Motor Imaging, Neglect, and Upper Extremity Function in Stroke

May 21, 2026 updated by: Havva Adlı, Inonu University

Investigation of the Relationship Between Motor Imagery Skill and Neglect Level, Upper Extremity Motor Function, Activities of Daily Living, and Quality of Life in Individuals After Stroke

This study aims to investigate the relationship between motor imagery skills and neglect level, upper extremity motor function, activities of daily living, quality of life, lateralization performance, and mental timer performance in individuals with stroke. Individuals with stroke who meet the inclusion criteria and voluntarily agree to participate will be evaluated. Demographic and clinical information of the participants will be recorded on an assessment form prepared by the researcher. Upper extremity motor functions will be assessed using the Fugl-Meyer Upper Extremity Motor Assessment Scale and the Wolf Motor Function Test; activities of daily living will be assessed using the Modified Barthel Index; and quality of life will be assessed using the Stroke-Specific Quality of Life Scale. Motor imagery skills will be measured using the Kinesthetic and Visual Imagery Questionnaire and a mental timer task; upper extremity lateralization performance will be assessed using the Recognise™ application. Neglect level will be assessed using the Catherine Bergego Scale, the Line Splitting Test, and the Star Erase Test. The data obtained will be statistically analyzed to examine the relationships between motor imagery skills and other clinical variables.

Study Overview

Status

Not yet recruiting

Conditions

Intervention / Treatment

Detailed Description

Stroke is a condition characterized by impaired cerebrovascular circulation due to bleeding or blockage, resulting in problems such as weakness on one side of the body, mobility, balance, coordination, and cognitive impairment. Motor impairment, usually restricting movement of the face, arm, and leg on one side of the body, affects approximately 80% of stroke individuals. Upper extremity function is significantly reduced in about 80% of stroke individuals due to spasticity and muscle weakness, which restricts elbow extension movement. Problems with shoulder, arm, hand, and wrist function-in short, upper extremity disorders-are very common after a stroke. These upper extremity disorders generally involve difficulty with arm, hand, and finger movement and coordination, significantly limiting individuals' interaction with their environment and functionality. In addition to motor losses, spatial neglect due to right hemisphere lesions is one of the frequently observed neuropsychological problems after a stroke. Neglect syndrome is characterized by an individual's inability to perceive, direct attention to, or maintain bodily awareness in the spatial area opposite to the damaged hemisphere of the brain. This negatively impacts motor performance and daily living activities, reducing the effectiveness of rehabilitation. In individuals with severe neglect, the use of the affected side decreases, slowing functional recovery. In recent years, motor cognition-based methods have gained increasing importance in post-stroke rehabilitation alongside classical approaches. One of these methods, motor imagery (MI), is the process of mentally visualizing a movement without actually performing it. Neuroimaging studies have shown that the brain regions activated during motor imagery are largely similar to the motor areas activated during actual movement. Therefore, it is suggested that there may be a relationship between motor functions and motor imagery ability in stroke patients. However, the reported results in this area are inconsistent in stroke patients. Although motor impairments do not directly reflect performance in imagery, motor consequences resulting from brain damage negatively affect imagery, and generally, more severe motor impairments have been associated with weaker imagery ability. Research has shown that individuals with high motor imagery skills experience positive effects in terms of motor performance and learning. Conversely, a decrease in imagery capacity or factors affecting the cognitive representation of movement (e.g., neglect or lateralization disorders) can limit the effectiveness of the rehabilitation process. Therefore, it is important to comprehensively investigate the relationships between motor imagery skills and neglect, upper extremity function, activities of daily living, and quality of life in individuals after a stroke. Based on this information, this study aimed to investigate the relationship between motor imagery skills and the level of neglect (neglet), upper extremity motor function, activities of daily living, quality of life, lateralization performance, and mental rotation ability in individuals after a stroke.

Hypotheses:

  1. Hypothesis: Motor imagery skills in individuals after a stroke are related to the level of neglect (neglet).
  2. Hypothesis: Motor imagery skills in individuals after a stroke are related to the level of upper extremity motor function.
  3. Hypothesis: Motor imagery skills in individuals after a stroke are related to activity of daily living performance.

Hypothesis 4: Motor imagery skills in individuals after stroke are related to their quality of life level.

Hypothesis 5: Motor imagery skills in individuals after stroke are related to lateralization performance.

Hypothesis 6: Motor imagery skills in individuals after stroke are related to mental rotation ability.

