Motor Imagery Training for Upper Limb Functional Strength in Chronic Stroke Patients

Stroke is a leading cause of upper extremity deficits worldwide. Persistent upper extremity dysfunction affects many post stroke patients and is strongly associated with decreased activities of daily living and poor quality of life.

There is accumulating evidence of a cross-over effect with training of one limb that slightly increase strength and coordination in contralateral untrained limb through neurological adaptations.

One of rehabilitation that is beneficial for stroke patient is motor imagery, a mental rehearsal of a movement that does not include physical movement has been shown to enhance upper limb function.

Evidence demonstrate that MI not only activates motor cortical and subcortical regions but also induces plastic change in motor networks and modulates synaptic activity at spinal level.

Study Overview

• Status: Recruiting
• Conditions: Chronic Stroke
• Intervention / Treatment: Procedure: Intervention Group A Conventional Physical Therapy; Procedure: Intervention Group B Motor Imagery with Conventional Physical Therapy

Detailed Description

OBJECTIVE:

The objectives of this study are:

1. To improve upper limb functional strength.
2. To improve the upper limb coordination.
3. To improve upper limb functional improvement.

HYPOTHESIS

Alternate Hypothesis:

There will be statistically significant difference in effects of motor imagery technique combined with conventional physical therapy and in comparison to conventional physical therapy alone on upper limb functional strength, coordination and functional improvement in chronic stroke. (p<0.05).

Null Hypothesis:

There will be no statistically significant difference in effects of motor imagery technique combined with conventional physical therapy and in comparison to conventional physical therapy alone on upper limb functional strength, coordination and functional improvement in chronic stroke. (p>0.05).

Research Design: Experimental study. Randomized Control Trial

• Study Type: Interventional
• Enrollment (Estimated): 26
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: AYESHA ASIF, DPT; Phone Number: +92 316-5314207; Email: ayesha97asif@gmail.com

Study Locations

• Pakistan
  • Islamabad, Pakistan, 44000
    • Recruiting
    • Foundation University College of Physical Thrapy
    • Contact: Sana Khalid, MS-NMPT; Phone Number: +92 344-4218174; Email: sana.khalid@fui.edu.pk

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Stroke duration 6 months onwards (chronic stroke).
• age 45 years and above.
• Both genders.
• Access cognitive function score > 24 on MoCA.

Exclusion Criteria:

• Patients with any comorbidity, previous surgery and congenital anomly.
• Patient with any fracture/ MSK disorders.
• Score 3 or more on Modified Ashworth scale.
• Patients with hearing impairments

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: N/A
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: CONTROL GROUP A- CONVENTIONAL PHYSICAL THERAPY; The participants will receive conventional physical therapy focusing on active range of motion, strengthing and coordination exercises. Subjects will receive protocol of 45 min thrice a week for 8 weeks with 2 min rest in between. The exercises will focus on active range of motion, weight exercises to increase strength and coordination exercises to improve movement coordination.	Procedure: Intervention Group A Conventional Physical Therapy; Active Range of Motion Exercises: (5-10 reps with 2 sets) Finger bends, finger spreads, finger to thumb opposition, thumb to palm stretches, palm up and down, wrist rotation, wrist bends, elbow bends, shoulder shrugging and shoulder rotation. Strengthening Exercises: (10-15 reps 2 sets weight 500 ml to 1L water bottle). Finger pinch, power grip, finger spread, pushing movement, wrist curls, roll and squeeze, bicep curls, side arm raise, lifting objects to a height, pulling resistance band. Coordination Exercises: (10-15 reps 2 sets) finger to finger, finger to doctor's finger, finger to nose, holding and lifting coins, buttoning, holding and lifting coins, alternate hand movement, closing and opening hand.
Experimental: INTERVENTION GROUP B- MOTOR IMAGERY WITH CONVENTIONAL PHYSICAL; The participants will recieve conventional physical therapy focusing on active range of motion, strengthing and coordination exercises. Subjects will recieve protocal of 45 min thrice a week for 8 weeks with 2 min rest in between. The exercises will focus on active range of motion, weight exercises to increase strength and coordination exercises to improve movement coordination.	Procedure: Intervention Group B Motor Imagery with Conventional Physical Therapy; Subjects will be asked to sit comfortably on a chair with a backrest. A Quiet environment is ensured for proper concentration of subject .Take deep breaths for 2-3 min to relax.; Subjects will be asked to close their eyes and imagine the training scene for each task for 5 min while listening to the therapist 's voice describing the motion.; The non-paralysis part of the body's movement was imagined first and then the movement of the paralysis part was imagined.; Upon completion of the mental practice for the first activity, the subject will be given a comfortable break. Motor Imagery Training: Week 1-2: Approaching and holding a cup, turning book pages and grasping pencil to write. Week 3-4: wiping desk, turning door handle and drinking water from cup. Week 5-6: pressing light switch on and off, turning faucet and putting card in wallet. Week 7-8: folding towel, brushing teeth and brushing hair. Imagine for 30 sec 2-3 repetitions.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
FUNCTIONAL STRENGTH	FUNCTONAL STRENGTH WILL BE ASSESSED USING WOLF MOTOR FUNCTION TEST	8 weeks
Coordination	The Action Research Arm Test (ARAT) will be used to assess upper extremity performance	8 weeks

Collaborators and Investigators

• Sponsor: Foundation University Islamabad

Study record dates

Study Major Dates

• Study Start (Actual): September 10, 2024
• Primary Completion (Estimated): May 15, 2025
• Study Completion (Estimated): May 30, 2025

Study Registration Dates

• First Submitted: April 18, 2025
• First Submitted That Met QC Criteria: April 24, 2025
• First Posted (Actual): April 25, 2025

Study Record Updates

• Last Update Posted (Actual): April 25, 2025
• Last Update Submitted That Met QC Criteria: April 24, 2025
• Last Verified: April 1, 2025

More Information

Terms related to this study

• Keywords: Stroke; Motor Imagery; Neurorehabilitation; Functional strength
• Additional Relevant MeSH Terms: Cerebrovascular Disorders; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Vascular Diseases; Cardiovascular Diseases; Stroke
• Other Study ID Numbers: FUI/CTR/2024/64

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No