Acute Effect of Graded Motor Imagery on Ankle Rehabilitation: A Pilot Study

February 9, 2026 updated by: Seda Ateş, Istanbul University - Cerrahpasa

The Acute Effect of Graded Motor Imagery-Based Mental Preparation on Ankle Rehabilitation: A Pilot Clinical Study

The primary aim of this study is to evaluate the immediate and short-term effects of the Graded Motor Imagery (GMI) method on individuals with chronic ankle instability (CAI). In this context, the effects of the Graded Motor Imagery intervention on pain level, muscle stiffness, muscle strength, functional performance, and subjective instability level will be investigated. Additionally, these effects will be comparatively analyzed with an age- and sex-matched control group consisting of healthy individuals.

Study Overview

Status

Recruiting

Conditions

Intervention / Treatment

Study Type

Interventional

Enrollment (Estimated)

48

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 Contact

Study Locations

  • Turkey (Türkiye)
      • Istanbul, Turkey (Türkiye)
        • Recruiting
        • İstanbul Üniversitesi-Cerrahpaşa

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

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • Aged between 18 and 40 years.
  • Diagnosed with chronic ankle instability (CAIT ≤ 24).
  • History of an acute ankle sprain occurring more than 3 months prior to enrollment.
  • Has not received ankle rehabilitation treatment.
  • Voluntarily participated in this study

Exclusion Criteria:

  • Vestibular or neurological disorders
  • Other lower extremity injuries
  • History of surgery

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: Supportive Care
  • Allocation: Non-Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Single

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Active Comparator: control group
Other: graded motor imagery

The Graded Motor Imagery (GMI) program will be applied six consecutive days nd will consist of three progressive stages:

Laterality Training:

Participants will perform right-left ankle discrimination tasks using validated foot and ankle images. Accuracy and response time will be recorded.

Motor Imagery:

Participants will mentally rehearse ankle movements such as dorsiflexion, plantarflexion, inversion, and eversion without performing the motion. Imagery tasks will progress from simple movements to functional patterns based on tolerance.

Mirror Therapy:

A mirror will be placed in the midsagittal plane, allowing participants to view the reflection of the non-affected ankle while performing movements. The visual illusion of normal movement is intended to improve motor control and proprioception.
Experimental: instability group
Other: graded motor imagery

The Graded Motor Imagery (GMI) program will be applied six consecutive days nd will consist of three progressive stages:

Laterality Training:

Participants will perform right-left ankle discrimination tasks using validated foot and ankle images. Accuracy and response time will be recorded.

Motor Imagery:

Participants will mentally rehearse ankle movements such as dorsiflexion, plantarflexion, inversion, and eversion without performing the motion. Imagery tasks will progress from simple movements to functional patterns based on tolerance.

Mirror Therapy:

A mirror will be placed in the midsagittal plane, allowing participants to view the reflection of the non-affected ankle while performing movements. The visual illusion of normal movement is intended to improve motor control and proprioception.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Subjective Instability (CAIT)
Time Frame: baseline

A valid-reliable questionnaire that questions the perceived instability in daily life and sports activities.

Clinical Significance: ≥ 3 point increase is considered clinically significant
baseline
Subjective Instability (CAIT)
Time Frame: 1-week post-intervention

A valid-reliable questionnaire that questions the perceived instability in daily life and sports activities.

Clinical Significance: ≥ 3 point increase is considered clinically significant
1-week post-intervention
Ground Reaction Force & Static Balance (ForceDecks)
Time Frame: baseline

Device: ForceDecks dual force platform.

  1. Single-Leg Jump Test* Values: Net vertical ground reaction force (N·kg-¹), flight time (ms), asymmetry (%).
  2. Single-Leg Static Balance* Values: Total sway path (mm), ellipse area (mm²).

Clinical Importance:* Captures short-term changes in neuromuscular control and explosive strength in a detailed manner.
baseline
Ground Reaction Force & Static Balance (ForceDecks)
Time Frame: 1-week post-intervention

Device: ForceDecks dual force platform.

  1. Single-Leg Jump Test* Values: Net vertical ground reaction force (N·kg-¹), flight time (ms), asymmetry (%).
  2. Single-Leg Static Balance* Values: Total sway path (mm), ellipse area (mm²).

Clinical Importance:* Captures short-term changes in neuromuscular control and explosive strength in a detailed manner.
1-week post-intervention

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Muscle Stiffness (Myoton PRO)
Time Frame: baseline

Tonic stiffness (N·m-¹) reflects the passive mechanical properties of muscle tissue. The device applies a 0.4 N mechanical impulse to the skin and records the resulting tissue oscillation response. In this study, data will be recorded as the average of 3 impulses.

Clinical Importance: Acute changes in stiffness are considered an indirect indicator of neuroplastic responses in proprioception and motor control.
baseline
Muscle Stiffness (Myoton PRO)
Time Frame: 1-week post-intervention

Tonic stiffness (N·m-¹) reflects the passive mechanical properties of muscle tissue. The device applies a 0.4 N mechanical impulse to the skin and records the resulting tissue oscillation response. In this study, data will be recorded as the average of 3 impulses.

