Efficacy of motor imagery in post-stroke rehabilitation: a systematic review

Andrea Zimmermann-Schlatter¹^,2 , Corina Schuster²^,3 , Milo A Puhan⁴ , Ewa Siekierka⁵ and Johann Steurer⁴

¹Zurich University of Applied Sciences, Winterthur, Switzerland

²Reha Rheinfelden, Salinenstrasse 98, 4310 Rheinfelden, Switzerland

³Oxford Brookes University, Oxford, United Kingdom

⁴Horten Centre for patient-oriented research and knowledge transfer, University of Zurich, Switzerland

⁵Department of Neurology, University Hospital Zurich, Switzerland

author email corresponding author email

Journal of NeuroEngineering and Rehabilitation 2008, 5:8doi:10.1186/1743-0003-5-8


Published:	14 March 2008

Abstract

Background

Evaluation of how Motor Imagery and conventional therapy (physiotherapy or occupational therapy) compare to conventional therapy only in their effects on clinically relevant outcomes during rehabilitation of persons with stroke.

Design

Systematic review of the literature

Methods

We conducted an electronic database search in seven databases in August 2005 and also hand-searched the bibliographies of studies that we selected for the review.

Two reviewers independently screened and selected all randomized controlled trials that compare the effects of conventional therapy plus Motor Imagery to those of only conventional therapy on stroke patients.

The outcome measurements were: Fugl-Meyer Stroke Assessment upper extremity score (66 points) and Action Research Arm Test upper extremity score (57 points).

Due to the high variability in the outcomes, we could not pool the data statistically.

Results

We identified four randomized controlled trials from Asia and North America. The quality of the included studies was poor to moderate. Two different Motor imagery techniques were used (three studies used audiotapes and one study had occupational therapists apply the intervention). Two studies found significant effects of Motor Imagery in the Fugl-Meyer Stroke Assessment: Differences between groups amounted to 11.0 (1.0 to 21.0) and 3.2 (-4 to 10.3) respectively and in the Action Research Arm Test 6.1 (-6.2 to 18.4) and 15.8 (0.5 to 31.0) respectively. One study did not find a significant effect in the Fugl-Meyer Stroke Assessment and Color trail Test (p = 0.28) but in the task-related outcomes (p > 0.001).

Conclusion

Current evidence suggests that Motor imagery provides additional benefits to conventional physiotherapy or occupational therapy. However, larger and methodologically sounder studies should be conducted to assess the benefits of Motor imagery.