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HOW VISUALIZATION CAN HELP STROKE PATIENTS?

After all mental imagination is a brainstorming medicine!

Does mind-body therapeutics works well in the neurorehabilitation of stroke patients for enhanced recovery and post traumatic performance?

Answer is neuroscientifically yes! So what would be that technique? It’s simply the simplest of all simple techniques used in mainstream mind-body therapeutics. Its called ‘The motor imagery’. Moreover, this strongly coincide with the visualization used in modern day psychotherapeutics of alternative options as well. The interesting thing is that this technique was not merely published as a case study or cohort instead it’s a study that was peer reviewed and published as a Randomised controlled trial making it self worthy of higher level of scientific evidence in bringing to mainstream therapeutics.

It’s an idealism based mental stimulation of motor cortex in the brain. Idealistic neurophilosophy believes by bringing changes in mind we can change the brain neuronal synapses. Imagining hand movements as a first person can stimulate restitution and redistribution of brain activity by 

(1) increasing blood flow to the infarct regions 

(2) inducing neuroplasticity in adjacent neurons

which is accompanied by the recovery of hand function, thus resulting in a reduced motor deficit in the paralysed limb. Hence, the enhanced recovery from stroke. There are three major aspects covered in it. They are 

(1) identification of right and left hand brain orientation through pictures.

(2) mental imagination of movements of paralysed hands.

(3) Use of video and mirror to enhance movement of paralysed hands.

How is the mind used to enhance brain plasticity?

In this technique of motor imagery, patients is asked to imagine the movements of the paralysed hand in the mind from a first person perspective (imagination) without any propioceptive stimuli from peripheral joints so that brain is activated only through mental imagination. The visual, auditory and verbal stimuli are incorporated to guide internally and thereby activate motor cortex of the brain through adjacent neuronal stimulation of motor cortex. This can be visualised in fMRI. This motor imaginary mental techniques is enforced with physiotherapy to improve recovery.

How the mental imagination is used in step two?

The mental practice with motor imagery sessions is structured with the first 30 minute of each session with mental practice actively imagining a variety of elementary movements (such as opening and closing of the hand, wrist rotation, arm elevation), goal directed movements (such as reaching, grasping and lifting household objects), and activities of daily living (such as ironing, washing under the arms or doing buttons on a shirt). Goal directed movements include mental performance of the timed manual dexterity task. The rationale behind these imaginary task is building neuroplasticity (increasing synaptic connections between the neurons) for simpler, complex and goal oriented tasks by creating a subconscious brain and increasing blood flow to these cortical regions in the motor cortex. 

A further 10 minutes per session is reserved for active motor imagery using mirrors and video, as described above in the intervention rationale. The use of mirrors or video is alternated between sessions to enhance the cognitive ability to reproduce physical movements of hand as videos and mirrors is found more effective than mental imagination.

The final 5 minutes of each session is reserved for a covert form of motor imagery activity of mentally rotating visual depiction of hands, judging handedness through mentally simulated action, as described above for mental re-enforcement.

So is it far away from reaching us?

Definitely no! The current blockade for its implementation lies within patient compliance with type of stroke involved impairing comprehension and the trained psychotherapists in implementing motor imagery technique. Motor imagery technique is in fact a more scientific way of visualization technique which is a neuroscience based approach with its application in therapeutics for patients rather than a simple woo woo mystical technique. Mind-body therapeutics is budding out with its wings thrilling every day in the neuroscience beyond our imagination ripping off the skeptical dumbs and superstitious puppets. I said a million times mind over matter at some instances yet dumb, deaf and blind to a millions of truth.

Dr. Fahad Basheer

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