Mental Practice Clinical/Neural Effects/Subacute Stroke

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DESCRIPTION (provided by applicant): Stroke-induced hemiparesis is the most frequent impairment treated by therapists in the United States. Although millions of dollars are spent annually on stroke motor rehabilitation, conventional treatments for hemiparesis are ineffective, leaving patients with substantial motor disability and continued reliance on healthcare and others. The best approach to treat this disabling condition may be to combine promising elements from established disciplines in a new and alternative way. This training plan applies established principles from clinical trial design, neuroscience, and rehabilitation in a nontraditional way to better treat and understand stroke-induced hemiparesis. The immediate objective is to acquire formal, intensive training and experiences in stroke clinical trial design and neuroimaging, and to obtain additional complementary/alternative medicine (CAM) experiences. These activities will fulfill the long-term career objective, which is improving motor function after stroke by organizing trials examining mechanisms of action and efficacy of CAM interventions in stroke. The training plan provides exceptional mentoring from recognized leaders, and didactics in outstanding interdisciplinary environments. Mental practice (MP), a CAM mind-body technique in which physical skills are cognitively rehearsed, increases motor learning and performance in nondisabled individuals. Our pilot data suggest that MP significantly reduces hemiparesis in subacute stroke patients. However, MP efficacy using randomized controlled methods, and MP mechanisms of action, are unknown. Aims of the research study herein proposed are to: (1) measure the impact of MP on affected arm function in subacute stroke patients using stroke-specific, established, outcome measures; and (2) determine MP mechanisms of action using functional magnetic resonance imaging (fMRI). The central study hypothesis is that MP will significantly improve affected arm function in subacute stroke patients, and that these improved outcomes are accompanied by cortical reorganization. The central hypothesis will be tested and aims fulfilled using a multiple baseline, randomized controlled study, in which 30 subacute stroke patients receive either MP or a control intervention, both after affected arm therapy. Outcome measures include the FugI-Meyer Motor Assessment, the Action Research Arm Test, the Wolf Motor Function Test, and the Stroke Impact Scale. fMRI will examine possible MP-induced cortical reorganizations. As an outcome of the proposed study, MP efficacy and mechanisms in subacute stroke will be determined, producing a validated protocol that improves motor function. This study will also increase understanding of relationships among neural and functional outcomes in stroke, and provide pilot data for a RO1 submission. The proposed study meets NCCAM priorities, including: (1) study of mind-body interactions; (2) application of CAM to cardiovascular diseases, including stroke; and (3) elucidation of mechanisms of action of CAM. The study will propel the applicant toward fulfillment of his long-term goal of testing efficacy and mechanisms of CAM interventions in stroke.