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Blending Mental Practice and Physical Therapy Helps in Stroke Recovery, say Experts

Stroke RecoveryStroke (also known as cerebrovascular disease or CVA) occurs when the blood flow to an area of brain is interrupted or reduced, depriving brain tissue of oxygen and nutrients. Both mental practice and physical therapy are used to improve impaired motor movement, coordination and balance after stroke. Mental practice is the mental rehearsal of a motor action without an overt action. On the other hand, PT involves repetitive, task-oriented training of the affected part.

Multiple cortical areas of the brain communicate with each other during normal brain function, but after a stroke, these interactions are interrupted. A new study at Georgia State University that analyzed the changes that occur in the brains of CVA patients after treatment, has found that both physical therapy (PT) and mental practice are important for recovery. It looked at how rehabilitation helps patients regain function as motor behaviors improve.

Thirteen older CVA survivors and 17 young, healthy controls participated in the study. They were divided into two groups for rehabilitation – mental practice only and both mental practice and PT. The patients received 14 to 51 days of treatment comprising 60 hours of rehab.

The effectiveness of each intervention on both the groups of stroke survivors was measured through functional magnetic resonance imaging (MRI) scans before and after their treatment. The scans, performed while the participants were inactive, determined the network activity in five core areas of the brain (associated with motor execution) – left primary motor area (LM1), right primary motor area (RM1), left pre-motor cortex (LPMC), right pre-motor cortex (RPMC) and supplementary motor area (SMA).

According to the researchers, CVA results in brain cell damage and it takes a long time for neurons to grow back. Treatment modalities like intense physical therapy make the brain adapt or compensate in order to recruit new neurons and restore movement. However, despite PT, some patients are unable to move. The study found that if the patients thought about moving, it would keep the neurons active around the area that died in the brain.
Based on this discovery, the researchers used mental practice as a primer for physical training. Their key findings are as follows

  • The casual flow of information between several brain regions was reduced significantly in people who had a stroke.
  • The casual flow of information showed an increase only when both PT and mental practice were combined (and not after mental practice alone).
  • Sensation and motor function scores showed notable improvement in patients who received the combined treatment.

Stroke is a major cause of death and adult disability in the United States. According to reports from the Centers for Disease Control and Prevention (CDC), nearly 800,000 people experience new or recurrent episodes of stroke each year. It is estimated that on an average, one American dies from the condition every 4 minutes. Research studies such as these offer new hope as it can save lives, prevent stroke and ensure better patient outcomes.

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