While recovering from a stroke, a patient should undergo both physical therapy and mental practice, according to a new study at Georgia State University in which researchers examined how the brains of stroke patients changed after treatment.
Mental practice, also known as motor imagery, is the mental rehearsal of a motor action without actually doing the action. Physical therapy involves using repetitive, task-oriented training on the impaired body part. Both interventions are commonly used to improve impaired motor movement, coordination and balance following stroke.
For the study, the researchers recruited 13 older stroke survivors as well as 17 young, healthy controls. Stroke participants were placed in two different groups for rehabilitation: mental practice only or both mental practice and physical therapy.
The treatment was given within 14 to 51 days of the participants’ stroke and consisted of 60 total hours of rehabilitation.
The effectiveness of each treatment was measured through functional magnetic resonance imaging (fMRI) scans on both the control group and on the stroke survivors before and after their treatment.
During normal brain function, multiple cortical areas of the brain communicate with each other, but these interactions are disrupted after a stroke. The researchers looked into how a stroke affects these interactions and how function is regained from rehabilitation as people begin to recover motor behaviors.
“When people have a stroke, there’s damage to brain cells and it takes a long time for neurons to grow back, if at all. You can use certain treatments to make the brain adapt or compensate in order to recruit new neurons and make you move again,” said Dr. Andrew Butler, interim dean in the Byrdine F. Lewis School of Nursing and Health Professions and associate faculty in the Neuroscience Institute at Georgia State.
“One of these treatments is really intense physical therapy, but some people can’t move at all. We found in our data that if they just think about moving, it keeps the neurons active right around the area that died in the brain. We used mental practice as a primer for physical training.
“As people improve and move along in their rehabilitation, they can progress from mental practice to physical practice and this can result in behavioral change, meaning they could move their arms better.”
The researchers discovered that the causal flow of information between several brain regions — how one area causes an influence on the other — was reduced significantly for people who had suffered from a stroke. This flow of information did not increase significantly after mental practice alone, but did increase significantly when mental practice and physical therapy were combined.
Furthermore, sensation and motor function scores were significantly higher when stroke patients underwent the combined mental practice and physical therapy.
The study results show that a combination of mental practice and physical therapy can be an effective means of treatment for stroke survivors to recover or regain the strength of motor behaviors. The researchers also found that causal information flow can be a reliable way to evaluate rehabilitation in stroke survivors.
The research is published in the journal Frontiers in Human Neuroscience.
Source: Georgia State University