Jenny Butler

Best practice for motor imagery: a systematic literature review on motor imagery training elements in five different disciplines

BackgroundThe literature suggests a beneficial effect of motor imagery (MI) if combined with physical practice, but detailed descriptions of MI training session (MITS) elements and temporal parameters are lacking. The aim of this review was to identify the characteristics of a successful MITS and compare these for different disciplines, MI session types, task focus, age, gender and MI modification during intervention.MethodsAn extended systematic literature search using 24 databases was performed for five disciplines: Education, Medicine, Music, Psychology and Sports. References that described an MI intervention that focused on motor skills, performance or strength improvement were included. Information describing 17 MITS elements was extracted based on the PETTLEP (physical, environment, timing, task, learning, emotion, perspective) approach. Seven elements describing the MITS temporal parameters were calculated: study duration, intervention duration, MITS duration, total MITS count, MITS per week, MI trials per MITS and total MI training time.ResultsBoth independent reviewers found 96% congruity, which was tested on a random sample of 20% of all references. After selection, 133 studies reporting 141 MI interventions were included. The locations of the MITS and position of the participants during MI were task-specific. Participants received acoustic detailed MI instructions, which were mostly standardised and live. During MI practice, participants kept their eyes closed. MI training was performed from an internal perspective with a kinaesthetic mode. Changes in MI content, duration and dosage were reported in 31 MI interventions. Familiarisation sessions before the start of the MI intervention were mentioned in 17 reports. MI interventions focused with decreasing relevance on motor-, cognitive- and strength-focused tasks. Average study intervention lasted 34 days, with participants practicing MI on average three times per week for 17 minutes, with 34 MI trials. Average total MI time was 178 minutes including 13 MITS. Reporting rate varied between 25.5% and 95.5%.ConclusionsMITS elements of successful interventions were individual, supervised and non-directed sessions, added after physical practice. Successful design characteristics were dominant in the Psychology literature, in interventions focusing on motor and strength-related tasks, in interventions with participants aged 20 to 29 years old, and in MI interventions including participants of both genders. Systematic searching of the MI literature was constrained by the lack of a defined MeSH term.

Intervention Effectiveness: Evidence from a Case Study of Ideomotor and Ideational Apraxia

This paper considers the characteristics of apraxia and presents a case study which explores the effectiveness of tactile and kinaesthetic stimulation as an intervention strategy, in addition to visual and verbal mediation input, in the rehabilitation of a man with ideomotor and ideational apraxia following a head injury. Using an ABA design, quantitative measures were used to monitor change in motor performance. The results indicated some significant differences in measured performances between baseline and intervention phases and provided limited evidence of the effectiveness of additional sensory input. The implications for occupational therapy are discussed as are the limitations of the study.

Motor Imagery Experiences and Use: Asking Patients after Stroke Where, When, What, Why, and How They Use Imagery: A Qualitative Investigation

Background. A framework on where, when, what, why, and how to use imagery from sports psychology was explored whether it can be applied in patients after stroke in their chronic stage. Methods. Eleven patients (ages 31–85, 3 females, 1.3–6.4 years after stroke) were interviewed. Semistructured interviews were conducted before and after a two-week MI intervention period with six MI sessions. Information was obtained regarding experiences and knowledge of MI, and the evaluation of an MI practical example. The coding scheme was based on the framework and a hierarchical categorisation. Results. Information regarding domains where, when, what, why, and how to use imagery was addressed. Patients imagined themselves as healthy individuals, did not focus on surroundings during MI practice,and reported to use positive imagery only. After MI training, patients became more flexible regarding their location and position during MI practice. Conclusions. MI became an automatic process, and patients did not need specific concentration and quietness as mentioned in the first interview. Patients recommended daily MI training and began to transfer MI to practice movements that were affected by the stroke. In contrast to sports, patients did not talk about how MI was triggered rather than how MI was designed.

Rehabilitation in Severe Ideomotor Apraxia Using Sensory Stimulation Strategies: A Single-Case Experimental Design Study

This study was designed to evaluate the treatment of a young head-injured woman with ideomotor apraxia. An ABA (baseline, intervention, baseline) single-case experimental design was employed to evaluate the impact of sensory stimulation on motor performance, using a range of measures including a simple timed task and active finger and hand movements measured by goniometry. A key finding was the extent of variance in performance day by day in both the baseline and intervention phases, although a reduction in that variability was achieved in the intervention phase of the study. Improvements were noted in motor performance across all the measures in the intervention phase of the study, although such improvements could not be attributed to sensory stimulation procedures alone. Improvements in motor performance were found immediately following sensory stimulation procedures, but no carryover was noted from one day to the next. This study suggests that practice in motor performance could enhance specific actions in people with ideomotor apraxia.

