A strategy for computer-assisted mental practice in stroke rehabilitation

Objective. To investigate the technical and clinical viability of using computer-facilitated mental practice in the rehabilitation of upper-limb hemiparesis following stroke. Design. A single-case study. Setting. Academic-affiliated rehabilitation center. Participant. A 46-year-old man with stable motor deficit of the upper right limb following subcortical ischemic stroke. Intervention. Three computer-enhanced mental practice sessions per week at the rehabilitation center, in addition to usual physical therapy. A custom-made virtual reality system equipped with arm-tracking sensors was used to guide mental practice. The system was designed to superimpose over the (unseen) paretic arm a virtual reconstruction of the movement registered from the nonparetic arm. The laboratory intervention was followed by a 1-month home- rehabilitation program, making use of a portable display device. Main outcome measures. Pretreatment and posttreatment clinical assessment measures were the upper-extremity scale of the Fugl-Meyer Assessment of Sensorimotor Impairment and the Action Research Arm Test. Performance of the affected arm was evaluated using the healthy arm as the control condition. Results. The patient's paretic limb improved after the first phase of intervention, with modest increases after home rehabilitation, as indicated by functional assessment scores and sensors data. Conclusion. Results suggest that technology-supported mental training is a feasible and potentially effective approach for improving motor skills after stroke.