Investigation of the Effect of Combined Motor Imagery and Activity Observation Therapy on Strengthening the Non-Dominant Hand in Healthy Individuals

November 17, 2025 updated by: Ammar Mahmoud Ahmed, Bahçeşehir University

Introduction:

Motor Imagery (MI) and Action Observation (AO) are well-established cognitive training techniques that activate neural networks similar to those involved in actual motor execution. MI involves the mental rehearsal of a movement without physically performing it, while AO relies on observing an action performed by others to stimulate motor-related brain areas. Recent studies suggest that when these methods are combined, they may enhance motor learning, cortical plasticity, and strength gains more effectively than when applied alone. The non-dominant hand, often less trained and weaker in performance compared to the dominant hand, provides an ideal model to examine the effects of these interventions. Strengthening the non-dominant upper limb has implications not only for improving functional balance between the limbs in healthy individuals but also for potential clinical applications in rehabilitation.

Aim:

The primary aim of this randomized controlled study is to investigate the combined effect of MI and AO on muscular strength and functional performance of the non-dominant hand in healthy university students. Specifically, the study seeks to compare the outcomes of three groups: (1) AO combined with MI, (2) MI only, and (3) a control group with no intervention. It is hypothesized that participants in the AO+MI group will demonstrate greater improvements in grip strength and functional outcomes compared to the other groups.

Evaluation:

To comprehensively measure the effects of the intervention, several standardized assessment tools will be employed. Motor imagery ability will be evaluated using the Motor Imagery Questionnaire-3 (MIQ-3). Hand dominance will be determined by the Edinburgh Handedness Inventory. Grip strength will be objectively measured using a Hand Grip Dynamometer. The Recognise App will be used to assess laterality recognition and sensorimotor integration, while overall upper limb function will be measured through the Short Musculoskeletal Function Assessment (SMMT). These evaluations will be conducted both before and after the 4-week intervention period to track changes.

Treatment:

The intervention will span four weeks, with participants attending 2-3 sessions per week. Training protocols will include both cognitive and physical components. In the MI group, participants will engage in guided motor imagery sessions focused on visualizing non-dominant hand exercises. The AO+MI group will observe video demonstrations of the same hand movements, followed by simultaneous motor imagery practice, thereby combining visual and cognitive engagement. Physical strengthening exercises will include dumbbell wrist flexion and handball squeeze, targeting key muscles of the non-dominant hand and forearm. The control group will not undergo any intervention during this period. By integrating AO and MI with specific strengthening exercises, the study aims to determine whether this combined approach enhances neural activation and muscular strength more effectively than MI alone.

Study Overview

Status

Not yet recruiting

Conditions

Intervention / Treatment

Study Type

Interventional

Enrollment (Estimated)

60

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

Yes

Description

Inclusion Criteria:

  • Age between 18 and 65 years old
  • They agreed to participate
  • Having no pathology in hearing and vision
  • Having no history of upper limb injury or musculoskeletal
  • Having no neurologic disorders
  • All subjects had no prior experience with motor imagery
  • Having a Standardized Mini-Mental State Test (SMMT) score of more than 24 points

Exclusion Criteria:

  • A score of the Movement Imagery Questionnaire (MIQ-3) was less than ≥5
  • Severe cognitive deficits
  • Neurological problems
  • Left-handedness that was measured using the Edinburgh Handedness Inventory

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Health Services Research
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Single

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Experimental: Motor Imager
Conservative Treatment + Motor imagery Program
Other: Conservative treatment + Motor imagery program
Participants will perform guided motor imagery of non-dominant hand strengthening exercises (dumbbell wrist flexion and handball squeeze) without video observation, 5 sessions per week for 4 weeks.
Experimental: Experimental: Motor imager + Action Observation
Conservative Treatment + Motor imagery and Action observation Program
Other: Conservative treatment + Motor imagery and action observation program
Participants will observe videos of non-dominant hand strengthening exercises (dumbbell wrist flexion and handball squeeze) and simultaneously perform guided motor imagery of the same movements, 5 sessions per week for 4 weeks.
Active Comparator: Experimental: Conservative
Conservative Treatment Program
Other: Conservative treatment via strengthening exercises
Participants will perform only the physical strengthening exercises (dumbbell wrist flexion and handball squeeze) for the non-dominant hand, 5 sessions per week for 4 weeks, without any motor imagery or action observation.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Handedness was measured using the Edinburgh Handedness Inventory
Time Frame: 3 minutes
Handedness was measured using the Edinburgh Handedness Inventory, a standardized tool that assesses hand preference in 10 everyday activities (e.g., writing, brushing teeth, using scissors). The Laterality Quotient (LQ) is calculated to determine whether a participant is right-handed, left-handed, or ambidextrous. This measure will be used to identify each participant's dominant and non-dominant hand for the study.
3 minutes
Standardized Mini-Mental State Test
Time Frame: 5 minutes
The Standardized Mini-Mental State Test (SMMT) is a 30-point cognitive screening tool assessing orientation, memory, attention, language, and visuospatial skills. Scores below 24 indicate cognitive impairment, while scores of 24-30 are considered normal. In this study, the SMMT was used to evaluate cognitive status, and only participants scoring 24 or higher were included.
5 minutes

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Movement Imagery Questionnaire (MIQ-3)
Time Frame: 10 minutes
The Movement Imagery Questionnaire-3 (MIQ-3) is a 12-item tool used to assess an individual's ability to imagine movements through kinesthetic, internal visual, and external visual imagery. Participants physically perform and then imagine specific movements, rating the ease of imagery on a 7-point Likert scale. In this study, the MIQ-3 was used to evaluate motor imagery ability.
10 minutes
Grip Strength Using a hand grip Dynamometer
Time Frame: 8 minutes
Grip strength, an indicator of upper limb strength and functional capacity, will be measured using a hand grip dynamometer. Participants will sit with the elbow at 90° and wrist in neutral, then squeeze the device maximally for 3-5 seconds. The highest value from 2-3 trials will be recorded as the grip strength score.
8 minutes
Recognize lateralization app
Time Frame: 10 minutes
The Recognise Hand App (Noigroup) is used to assess left-right hand discrimination and implicit motor imagery ability. Participants view images of hands in different orientations and identify them as left or right, with response time and accuracy recorded. In this study, the app was used to evaluate laterality recognition of the non-dominant hand.
10 minutes

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Bahçeşehir University

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Estimated)

November 20, 2025

Primary Completion (Estimated)

January 16, 2026

Study Completion (Estimated)

January 16, 2026

Study Registration Dates

First Submitted

October 2, 2025

First Submitted That Met QC Criteria

November 17, 2025

First Posted (Actual)

November 19, 2025

Study Record Updates

Last Update Posted (Actual)

November 19, 2025

Last Update Submitted That Met QC Criteria

November 17, 2025

Last Verified

October 1, 2025

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • 61351342/020-1391

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

UNDECIDED

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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