Kinematic parameters of hand movement during a disparate bimanual movement task in children with unilateral Cerebral Palsy

Children with unilateral Cerebral Palsy (uCP) experience problems performing tasks requiring the coordinated use of both hands (bimanual coordination; BC). Additionally, some children with uCP display involuntary symmetrical activation of the opposing hand (mirrored movements). Measures, used to investigate therapy-related improvements focus on the functionality of the affected hand during unimanual or bimanual tasks. None however specifically address spatiotemporal integration of both hands. We explored the kinematics of hand movements during a bimanual task to identify parameters of BC. Thirty-seven children (aged 10.9±2.6years, 20 male) diagnosed with uCP participated. 3D kinematic motion analysis was performed during the task requiring opening of a box with their affected- (AH) or less-affected hand (LAH), and pressing a button inside with the opposite hand. Temporal and spatial components of data were extracted and related to measures of hand function and level of impairment. Total task duration was correlated with the Jebsen-Taylor Test of Hand Function in both conditions (either hand leading with the lid-opening). Spatial accuracy of the LAH when the box was opened with their AH was correlated with outcomes on the Childrens Hand Use Experience Questionnaire. Additionally, we found a subgroup of children displaying non-symmetrical movement interference associated with greater movement overlap when their affected hand opened the box. This subgroup also demonstrated decreased use of the affected hand during bimanual tasks. Further investigation of bimanual interference, which goes beyond small scaled symmetrical mirrored movements, is needed to consider its impact on bimanual task performance following early unilateral brain injury.

The Casson Memorial Lecture 2004: The Fascination of the Difficult

The Casson Memorial Lecture 2004, given on 11 June at the 28th Annual Conference of the College of Occupational Therapists, held at the Harrogate International Centre, Harrogate. The conference theme was ‘Occupation Matters’.

Developmental Characteristics of Disparate Bimanual Movement Skills in Typically Developing Children

ABSTRACT Mastery of many tasks in daily life requires role differentiated bimanual hand use with high spatiotemporal cooperation and minimal interference. The authors investigated developmental changes in the performance of a disparate bimanual movement task requiring sequenced movements. Age groups were attributed to changes in CNS structures critical for bimanual control such as the corpus callosum (CC) and the prefrontal cortex; young children (5–6 years old), older children (7–9 years old), and adolescents (10–16 years old). Results show qualitative changes in spatiotemporal sequencing between the young and older children which typically marks a phase of distinct reduction of growth and myelination of the CC. Results show qualitative changes in spatiotemporal sequencing between the young and older children, which coincides with distinct changes in the growth rate and myelination of the CC. The results further support the hypothesis that CC maturation plays an important role in the development of bimanual skills.

Invest in Your Future

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The Fascination of the Difficult

Your Royal Highness, ladies and gentlemen: I am delighted to be here today and, of course, very honoured to be giving this Casson Memorial Lecture in the 50th anniversary year of Dr Casson’s death. It has even more resonance for me personally because this year marks the end of my seconded 5-year post as the Elizabeth Casson Trust Reader in Occupational Therapy at Oxford Brookes University. I would like, at this point, to thank the Elizabeth Casson Trust for the Readership because it has given me so many wonderful opportunities.

Community Care and Rehabilitation after Stroke in Japan

The purpose of the research project was to determine, from a cross-cultural perspective, the care services and rehabilitation for elderly people with stroke living in the community in Japan. A written questionnaire and a semi-structured interview were used. The participants were a purposive sample of 21 elderly people and family/carer living in the metropolitan area of Tokyo, Japan. There were 11 men and 10 women with an average age of 70 years (range 42–86 years). The mean age at onset of stroke was 66.5 years (range 42–81 years) and the mean time since stroke was 3.2 years (range 3 months to 8 years). Varying levels of dependency were found, with an average Barthel Index score of 9.32 (range 0–18). Varying experiences of rehabilitation services were also reported: six people received physiotherapy only, six received physiotherapy and occupational therapy, and nine received no formal rehabilitation service either in hospital or in the community. Many participants were living in multi-generational households. Women had frequently given up jobs to care for their elderly relative, but were assisted in the caring role by community care workers (mainly nurses and home helpers). Environmental changes and disability equipment were evident in the homes. The project concluded that elderly people in Japan were supported by good community health care, although rehabilitation resources were limited. Cultural understanding as a key factor in rehabilitation processes is explored in the paper.