Motor Imagery and Mental Practice in the Subacute and Chronic Phases in Upper Limb Rehabilitation after Stroke: A Systematic Review.

Every study combined mental practice with conventional physiotherapy and/or occupational therapy, so the independent effect of mental practice cannot be separated from the standard treatment it was layered on. Sample sizes were small in most studies (10 to 38 patients), and 7 of the 11 did not report a sample size calculation. Protocols varied widely: different imagery types (first-person vs third-person), different facilitation methods (audio, spoken instruction, video), different task sets, and different session lengths and frequencies. There was no consensus on dose. Only one study included a follow-up beyond the post-treatment assessment, so it is unknown whether the gains lasted. None of the studies assessed whether patients could actually generate the mental images, and none screened for the cognitive capacity (attention, concentration) needed to perform the task. Lesion location and stroke type (ischaemic vs haemorrhagic) were inconsistently reported or excluded, making it hard to know which patients would benefit. The subacute-phase results were genuinely split, with several studies showing no significant difference between groups.

Do not read this as proof that imagining movements alone improves upper limb function. Every one of the 11 studies paired mental practice with physiotherapy or occupational therapy, and in the subacute phase several studies found no significant difference between the mental-practice group and the conventional-therapy-only group.