Study Type

Observational

Enrollment (Estimated)

50

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

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

No

Sampling Method

Probability Sample

Study Population

The study population consists of stroke patients residing in Malatya province, and the sample comprises patients who have presented to a specialist physician with this complaint, received a stroke diagnosis, and applied to our clinic. Patients who consult a physical medicine and rehabilitation specialist, have no contraindications indicated by the physician, voluntarily agree to participate in the study, and meet the study criteria will be randomly selected.

Description

Inclusion Criteria:

  • Individuals who have experienced hemiplegia after an ischemic stroke,
  • who actively use their right extremity according to the Edinburgh Hand Preference Questionnaire,
  • who have right hemisphere involvement,
  • who are 18 years of age or older,
  • who have been diagnosed with a stroke at least 1 and at most 6 months ago,
  • who have middle cerebral artery involvement,
  • who have a Standardized Mini Mental Test score of 24 or higher,
  • who are Stage 2b or higher according to Eggers staging,
  • who can actively control their hand, wrist, and fingers and perform the release reflex,
  • who wish to participate in the study voluntarily, and
  • who have given their informed consent will be included in the research.

Exclusion Criteria:

  • Individuals with major neurological, orthopedic, or rheumatological disorders affecting upper extremity function other than stroke (Polyneuropathy, Parkinson's Disease, Multiple Sclerosis, Rheumatoid Arthritis, etc.),
  • Individuals with upper extremity amputation,
  • Individuals with uncontrolled arrhythmia, uncontrolled hypertension, or unstable cardiac conditions,
  • Individuals with active malignancy and receiving related chemo/radiotherapy,
  • Individuals unable to cooperate due to aphasia or cognitive impairment,
  • Individuals with visual and hearing problems,
  • Individuals with communication problems that would hinder the evaluation and/or implementation of the treatment program,
  • Individuals who are unable to undergo mental assessment, complete the scales, or are illiterate will be excluded from the study.

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

Cohorts and Interventions

Group / Cohort
Intervention / Treatment
stroke group
The study population consists of stroke patients residing in Malatya province, and the sample comprises patients who have presented to a specialist physician with this complaint, received a stroke diagnosis, and applied to our clinic. Patients will be randomly selected from among those who consulted a physical medicine and rehabilitation specialist, had no contraindications indicated by the physician, agreed to participate voluntarily in the study, and met the study criteria. They will be evaluated using appropriate assessment methods.
Other: No intervention will be made; an assessment will be conducted.
No intervention will be made; an assessment will be conducted.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Fugl-Meyer Upper Extremity Motor Assessment Scale
Time Frame: 6 mounth
Fugl-Meyer and colleagues developed the Fugl-Meyer Motor Assessment Scale in 1975 by expanding on Brunnstrom's motor assessment method. The scale is a widely used, reliable, and valid test for assessing paretic upper extremity motor impairment in stroke patients. The FM-UE is a 33-item sub-section of this scale. The scale evaluates the movement, coordination, and reflexes of the shoulder, elbow, forearm, wrist, and fingers. Each parameter is scored between 0 and 2 points, with a maximum score of 66, indicating good motor function. In tests evaluating upper extremity movement, the scoring is as follows: 0: movement cannot be performed, 1: movement is partially performed, and 2: movement is performed normally.
6 mounth
Kinesthetic and Visual Imagination Questionnaire (KVIQ)
Time Frame: 6 mounth
The KGIA will be used to evaluate motor imagery skills. The Turkish validity and reliability study of the scale developed by Malouin et al. was conducted by Dilek et al. The questionnaire, administered with the assistance of an evaluator, consists of 10 movements and assesses how well participants can visualize and feel the movements. Participants are first asked to perform the movement actually, and then to visually and kinesthetically imagine the same movement. The level of visual and kinesthetic imagery is scored between 1 (no image/feeling) and 5 (very clear/very intense), and visual and kinesthetic imagery scores are calculated at the end of the evaluation.
6 mounth
Catherine Bergego Scale
Time Frame: 6 mounth
It is a scale that assesses neglect syndrome by directly observing daily life. The 10-item scale was developed by Professor Philippe Azouvi (1996). The Turkish validity and reliability study was done by Kulaç et al.
6 mounth
Line Bisection Test
Time Frame: 6 mounth
The line-splitting test is one of the tests used in the clinical diagnosis of neglect syndrome. In this test, patients are presented with a sheet of paper printed on A4 paper, consisting of straight horizontal lines of varying lengths. These lines are positioned in the center, to the right, and to the left of the paper. The paper is placed in front of the patient, in the midline. In this test, the patient is asked to mark the midpoint of all the lines on the paper. Patients with neglect often mark the right side of the original center.
6 mounth
The Star Cancellation Test
Time Frame: 6 mounth
The Star Erase Test was developed in 1987 by Wilson, Cockburn, and Halligan. It consists of an A4-sized sheet of paper with randomly distributed small stars, large stars, words, and letters. In the Star Erase Test, there are 52 small stars interspersed among 52 large stars, 10 short words, and 13 letters. The paper is placed mid-line directly in front of the patient, and the patient is asked to mark the small stars. The maximum score is 54, as the two middle stars are marked as examples by the observer. A score of 51 or lower indicates visual inattention.
6 mounth
Wolf Motor Function Test
Time Frame: 6 mounth
The WMFT was developed by Wolf et al. to evaluate motor skills in patients with upper extremity motor dysfunction and was later modified by Morris et al. for use in patients with lower motor function. In this study, the modified WMFT will be used. The test consists of 17 tasks, including 2 muscle strength items and 15 functional activities. Functional activities are scored on a 0-5 scale, and the average score represents the functional ability score, with higher scores indicating better motor performance. Performance time for each task is also recorded, with a maximum time limit of 120 seconds per activity. Participants are instructed to perform each task as quickly as possible after the command "start. "
6 mounth

