The Efficacy of Combined Physical and Mental Practice in the Learning of a Foot-Sequence Task after Stroke: A Case Report

OBJECTIVE: To investigate the effect of mental practice on the learning of a sequential task for the lower limb in a patient with a hemiparesis resulting from a stroke. DESIGN: A single-case study. SETTING: Research laboratory of a university-affiliated rehabilitation center. PATIENT: A right-handed 38-year-old man who had suffered a left hemorrhagic subcortical stroke 4 months prior. INTERVENTION: The patient practiced a serial response time task with the lower limb in 3 distinct training phases over a period of 5 weeks: 2 weeks of physical practice, 1 week of combined physical and mental practice, and then 2 weeks of mental practice alone. MAIN OUTCOME MEASURES: Performance on the task measured through errors and response times. Imagery abilities measured through questionnaires. RESULTS: The patient's average response time improved significantly during the 1st 5 days of physical practice (26%) but then failed to show further improvement during the following week of physical practice. The combination of mental and physical practice during the 3rd week yielded additional improvement (10.3%), whereas the following 2 weeks of mental practice resulted in a marginal increase in performance (2.2%). CONCLUSION: The findings show that mental practice, when combined with physical practice, can improve the performance of a sequential motor skill in people who had a stroke, and suggest that mental practice could play a role in the retention of newly acquired abilities.