Mental imagery for promoting relearning for people after stroke: a randomized controlled trial

OBJECTIVE: To study the efficacy of mental imagery at promoting relearning for people after a stroke. DESIGN: Prospective, randomized controlled trial. SETTING: An inpatient rehabilitation stroke unit in Hong Kong. PARTICIPANTS: Forty-six inpatients, 60 years of age or older, after a cerebral infarction. INTERVENTIONS: Patients were randomized to receive 15 sessions (1 h/d for 3 wk) of either the mental imagery program or the conventional functional training intervention on the relearning of daily living tasks. MAIN OUTCOME MEASURES: Performance of 15 trained and 5 untrained tasks, including household, cooking, and shopping tasks; and the Fugl-Meyer Assessment and Color Trails Test (CTT). RESULTS: Patients engaged in mental imagery-based intervention showed better relearning of both trained and untrained tasks compared with the control group (trained tasks: P<.005; untrained tasks: P<.001). They also demonstrated a greater ability to retain the trained tasks after 1 month and transfer the skills relearned to other untrained tasks (P<.001). However, among the various ability measures, the mental imagery group showed a significant increase in the CTT scores only after the intervention (P<.005). CONCLUSIONS: Mental imagery can be used as a training strategy to promote the relearning of daily tasks for people after an acute stroke. The imagery process is likely to improve the planning and execution of both the trained and the untrained (novel) tasks. The effect of its relearning appears to help patients to retain and generalize the skills and tasks learned in the rehabilitation program.     

Age-related differences in neural activities during risk taking as revealed by functional MRI

Previous research has clearly documented that risky decisionmaking is different in young and older adults. Yet, there hasbeen a relative dearth of research that seeks to understandsuch age-related changes in the neural activities associatedwith risk taking. To address this research issue, 21 men (12young men, mean age 29.9 ± 6.2 years and 9 older men,mean age 65.2 ± 4.2 years) performed a risky-gains taskwhile their brain activities were monitored by an fMRI scanner.The older adults, relative to their younger peers, presentedwith contralateral prefrontal activity, particularly at theorbitofrontal cortex. Furthermore, stronger activation of theright insula was observed for the older-aged participants comparedto the younger-aged adults. The findings of this study are consistentwith the a priori speculations established in accordance withthe HAROLD model as well as previous findings. Findings of thisstudy suggest that when making risky decisions, there may bepossible neuropsychological mechanisms underlying the changein impulsive and risk-taking behaviors during the course ofnatural ageing.     

Does intensive rehabilitation improve the functional outcome of patients with traumatic brain injury (TBI)? A randomized controlled trial

Objective: To evaluate the effects of an increase in the intensity of rehabilitation on the functional outcome of patients with traumatic brain injury (TBI).

Design and methods: Sixty-eight patients (age 12-65 years) with moderate-to-severe TBI were included. They were randomized into high (4-hour/day) or control (2-hour/day) intensity rehabilitation programmes at an average of 20 days after the injury. The programmes ended when the patients achieved independence in daily activities or when 6 months had passed.

Outcome and results: No significant differences were found in the Functional Independence Measure (FIM) (primary outcome) and Neurobehavioural Cognitive Status Examination (NCSE) total scores between the two groups. There were significantly more patients in the high intensity group than in the control group who achieved a maximum FIM total score at the third month (47% vs. 19%, p = 0.015) and a maximum Glasgow Outcome Scale (GOS) score at the second (28% vs. 8%, p = 0.034) and third months (34% vs. 14%, p = 0.044).

Conclusions: Early intensive rehabilitation may improve the functional outcome of patients with TBI in the early months post-injury and hence increase the chance of their returning to work early. Intensive rehabilitation in this study speeded up recovery rather than changed the final outcome.     

Motor relearning programme for stroke patients: a randomized controlled trial

OBJECTIVE: To study the efficacy of the motor relearning approach in promoting physical function and task performance for patients after a stroke. DESIGN: Matched-pair randomized controlled trial. SETTING: An outpatient rehabilitation centre in Hong Kong. PARTICIPANTS: Fifty-two outpatients with either a thrombotic or haemorrhagic stroke who completed either the study or control group. INTERVENTIONS: The patients received 18 2-h sessions in six weeks of either the motor relearning programme or a conventional therapy programme. MAIN OUTCOME MEASURES: The Berg Balance Scale, the Timed Up and Go Test, the Functional Independence Measure (FIM), the modified Lawton Instrumental Activities of Daily Living (IADL) test, and the Community Integration Questionnaire. RESULTS: Patients in the motor relearning group showed significantly better performance on all but the Timed Up and Go Test when compared with the control group (F(1,150) = 6.34-41.86, P < or = 0.015). The interactions between group and occasion were significant on all five outcome measures, indicating that the rates of change across time between the motor relearning and control groups differed (F(3,150) = 3.60-33.58, P < 0.015). CONCLUSION: The motor relearning programme was found to be effective for enhancing functional recovery of patients who had a stroke. Both 'sequential' and 'function-based' concepts are important in applying the motor relearning approach to the rehabilitation of stroke patients.