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Open Access Study protocol

Effects of mental practice embedded in daily therapy compared to therapy as usual in adult stroke patients in Dutch nursing homes: design of a randomised controlled trial

Susy M Braun1234*, Anna J Beurskens23, Susanne M van Kroonenburgh5, Jeroen Demarteau6, Jos M Schols578 and Derick T Wade109

Author Affiliations

1 The centre of expertise in life sciences, Zuyd University, Heerlen, The Netherlands

2 The department of health and technique, Zuyd University, Heerlen, The Netherlands

3 The research centre autonomy and participation, Zuyd University, Heerlen, The Netherlands

4 The care & public health institute, Maastricht University, Maastricht, The Netherlands

5 Klevarie nursing home, Vivre foundation, Maastricht, The Netherlands

6 Nursing home St. Camillus, Land van Gelre en Gulick, Roermond, The Netherlands

7 Department of general practice, Maastricht University, The Netherlands

8 Department Tranzo, Tilburg University, Tilburg, The Netherlands

9 Department of rehabilitation, Maastricht University, Maastricht, The Netherlands

10 Oxford centre for enablement, Oxford, UK

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BMC Neurology 2007, 7:34  doi:10.1186/1471-2377-7-34

Published: 15 October 2007



Mental practice as an additional cognitive therapy is getting increased attention in stroke rehabilitation. A systematic review shows some evidence that several techniques in which movements are rehearsed mentally might be effective but not enough to be certain. This trial investigates whether mental practice can contribute to a quicker and/or better recovery of stroke in two Dutch nursing homes. The objective is to investigate the therapeutic potential of mental practice embedded in daily therapy to improve individually chosen daily activities of adult stroke patients compared to therapy as usual. In addition, we will investigate prognostic variables and feasibility (process evaluation).


A randomised, controlled, observer masked prospective trial will be conducted with adult stroke patients in the (sub)acute phase of stroke recovery. Over a six weeks intervention period the control group will receive multi professional therapy as usual. Patients in the experimental group will be instructed how to perform mental practice, and will receive care as usual in which mental practice is embedded in physical, occupation and speech therapy sessions. Outcome will be assessed at six weeks and six months. The primary outcome measure is the patient-perceived effect on performance of daily activities as assessed by an 11-point Likert Scale. Secondary outcomes are: Motricity Index, Nine Hole Peg Test, Barthel Index, Timed up and Go, 10 metres walking test, Rivermead Mobility Index. A sample size of the patients group and all therapists will be interviewed on their opinion of the experimental program to assess feasibility. All patients are asked to keep a log to determine unguided training intensity.


Advantages and disadvantages of several aspects of the chosen design are discussed.

Trial registration