Multimodal Mental Practice Versus Repetitive Task Practice Only to Treat Chronic Stroke: A Randomized Controlled Pilot Study

Importance: Occupational therapists are the primary clinicians tasked with management of the more affected upper extremity (UE) after stroke. However, there is a paucity of efficacious, easy-to-use, inexpensive interventions to increase poststroke UE function. Objective: To compare the effect of a multimodal mental practice (MMMP) regimen with a repetitive task practice (RTP)–only regimen on paretic UE functional limitation. Design: Secondary analysis of randomized controlled pilot study data. Setting: Outpatient clinical rehabilitation laboratory. Participants: Eighteen chronic stroke survivors exhibiting moderate, stable UE impairment. Intervention: Participants administered RTP only participated in 45-min, one-on-one occupational therapy sessions 3 times per week for 10 wk; participants administered MMMP completed time-matched UE training sessions consisting of action observation, RTP, and mental practice, delivered in 15-min increments. Outcomes and Measures: The Action Research Arm Test, the UE section of the Fugl-Meyer Scale, and the Hand subscale of the Stroke Impact Scale (Version 3.0) were administered 1 wk before and 1 wk after intervention. Results: The MMMP group exhibited significantly larger (p < .01) increases on all three outcome measures compared with the RTP group and surpassed minimal clinically important difference standards for all three UE outcome measures. Conclusions and Relevance: Because of the time-matched duration of MMMP and RTP, findings suggest that MMMP may be just as feasible as RTP to implement in clinical settings. Efforts to replicate results of this study in a large-scale trial are warranted. What This Article Adds: This study shows the efficacy of an easy-to-use protocol that significantly increased affected arm function even years after stroke.