Karen P. Y. Liu

A Randomized Controlled Trial of Mental Imagery Augment Generalization of Learning in Acute Poststroke Patients

Background and Purpose— Our previous studies demonstrated that mental imagery intervention enhanced poststroke patients relearning daily task performance. This study aimed to test the efficacy of mental imagery for promoting generalization of the task skills learned in a training environment to trained and untrained tasks carried out in a novel environment. Methods— Thirty-five acute poststroke patients were randomly assigned to the mental imagery (MI; n=18) or conventional functional rehabilitation (FR; n=17) group. The MI intervention was 3-week standardized practices and daily tasks using the chunking-regulation-rehearsal strategies. Outcome measurements were the performances on trained and untrained tasks in the training and novel environments. Results— The MI patients showed significantly better performances on 4 of 5 trained tasks (P=0.001 to 0.026) versus only 1 task in the FR patients (P=0.021). The MI patients also outperformed their FR counterpart on the 3 (of 5) (P=0.025 to 0.049) trained and 2 (of 3) untrained tasks (P=0.042 to 0.045) carried out in the novel environment. Conclusions— The mental imagery intervention was useful for improving patients’ ability on performing the tasks which they did not previously trained on and in places different from the training environments. These involved generalization of the skills learned at the task performance level. Our findings are limited to poststoke patients who share similar characteristics with those in this study.

Mental imagery for relearning of people after brain injury

Objective: This paper reported on the application of mental imagery to the relearning of daily task performance in people with brain injury. Method: The changes in two subjects who had suffered from cerebral infarction shown throughout a 3-week mental imagery programme were described. The subjects’ improvement in task performance and other clinical outcomes illustrated the programmes therapeutic effects on skill relearning, maintenance and generalization. Results: After completing the programme, the subjects showed improvements in performance at both the trained and untrained tasks. Feedback from the patients also suggested its ability to enhance their day-to-day functioning. Clinical assessment results indicated that the subjects experienced an increase in the attention and sequential processing functions but not in the motor and other cognitive functions. Conclusion: Mental imagery appears to be effective at enhancing the task relearning of subjects after brain injury. The skills acquired under this treatment regime can be retained and then generalized to other tasks. Its therapeutic effect is probably mediated by the improved attention and planning and execution functions associated with the rehearsal. Further research should conduct clinical controlled trials to gather evidence on its efficacy at promoting functional regain in people suffering from neurological disorders.

Activities of daily living performance in dementia

Objective –  To explore the activities of daily living ADL performance profile of community‐living people with dementia and to investigate its relationship with dementia severity.

Meta‐analysis on the effect of mental imagery on motor recovery of the hemiplegic upper extremity function

BACKGROUND/AIM Studies have shown that mental imagery can enhance relearning and generalisation of function after stroke. The aim of this meta-analysis was to evaluate evidence on the effects of mental imagery on motor recovery of the hemiplegic upper extremities after stroke. METHODS A comprehensive data base search of the literature up to December 2012 was performed using PubMed, EBSCO host (Academic Search Premier, CINAHL and Educational Resource Information Center), PsycINFO, Medline, and ISI Web of Knowledge (Science Citation Index and Social Sciences Citation Index). Randomised clinical trials or controlled clinical trials that included mental imagery for improving upper extremity motor function for stroke patients were located. Relevant articles were critically reviewed and methodological quality was evaluated using the PEDro Scale, and study results synthesised. RESULTS Five randomised clinical trials and one controlled clinical trial met the inclusion criteria. Five of the six studies yielded positive findings in favour of mental imagery. Quantitative analysis showed a significant difference in the Action Research Arm Test (overall effect: Z=6.75; P<<0.001). CONCLUSION Review of the literature revealed a trend in support of the use of motor imagery for upper extremity motor rehabilitation after stroke. Mental imagery could be a viable intervention for stroke patients given its benefits of being safe, cost-effective and rendering multiple and unlimited practice opportunities. It is recommended that researchers incorporate imaging techniques into clinical studies so that the mechanism whereby mental imagery mediates motor recovery or neural adaptation for people with stroke can be better understood.

Review of self-awareness and its clinical application in stroke rehabilitation.

The objectives of this study were (i) to explore, following a literature review, the concepts of self-awareness, its assessment, and intervention for self-awareness deficits, as well as its clinical significance in stroke rehabilitation; and (ii) to apply the concepts of self-awareness in the context of a rehabilitation program. The search was conducted by the electronic databases Web of Science, Science Direct, MEDLINE, and PsychcInfo. A systematic literature search of publications written in English between 1980 and 2010 was conducted using the keywords, self-awareness or self-regulation. The search was limited to the following keywords: stroke, deficits, assessment, intervention, and rehabilitation. Two important conceptual models, namely, the Pyramid Model of Self-Awareness and the Dynamic Comprehensive Model of Awareness, were reviewed. Suggestions were made to the constraint-induced movement therapy for enhancement of both assessment and treatment of self-awareness deficits. In conclusion, self-awareness is essential for the success of rehabilitation. It is hoped that more studies can be conducted on the effectiveness of awareness enhancement programs incorporated in on-going therapies can be conducted, so that the evidence base can be further built up in this evolving area of practice.

