Mental practice is generally described as repeated mental simulation of the execution of a target movement in the absence of bodily activity for the purpose of improving a given movement. This movement imagery technique can be described to patients as imagining oneself undertaking the skilled movement without

actually doing the movement. Brain imaging research in healthy subjects has shown that during vivid imagery of a specific movement almost the same brain areas are active as during overt movement (Milton et al 2008). Fundamental research in patients has mainly been done with patients suffering from stroke (Sharma et al 2006) and this kind of research with patients with Parkinson’s disease shows that some but not all are able to perform mental imagery (Cunnington et al 2001, Frak et al 2004). Clinical studies of mental practice have been performed in various patient populations. buy Linsitinib There is some evidence Bosutinib datasheet that mental practice might help patients with conditions such as chronic pain, cancer, and orthopaedic pathologies (Dickstein and Deutsch 2007). However, the

majority of clinical research has been performed in stroke patients (Braun et al 2006). Initially the focus of mental practice was on the improvement of arm-hand functions, but recently more studies have been performed to assess possible effects on locomotor tasks (Malouin and Richards 2009). There is also some evidence that several different mental practice interventions might work. It seems important, however, to tailor the content of the mental practice to the abilities of the patient, as neurological

conditions can influence the ability of patients to generate vivid images (cognitive level), decrease kinesthetic input, and limit physical performance either (Braun et al 2008). Only a few clinical studies have been conducted in patients with Parkinson’s disease (Tamir et al 2007, Yaguez et al 1999) and results show some controversy on what effects a mental practice intervention might have. Mental practice should have the greatest effects on the movement that is actually mentally rehearsed (Feltz and Landers 1988). Recently, however, promising results on mobility tasks in a randomised clinical trial of reasonable size and duration have been published (Tamir et al 2007). It seems that mental practice might have a positive effect, but more research is needed to determine the effects with more certainty. We therefore performed a randomised controlled trial of a mental practice framework that is tailored to the patients’ abilities, in which patients with a wide range of disease severity were eligible. In this study, relaxation was treated as a sham intervention and only used to control for attention. Therefore the research questions for this study were: 1.