ironing and washing under the arms. The study included two control conditions, an attention-placebo control condition and a routine-care control condition. Among the 121 patients participated, 41 were in the motor imagery training group, 39 in the attention-placebo control group and 41 in the normal care control group.

The authors did not find any significant difference between test and control groups on the primary outcome measure, which was recovery of the upper extremity function following cortical injury. According to the research paper, "this trial demonstrates clear nil-findings with regards to the efficacy of mental practice with motor imagery in stroke rehabilitation, raising some important issues with regards to the clinical benefit of mental practice."

The authors of the study were, Magdalena Ietswaart, Marie Johnston, H. Chris Dijkerman, Sara Joice, Clare L. Scott, Ronald S. MacWalter and Steven J.C. Hamilton from institutions in the UK and the Netherlands.

The same authors had previously reported beneficial effect of mental practice, and they now conclude that the benefit of mental practice previously found was due to combined physical and mental practice. This study shows that mental practice alone does not enhance motor recovery in patients early post-stroke.

Source paper: Ietswaart M, Johnston M, Dijkerman HS, Joice S, Scott CL, MacWalter RS and Hamilton SJC. Mental practice with motor imagery in stroke recovery: randomized controlled trial of efficacy. Brain 2011; April 22; doi: 10.1093/brain/awr077.

Other References:
Dijkerman HC, Ietswaart M, Johnston M, MacWalter RS. Does motor imagery training improve hand function in chronic stroke patients? A pilot study. Clin Rehab 2004;18:538.

Butler AJ, Page SJ. Mental practice with motor imagery: evidence for motor recovery and cortical reorganization after stroke. Arch Phys Med Rehabil. 2006;87:S2.

And they consider this science? Only a four week trial and they have no idea if they are trying to assist damage recovery or dead brain relocation. The emperor is truly naked on this one.