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Mental Practice: How It Helps Improve Motor Recovery (Even After Post-Stroke Paralysis)

stroke survivor sitting on a couch with eyes closed doing mental practice

During stroke recovery, it’s important to participate in rehabilitation on a regular basis. It’s also a good idea to combine multiple therapies to maximize recovery outcomes. If you’re not already doing mental practice with your other therapies, this guide will provide a strong reason why you should start today.

To help you understand what mental practice is and how to use it, this guide will discuss:

What Is Mental Practice?

Mental practice involves visualizing yourself rehearsing something that you want to get better at. For example, if you’re a stroke survivor that wants to get back to driving, then you can help encourage recovery of driving-related functions by mentally practicing driving. You can visualize gripping the steering wheel with your hands, turning the wheel with your arms, and pushing the gas and brake pedals with your foot.

There are two ways to use mental practice: with internal and external imagery. First, you can visualize a task internally from the first-person perspective, where you are in your body and viewing the world. Secondly, you can visualize externally from the third-person perspective, where you are outside of your body looking upon yourself. It can be a good idea to try both types of mental practice to provide different types of stimulation to the brain.

How Does Mental Practice Help with Rehabilitation?

Evidence has shown that mental practice sparks changes in the areas of the brain correlated with movement, such as the motor and premotor areas, especially when used with other rehabilitation techniques. This is a key benefit for stroke survivors and others that wish to develop or redevelop their motor skills.

When a stroke damages part of the brain, it also damages the neural pathways in that area. When the areas that controls movement are damaged, for example, then movement can become impaired. Through rehabilitation, the brain can rewire itself to rebuild and strengthen new neural pathways that control various functions such as movement.

This is possible thanks to neuroplasticity: the mechanism the brain uses to create and strengthen neural pathways. It occurs based on experience. The tasks you repeat on a regular basis have stronger neural pathways than the tasks you don’t frequently practice. This is why tying your shoes feels second nature, but you may struggle to remember the quadratic formula that you once had memorized in high school.

Your brain is constantly adapting to the thoughts and activities that you practice regularly. Rehabilitation after stroke draws upon this principle by encouraging survivors to practice therapeutic exercises to encourage the brain to rewire itself.

While physical practice helps activate neuroplasticity, mental practice also helps engage the brain and spark the rewiring process.

Furthermore, mental practice isn’t just used for rehabilitation. Musicians and athletes are particularly known to use mental practice to prepare for performances and competitions. Michael Phelps, for example, was reported to mentally rehearse for two hours a day for months before a race!

Can Someone with Paralysis Use Mental Practice?

Mental practice is an effective and free rehabilitation method, but perhaps its most promising feature is that it’s accessible to everyone, including those with post-stroke paralysis.

Hemiplegia involves paralysis on half the body, most commonly caused by a stroke. The prognosis for strokes that result in hemiplegia tend to be worse than strokes that result in hemiparesis (weakness on the affected side).

The NIH Stroke Scale, which is commonly used to assess the severity of a stroke, scores a patient differently if they have no movement versus existing movement. It generally associates those without movement with poorer clinical outcomes. However, just because a survivor scores poorly on the NIH Stroke Scale does NOT mean they cannot recover movement.

Neuroplasticity occurs throughout an individual’s entire life, and it does not stop after injury. Individuals with hemiplegia after stroke should participate in both outpatient therapy sessions and a rigorous at-home therapy program to encourage as much motor recovery as possible.

Furthermore, mental practice can help these individuals reach their recovery goals. Before every rehab exercise session – which generally involves passive exercise for individuals with paralysis – survivors can spend time mentally rehearsing their exercises before actually doing them.

Studies have shown that combining mental practice with physical practice leads to better results that just physical practice alone.

You don’t need to spend two hours mentally rehearsing like Michael Phelps, but some mental practice on a regular basis will provide the brain with the stimulation it needs to rewire itself.

Is It Too Late for Mental Practice?

Not only is mental practice accessible to everyone and risk-free, but it’s also helpful during all stages of recovery. This includes survivors that had their stroke many months or years ago.

One study focused specifically on the benefits of mental practice for chronic stroke survivors, which means at least 6 months have passed since the stroke. The average participant was 3.6 years post-stroke, and the study found that mental practice combined with active practice helped survivors significantly improve arm function.

Studies like this help illustrate that there’s always hope for recovery when you pick your therapies back up and stimulate the brain. If you have taken a break in your rehabilitation, this is a compelling reason why you should start again.

How to Do Mental Practice

How exactly is mental practice done? There are many methods, and every person can experiment with different techniques until they find something they like and that is effective for them.

Here are some methods you can try for your mental practice:

  • Internal & external. You can try mental practice internally by visualizing yourself from the first-person view, looking out upon the world. You can try it externally from the third-person view, looking upon yourself. You can even try both types to provide extra stimulation to the brain.
  • Rehab exercises & activities of daily living. If you’re working on specific exercises during therapy (or with at-home exercise devices like FitMi), you can mentally practice those exercises before actually practicing them. If you’re working on activities of daily living like self-feeding, then you can mentally practice relevant tasks such as using a fork.
  • Short & long visualizations. Try to spend about 3-5 minutes mentally practicing a task before physically practicing it. If you can manage 20 minutes or more, feel free to do so.
  • Improvised & recorded. You can improvise your mental practice by simply closing your eyes and working on the task that draws your attention that day. Keep in mind, however, that the brain needs consistency and repetition to rewire itself, so if you improvise, try to stick to the same exercises or activities for at least a week. For even more stimulation, you can make yourself and audio recording where you guide yourself through a visualization.
  • Simple & complex. The more senses you engage in your visualization, the more powerful it will be. Try to think about all the things you’ll feel, smell, and hear as you’re mentally practicing a task. For example, if you’re visualizing yourself getting dressed, try to focus on the texture of the fabric, the feel of the clothes on your skin, what sounds you hear in your house, etc.

There’s an infinite number of ways to mentally practice something. Try to figure out what’s exciting and interesting to you so that you’re more likely to stick with it.

Fortunately, consistency should be easy if you already have an at-home exercise regimen that you like. Mental practice works best when combined with active practice, and this therapy becomes straight-forward if you already have a routine in place.

If you don’t have an at-home therapy program yet, now is a great time to start one. Give your brain the stimulation it needs so that you can help maximize your chances of recovery.

Using Mental Practice to Boost Your Recovery

Mental practice is an effective, accessible, and affordable rehabilitation method that should not be overlooked. There is an abundance of evidence showing that it helps improve movement after stroke.

Survivors can see better results by combining mental practice with physical practice. Best of all, even survivors with paralysis can benefit from mental practice by activating neuroplasticity through visualized movements.

We hope this guide has inspired you to start practicing this evidence-based rehabilitation method today.

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