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Lateralization Assessment
Time Frame: 6 mounth
Upper extremity right/left lateralization performance will be evaluated using the "Recognise™" application developed by the Neuro-Orthopaedic Institute. The "Recognise™ Hand" and "Recognise™ Shoulder" sections, specifically the "Vanilla" version of these sections, will be used. A total of 20 shoulder and 20 hand images will be displayed for 5 seconds, and participants will be asked to press the right or left button on the screen as accurately and quickly as possible, without focusing on their extremity. Participants will be allowed to practice before the actual assessment. Accuracy rates and reaction times will be recorded.
6 mounth
Mental Cronometre Time
Time Frame: 6 mounth
This will be used to evaluate the chronometric aspect of motor imagery. A towel folding task will be given for the mental timer. First, the motor imagery task will be performed. The time displayed on the screen will be recorded by the observer. For the physical phase of the test, the same procedure will be performed and the time recorded using a timer. The mental timer ratio will be calculated.
6 mounth
Stroke-Specific Quality of Life Scale
Time Frame: 6 mounth
The Quality of Life Assessment Scale (QQS), developed by Williams et al. in 1999, consists of 49 items covering 12 subcategories (mobility, fitness, upper extremity functionality, work/productivity, mood, self-care, social roles, family roles, language, vision, thinking, and personality) that assess the quality of life of individuals with stroke. The QQS is a 5-point Likert-type scale; the higher the total score (1=Strongly agree, 2=Partially agree, 3=Neither agree nor disagree, 4=Partially disagree, 5=Disagree), the better the quality of life of the stroke individual. The Turkish validity and reliability of the scale was established by Hakverdioğlu et al.
6 mounth
Modified Barthel Index
Time Frame: 6 mounth
The Daily Living Independence Scale (DLI), used to measure individuals' independence in activities of daily living, is a modification of the Barthel Index. The DLI includes 10 items related to activities of daily living (eating, personal hygiene, bathing, dressing, bowel and bladder care, toilet use, ambulation, transfers, and stair climbing). Each item in the DLI has levels from 0 to 5. A different scoring system is used for each activity (for example, the scores for the eating sub-item are 0-2-5-8-10, while the scores for the transfer sub-item are 0-3-8-12-15). At level 1, the individual is unable to perform the activity, while at level 5, the individual can perform the activity unaided, albeit slowly. The total score ranges from 0 to 100. As the score increases, the individual's independence in activities of daily living increases. The DLI has good reliability and validity. The Turkish validity and reliability of the scale was established by Küçükdeveci et al.
6 mounth

Collaborators and Investigators

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

Sponsor

Inonu 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)

May 25, 2026

Primary Completion (Estimated)

June 25, 2026

Study Completion (Estimated)

August 15, 2026

Study Registration Dates

First Submitted

March 13, 2026

First Submitted That Met QC Criteria

March 13, 2026

First Posted (Actual)

March 18, 2026

Study Record Updates

Last Update Posted (Actual)

May 22, 2026

Last Update Submitted That Met QC Criteria

May 21, 2026

Last Verified

May 1, 2026

More Information

Terms related to this study

Additional Relevant MeSH Terms

Other Study ID Numbers

  • 2026/013

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

IPD Plan Description

We do not intend to share our data.

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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