Review Article 1 Faculty of Medicine and Surgery, University of Rome “Tor Vergata,” Rome, Italy 2 Department of Systems Medicine, University of Rome “Tor Vergata,” Rome, Italy 3 The Jordanian Center for Physiotherapy,, Amman, Jordan 4 Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Rome, Italy Corresponding author: Anas R. Alashram, Department of Systems Medicine, Faculty of Medicine and Surgery, University of Rome “Tor Vergata,” Cambridge Street, Rome 00133, Italy. E-mail: anasalashram@gmail.com Mental Practice Combined With Physical Practice to Enhance Upper Extremity Functional Ability Poststroke: A Systematic Review Anas R. Alashram 1,2 , Giuseppe Annino 2 , Mohammed Al-qtaishat 3 , and Elvira Padua 4 Abstract Background: Upper extremity deficits are one of the most common impairments in individuals with stroke. Mental practice is exercised cognitively in the absence of the physical trials. The effects of the combination of mental and physical practice remain unclear. Objectives: This study aimed to examine the effects of combined physical practice and mental practice on the upper extremity functional ability poststroke, to identify which stroke population is most likely to benefit from the intervention, and to determine the effective treatment dosage. Methods: We searched in the PubMed, SCOPUS, National Rehabilitation Information REHABDATA, PEDro, and Web of Science until February 2020. Randomized clinical trials examined the effects of combined physical practice and mental practice on the upper extremity functional ability in people with a stroke. The risk of bias was evaluated and the effect sizes were calculated. Results: Nine studies met our inclusion criteria. In total, 230 stroke survivors were included in this analysis (mean age: 60.84 years). This review found that combining physical practice and mental practice has beneficial effects in improving the upper extremity functional ability poststroke. Conclusion: Combining physical practice and mental practice improves the upper extremity functional ability poststroke, this improvement can extend for 3 months after the treatment intervention. We propose that using 30 to 60 min of physical practice followed by 30 min of mental practice, 2 to 3 times weekly for 6 to 10 weeks, may give meaningful effects in individuals with stroke. Keywords Stroke, upper extremity, recovery of function, imagery (psychotherapy), mental healing, rehabilitation Journal of Stroke Medicine 1–11 © 2020 Indian Stroke Association Reprints and permissions: in.sagepub.com/journals-permissions-india DOI: 10.1177/2516608520943793 journals.sagepub.com/home/stm Introduction Stroke is a leading cause of upper extremity deficits worldwide. 1 About 40% to 50% of people with stroke suffer from upper extremity functional limitations that affect their activities of daily living. 2-4 The limitations in the activity of daily living results mainly from muscle strength reduction and abnormal muscle tone. 2 Common upper extremity impairments include muscle weakness, 5 reductions in movement velocity, 6 impaired coordination, 7 abnormal muscle tone, 7 as well as diminished hand function. 8 Hemiparesis is considered as one of the most common impairments in people with stroke. 9 The hemiplegic upper extremity only regains motor functions and return of task- specific activity of daily living <15% of the time. 10 People with a stroke can regain some motor functions as time progresses. It has been seen that spontaneous recovery can occur up to 6 months after stroke. However, new treatments clarified that motor recovery continued after that. 11 Approximately 80% of people with stroke require upper extremity therapy. 12