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Imagery, mirror box therapy and action observation in stroke

Wilson, Christine Sarah (2015) Imagery, mirror box therapy and action observation in stroke. Masters thesis (MPhil), Manchester Metropolitan University.


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Imagery, mirror box therapy and action observation are simple, inexpensive and patient led treatments that can be used to aid in the improvement of motor function in both the upper- and lower-extremities post-stroke. This thesis examined the effects of imagery on physical movement post-stroke and therapists’ use of imagery, mirror box therapy and action observation as part of stroke rehabilitation. Study one was a meta-analysis investigating the effect of imagery on upper- and lower-limb movement ability post-stroke. The results revealed that imagery produced a moderate mean treatment effect (p= 0.03; d= 0.48; 95% confidence interval: 0.05 to 0.91). Imagery that was performed in the third person and performance analysis (the identification of incorrect task performance to help facilitate a positive change in performance) showed the largest improvements in movement. However, the effectiveness of imagery during stroke rehabilitation is still uncertain, as indicated by the large confidence interval. The second study investigated the extent to which physiotherapists and occupational therapists in the UK used cognitive therapies during stroke rehabilitation. In addition, how the therapies were conducted and the therapists’ views on their delivery were investigated. The skill audit had a response rate of 25% and showed that during stroke rehabilitation 68% (91/133) of therapists used imagery, 53% (68/129) used action observation and 41% (52/128) used mirror box therapy. Only 12% of therapists had received specific training in these therapies and therapists would like guidance on how to administer cognitive therapies. Unfortunately, due to the poor response rate the skill audit data may not be generalizable to the whole stroke therapy population. To conclude, the meta-analysis and skill audit have highlighted the potential of cognitive therapies and will help inform the production of clinical guidelines on the use of cognitive therapies during stroke rehabilitation. Clinical guidelines would help standardise the delivery of cognitive therapies and inform therapists how to motivate patients’, post-stroke.

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