Progress in the application of motor imagery therapy in upper limb motor function rehabilitation of stroke patients with hemiplegia

 Useless! You delivered NO PROTOCOLS on the use of motor imagery.

Progress in the application of motor imagery therapy in upper limb motor function rehabilitation of stroke patients with hemiplegia

Shuying Shen¹Tianchen Chu²Jing Wang¹Hangyu Zhao³Jinli Tang⁴Linya Xu⁵Wei Ni⁶Liping Tan^3*Yu Chen^7*

• ¹Department of Neurosurgery, Suzhou Ninth People’s Hospital, Suzhou, China
• ²Suzhou Medical College of Soochow University, Suzhou, China
• ³Department of Neurosurgery, The Second Affiliated Hospital of Soochow University, Suzhou, China
• ⁴Department of Neurosurgery, The Affiliated Hospital of Nantong University, Nantong, China
• ⁵Department of Neurosurgery, Yancheng NO.1 People’s Hospital, Yancheng, China
• ⁶Department of Neurosurgery, The Second People’s Hospital of Huai'an, Huai'an, China
• ⁷Department of Emergency, Suzhou Ninth People’s Hospital, Suzhou, China

Stroke is the leading cause of disability in Chinese adults. Upper limb motor dysfunction is a common manifestation of neurological dysfunction after stroke and can exert significant effects on a patient’s daily living ability and quality-of-life. Therefore, it is crucial to provide appropriate rehabilitation treatment for upper limb motor function in stroke patients with hemiplegia. Currently, rehabilitation treatment for upper limb motor function in hemiplegic stroke patients in China includes motor therapy, neuro-promoting technology, occupational therapy, physical factor intervention, speech therapy, and swallowing therapy. Motor imagery therapy has also been shown to effectively promote the rehabilitation of upper limb function in stroke patients. Here, we review(What is needed is delivery of EXACT PROTOCOLS! And your mentors were incompetent in setting your goals for this research!) the concept, classification, mechanism of action, application, and effect of motor imagery therapy for the rehabilitation of upper limb motor function in stroke patients with hemiplegia in China. We summarize the available evidence, arising from Chinese experience, to support the implementation of this method in medical and rehabilitation institutions.

1 Introduction

Stroke is a medical condition in which the blood vessels in the brain suddenly burst or become blocked, thus obstructing blood flow and causing damage to brain tissue (1). There are approximately 13.7 million new stroke patients worldwide each year. In China, the incidence of stroke ranges from 1.2 to 180 per 100,000, resulting in approximately 2 million new cases annually. Stroke is the second leading cause of death, following ischemic heart disease. Stroke is the primary cause of adult impairment in China due to its high incidence, disability, mortality, recurrence, and economic burden (2). Upper limb motor impairment is one of the most common neurological conditions following stroke, exerting significant impact on a patient’s quality of life. Even six months after a stroke, 30 to 60% of patients still exhibit this impairment, which significantly affects their ability to perform daily activities.

Although traditional rehabilitation methods, such as acupuncture, massage, and cupping, have been used to treat upper limb problems, their efficacy remains limited. Over recent years, kinesthetic therapy has emerged as one of the most prominent therapeutic modalities in this field. Motor imagery (MI) therapy involves repeatedly simulating and rehearsing a specific action without producing any obvious motor output. This practice activates the corresponding area of the brain responsible for motor memory, ultimately improving corresponding motor function. MI therapy has been shown to have a positive impact on the ability of stroke patients to regain the use of their upper limbs. The concept of MI originates from mental imagery. In 1950, Hossack introduced the idea of a mental image, which suggests that the central nervous system can produce a response similar to that caused by receptor activation even when the senses are not stimulated. According to Decety et al. (3), MI is a dynamic condition in which a specific motor behavior is internally practiced in memory without any explicit motor output. Using various methods of imagination, MI can be classified into internal MI and external MI. Internal MI is also referred to as kinesthetic imagery (KI). During kinesthetic imagery, an individual focuses on their own sense of movement and visualizes completing the entire action. Furthermore, KI involves using one’s own proprioception as the point of attention and visualizing the completion of the entire movement. External MI, also known as visual imagery (VI), involves visualization of the movement from an external perspective. During VI, the imager assumes the role of a bystander and observes themselves or others in action from a distance. This technique, also known as third-party imagination, relies heavily on visual sensory input and is closely associated with the surrounding environment. Embedded motor imagery (EMI) and added motor imagery (AMI) are two categories of MI that can be distinguished by whether they are used in conjunction with other therapeutic techniques. EMI refers to the application of MI therapy throughout the entirety of the rehabilitation training process and aims to complete different tasks at the same time to increase the imagination component. AMI is separated from other training tasks, and patients complete MI treatment individually and completely by listening to recordings or a therapist’s direct instructions (4). Currently, supplementary kinesthetic imagination is used extensively; this is because this technique is easier to employ than other methods.

In this study, we investigated the use of MI therapy for the rehabilitation of upper limb motor function in stroke patients with hemiplegia. Our research provides reference guidelines for potential future use in domestic medical and rehabilitation facilities.

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