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Disabil Rehabil. 2018 Oct;40(20):2449-2457. doi: 10.1080/09638288.2017.1337817. Epub 2017 Jun 9.

The effects of mental practice combined with modified constraint-induced therapy on corticospinal excitability, movement quality, function, and activities of daily living in persons with stroke.

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a Department of Occupational Therapy , Konyang University , Daejeon , Republic of Korea.
b Department of Occupational Therapy , Yonsei University , Wonju , Republic of Korea.
c Department of Occupational Therapy , Hanseo University , Seosan , Republic of Korea.



Studies on to what extent the combined therapy of modified constraint-induced movement therapy and mental practice is more effective than modified constraint-induced movement therapy alone are lacking. This study aims to compare the effects of the combined therapy with modified constraint-induced movement therapy alone on corticospinal excitability, quality of the movement of the affected upper extremity, upper motor functions, and performance of the affected arm in daily life of hemiplegic stroke patients.


The participants comprised 14 people who had suffered stroke and were randomly divided into two groups. All participants participated in modified constraint-induced movement therapy, while only the experimental group partook in additional mental practice. Both groups were tested for corticospinal excitability, quality of movement, hand function, and activities of daily living.


Both groups showed significant improvement in the movement quality of reaching and performance of activities of daily living. In the experimental group, functional improvement of the upper limb was also observed. The improvements in corticospinal excitability, upper extremity function, and performance in daily activities were significantly greater in the experimental group compared to the control group.


This study confirmed that the combined therapy produces more effective improvement in corticospinal excitability, upper limb function, and performance in daily activities. The combined therapy of mental practice and modified constraint-induced movement therapy could be used as a clinically useful intervention. Implications for rehabilitation Modified constraint-induced movement therapy could be used as an intervention method for people with stroke to make improvements in the quality of movement and performance in activities of daily livings with the affected side. With additional mental practice, upper extremity functions improve, and changes in neurological, functional and performance in daily lives are greater compared to modified constraint-induced movement therapy without mental practice. Impact of mental practice has on rehabilitation should not be underestimated.


Corticospinal excitability; motor imagery; occupational performance; stratified randomization; stroke; task-oriented training

[Indexed for MEDLINE]

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