Wheelchair accessibility of public buildings : a review of the literature

Purpose. The purpose of this review was to examine the wheelchair accessibility in public buildings and discuss the role of professional in this practice area. Method. Of the 85 originally identified publications from a search of major electronic bibliographic databases, 12 studies relating to wheelchair accessibility in public buildings were selected. The compliance rates with wheelchair accessibility in different areas were summarised. Results. No study reported 100% wheelchair accessibility despite the enforcement of existing laws and regulations. Parking had the lowest compliance rate among all facilities in terms of accessibility, while entrances had the highest. Conclusions. A global review is needed of both new and old buildings regarding wheelchair accessibility. Professional in this practice area has an important role to play in advocating wheelchair accessibility and assisting wheelchair users to participate fully in all areas of the community.

Self-regulatory learning and generalization for people with brain injury.

Primary objective : Brain injury can result in the loss of previous learnt behaviours that affect an individuals daily functioning. The use of self-regulation helps the individual to relearn the lost behaviours by bringing him/her to self-conscious level through independent and reflective learning derived using a social cognitive perspective. The purpose of this paper is to report on clinical observations made with the use of self-regulation in people with brain injury during the relearning of lost functions. Methods and procedures : Daily tasks were used to assess the relearning ability of the subjects pre- and post-programme. Experimental intervention : One-week self-regulatory training on five selected daily tasks. Main outcomes and results : These provisory observations would suggest that, with specific guidance for people with different needs, such as with impaired cognitive function and depression, self-regulation is effective in enhancing their relearning. Conclusion : Self-regulatory training is effective in enhancing the relearning of lost functions.

Pilot Randomized Controlled Trial of Self-Regulation in Promoting Function in Acute Poststroke Patients

OBJECTIVE To test the efficacy of self-regulation (SR) for promoting task performance and motor and cognitive functions. DESIGN Pilot randomized controlled trial. SETTING Rehabilitation unit. PARTICIPANTS Inpatients with acute poststroke (N=44) after a cerebral infarction aged ≥60 years. INTERVENTIONS Patients were randomly assigned to the SR (n=24) or functional rehabilitation (control; n=20) intervention. The SR intervention consisted of 1 week of therapist-supervised practices of daily tasks using SR of ones own performance (five 1-h sessions). Patients in the control intervention practiced the same daily tasks with a therapists demonstration and guidance. MAIN OUTCOME MEASURES Performance of tasks, including household and monetary transaction tasks; FIM; Fugl-Meyer Assessment (FMA); and Color Trails Test (CTT). RESULTS The SR group showed significant improvement in all tasks (median difference, 1-2; effect size [r]=.74-.89) versus none (median difference, 0-0.5) in the control group. Results of the FIM (P<.001, r=.87 in the motor subscale; P<.001, r=.49 in the cognitive subscale), FMA (P<.001, r=.84 for upper extremity motor function and r=.63 for lower extremity motor function), and CTT (P=.002, r=.72) of the SR group improved. The SR group outperformed their control counterparts in 4 of the 5 tasks (median difference, 1; r=.30-.52) and in the FIM motor subscale (P=.002, r=.47), but not in the cognitive subscale and motor and cognitive functions. CONCLUSIONS SR appears useful for improving task performance that demands both motor and cognitive abilities by promoting information processing and active learning.

Effectiveness of a Workplace Training Programme in Improving Social, Communication and Emotional Skills for Adults with Autism and Intellectual Disability in Hong Kong – A Pilot Study

This pilot study explored the effectiveness of workplace training programme that aimed to enhance the work-related behaviours in individuals with autism and intellectual disabilities. Fourteen participants with autism and mild to moderate intellectual disability (mean age = 24.6 years) were recruited. The workplace training programme included practices in work context and group educational sessions. A pre-test-post-test design was used with the Work Personality Profile, the Scale of Independent Behaviour Revised and the Observational Emotional Inventory Revised to evaluate the targeted behaviours. Improvement in social and communication skills specific to the workplace was achieved. For emotional control, participants became less confused and had a better self-concept. However, improvement in other general emotional behaviours, such as impulse control, was limited. The results indicated that a structured workplace training programme aimed at improving social, communication and emotional behaviours can be helpful for people with autism and intellectual disability. Further study with a larger sample size and a control group is recommended. The development of specific programme to cater for the emotional control needs at workplace for people with autism is also suggested.

Differentiation of perceptual and semantic subsequent memory effects using an orthographic paradigm

This study aimed to differentiate perceptual and semantic encoding processes using subsequent memory effects (SMEs) elicited by the recognition of orthographs of single Chinese characters. Participants studied a series of Chinese characters perceptually (by inspecting orthographic components) or semantically (by determining the object making sounds), and then made studied or unstudied judgments during the recognition phase. Recognition performance in terms of d-prime measure in the semantic condition was higher, though not significant, than that of the perceptual condition. The between perceptual-semantic condition differences in SMEs at P550 and late positive component latencies (700-1000ms) were not significant in the frontal area. An additional analysis identified larger SME in the semantic condition during 600-1000ms in the frontal pole regions. These results indicate that coordination and incorporation of orthographic information into mental representation is essential to both task conditions. The differentiation was also revealed in earlier SMEs (perceptual>semantic) at N3 (240-360ms) latency, which is a novel finding. The left-distributed N3 was interpreted as more efficient processing of meaning with semantically learned characters. Frontal pole SMEs indicated strategic processing by executive functions, which would further enhance memory.