Clinical Importance: Acute changes in stiffness are considered an indirect indicator of neuroplastic responses in proprioception and motor control.
1-week post-intervention
Muscle Strength Assessment - Isokinetic dynamometer (Isoforce)
Time Frame: baseline

Parameter: Concentric inversion-eversion peak torque (Nm) at 60°·s-¹ Objectively measures agonist-antagonist muscle performance around the ankle joint.

Clinical Significance:* Improvements in strength contribute to functional stability and a reduced risk of re-injury.
baseline
Muscle Strength Assessment - Isokinetic dynamometer (Isoforce)
Time Frame: 1-week post-intervention

Parameter: Concentric inversion-eversion peak torque (Nm) at 60°·s-¹ Objectively measures agonist-antagonist muscle performance around the ankle joint.

Clinical Significance:* Improvements in strength contribute to functional stability and a reduced risk of re-injury.
1-week post-intervention
Pain Level
Time Frame: baseline
Visual Analog Scale (VAS, 0-10 cm): 0 = "no pain," 10 = "unbearable pain"; the participant marks the scale before and after the session.
baseline
Pain Level
Time Frame: 1-week post-intervention
Visual Analog Scale (VAS, 0-10 cm): 0 = "no pain," 10 = "unbearable pain"; the participant marks the scale before and after the session.
1-week post-intervention
Functional Performance
Time Frame: baseline

Star Excursion Balance Test (SEBT) Parameter: Normalized reach distance in three primary directions (anteromedial, medial, posteromedial), expressed as a percentage of leg length.

Clinical Significance: Assesses dynamic balance and lateral load-transfer capacity; asymmetries in individuals with chronic ankle instability (CAI) may serve as prognostic indicators.
baseline
Functional Performance
Time Frame: 1-week post-intervention

Star Excursion Balance Test (SEBT) Parameter: Normalized reach distance in three primary directions (anteromedial, medial, posteromedial), expressed as a percentage of leg length.

Clinical Significance: Assesses dynamic balance and lateral load-transfer capacity; asymmetries in individuals with chronic ankle instability (CAI) may serve as prognostic indicators.
1-week post-intervention

Collaborators and Investigators

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

Sponsor

Istanbul University - Cerrahpasa

Investigators

  • Study Director: SEZEN KARABÖRKLÜ ARGUT, Assistant Professor, PhD, Istanbul University-Cerrahpasa, Faculty of Health Sciences

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

  • Kim KM, Estepa-Galego A, Estudilo-Martínez MD, Castelote-Cabalero Y, Cruz-Díaz D. Comparative Effects of Neuromuscular- and Strength-Training Protocols on Pathomechanical, Sensory-Perceptual, and Motor-Behavioral Impairments in Patients with Chronic Ankle Instability: Randomized Contro led Trial. Healthcare (Basel). 2022 Jul 22;10(8):1364. doi: 10.3390/healthcare10081364. PMID: 35893186; PMCID: PMC9394255.
  • Naderi A, Ahi K. Comparative analysis of land-based vs. water-based balance training on quality of life and physical and psychological deficits in athletes with chronic ankle instability: a randomized contro led trial. BMC Sports Sci Med Rehabil. 2025 Jan 20;17(1):9. doi: 10.1186/s13102-024-01049-3. PMID: 39828772; PMCID: PMC11744859.
  • David P, Halimi M, Mora I, Doutrelot PL, Petitjean M. Isokinetic testing of evertor and invertor muscles in patients with chronic ankle instability. J Appl Biomech. 2013 Dec;29(6):696-704. doi: 10.1123/jab.29.6.696. Epub 2013 Jan 18. PMID: 23343782.
  • Wright CJ, Linens SW, Cain MS. Establishing the Minimal Clinical Important Difference and Minimal Detectable Change for the Cumberland Ankle Instability Tool. Arch Phys Med Rehabil. 2017 Sep;98(9):1806-1811. doi: 10.1016/j.apmr.2017.01.003.
  • Moseley GL. Graded motor imagery for pathologic pain: a randomized controled trial. Neurology. 2006 Dec 26;67(12):2129 34. doi: 10.1212/01.wnl.0000249112.56935.32. Epub 2006 Nov 2. PMID: 17082465.

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 (Actual)

February 9, 2026

Primary Completion (Estimated)

June 9, 2026

Study Completion (Estimated)

June 9, 2026

Study Registration Dates

First Submitted

December 17, 2025

First Submitted That Met QC Criteria

January 26, 2026

First Posted (Actual)

January 29, 2026

Study Record Updates

Last Update Posted (Actual)

February 11, 2026

Last Update Submitted That Met QC Criteria

February 9, 2026

Last Verified

January 1, 2026

More Information

Terms related to this study

Other Study ID Numbers

  • 2025/377

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

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.

Clinical Trials on Healthy Controls

Clinical Trials on graded motor imagery

Search Similar Trials

Sponsors and Collaborators

Medical Conditions

Drug Interventions

CROs by country

CROs in Bangladesh

Conditions

Rare Diseases

Drug Interventions

Dietary Supplements

Sponsor/Collaborators

Locations

Subscribe