Thinking about better speech: Mental practice for stroke-induced motor speech impairments

Abstract

Background: Mental practice (MP) is a mind–body technique in which physical movements are cognitively rehearsed. It has shown efficacy in reducing the severity of a number of neurological impairments.

Aims: In the present review we highlight recent developments in MP research, and the basis for MP use after stroke-induced motor speech disorders.

Main Contribution: In this review we (a) propose a novel conceptual model regarding the development of learned non-use in people with motor speech impairments; (b) review the rationale and efficacy of MP for reducing the severity of stroke-induced impairments; (c) review evidence demonstrating muscular and neural activations during and following MP use; (d) review evidence showing that MP increases skill acquisition, use, and function in stroke; (e) review literature regarding neuroplasticity after stroke, including MP-induced neuroplasticity and the neural substrates underlying motor and language reacquisition; and (f) based on the above, review the rationale and clinical application of MP for stroke-induced motor speech impairments.

Conclusions: Support for MP use includes decades of MP neurobiological and behavioural efficacy data in a number of populations. Most recently these data have expanded to the application of MP in neurological populations. Given increasingly demanding managed care environments, efficacious strategies that can be easily administered are needed. We also encounter clinicians who aspire to use MP, but their protocols do not contain several of the elements shown to be fundamental to effective MP implementation. Given shortfalls of some conventional aphasia and motor speech rehabilitative techniques, and uncertainty regarding optimal MP implementation, this paper introduces the neurophysiological bases for MP, the evidence for MP use in stroke rehabilitation, and discusses its applications and considerations in patients with stroke-induced motor speech impairments.

Keywords:

• Motor
• Aphasia
• Occupational therapy
• Speech therapy
• Stroke

Acknowledgments

This study was supported by a grant from the National Institutes of Health (R01AT004454-01).

Notes

¹A possible “workaround” for such patients may be the use of computer-based MP strategies as discussed earlier in this paper. Rather than having to produce the mental images themselves, this would allow patients to observe others performing the movements, enacting the “mirror neuron” cortical network that likely subserves both MP and passive observation of movements.