Immediate Effects of PETTLEP-Based AOMI on Upper Limb Kinematics in Stroke Survivors

Immediate Effects of PETTLEP-Based AOMI on Upper Limb Kinematics in Stroke Survivors: A Randomized Controlled Trial.

The purpose of this study is to investigate the immediate effects of a mental practice technique, called Physical, Environment, Task, Timing, Learning, Emotion, Perspective (PETTLEP)-based Action Observation and Motor Imagery (AOMI), on arm movement in stroke survivors. Stroke often causes difficulty in moving the arm smoothly, leading patients to compensate by using their back or shoulder. In this study, participants will either receive a single session of the AOMI training (watching and mentally practicing a reach-to-grasp movement) or a control relaxation task. The researchers will use a smartphone-based motion capture system (OpenCap) to measure if the mental practice immediately improves the smoothness of the arm movement and reduces compensatory body movements.

Study Overview

• Status: Not yet recruiting
• Conditions: Stroke; Hemiplegia; Hemiplegia and/or Hemiparesis Following Stroke
• Intervention / Treatment: Behavioral: PETTLEP-based Action Observation and Motor Imagery (AOMI); Behavioral: Cognitive and Somatic Control Tasks

Detailed Description

This study employs a single-blind, pretest-posttest, prospective randomized controlled trial design to evaluate the acute effects of a single session of Physical, Environment, Task, Timing, Learning, Emotion, Perspective (PETTLEP)-based Action Observation and Motor Imagery (AOMI) in stroke patients. Following a stroke, patients often develop pathological movement patterns and maladaptive compensatory strategies, such as trunk displacement or shoulder girdle elevation, due to impaired motor commands. Traditional task practice requires voluntary motor output that many severely impaired patients lack. Motor imagery combined with action observation offers a cognitive simulation alternative that activates neural motor planning circuits.

A total of 28 eligible stroke survivors will be randomized in a 1:1 ratio into an experimental (AOMI) group or a control (cognitive and somatic) group. Baseline kinematics of a standardized Reach-to-Grasp task will be recorded using OpenCap, a markerless 3D motion capture system utilizing smartphone cameras.

The intervention consists of three blocks lasting approximately 25 minutes in total. The experimental group will engage in a scaffolded AOMI protocol using a 1:3 physical-to-mental practice ratio. This includes sensory priming (holding the target object), action observation (watching a 1st-person video of the task), and selective motor imagery with specific constraints targeting movement smoothness and the inhibition of compensatory trunk and shoulder movements. The control group will perform matched-duration non-motor tasks, including body scanning and visuospatial navigation.

Immediately following the intervention, the reach-to-grasp task will be re-assessed using the OpenCap system to quantify short-term changes in movement smoothness (Number of Velocity Peaks), trunk displacement, and shoulder girdle elevation.

• Study Type: Interventional
• Enrollment (Estimated): 28
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Abdelrahman Walid Sabee, BSc; Phone Number: +905379600520; Email: 2433095024@stu.istinye.edu.tr
• Study Contact Backup: Name: Begüm Kara Kaya, Asst. Prof.; Phone Number: +90 535 572 00 21; Email: bkara@biruni.edu.tr

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

• Female and male adults aged 40 to 80 years with a diagnosis of unilateral ischemic or hemorrhagic stroke.
• Residual voluntary movement activity of the affected upper limb.
• Mild to moderate spasticity (Modified Ashworth Scale ≤ 3).
• Adequate cognitive function to understand and follow verbal instructions (Mini-Mental State Examination ≥ 21).
• Medically stable patients, with no active or uncontrolled systemic illness.
• Ability to sit unsupported for at least 30 minutes and be able to perform brief cognitive-motor exercises.

Exclusion Criteria:

• Other central nervous system disorders (e.g., Parkinson's disease, multiple sclerosis, traumatic brain injury).
• Musculoskeletal or orthopedic conditions causing restriction of movement in the upper-limb (such as fixed contractures, severe joint deformities, shoulder subluxation).
• Severe sensory deprivation, visual neglect, or inattention that interferes with completion of the task or the ability to engage in motor imagery.
• Uncontrolled seizures, severe cardiovascular instability, or any other contraindication to imagery.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Experimental Group: PETTLEP-based AOMI; Participants will receive a single 25-minute session of a scaffolded protocol featuring a 1:3 physical-to-mental practice ratio. The session includes sensory priming, action observation of a 1st-person video, and selective motor imagery with smoothness and trunk control constraints, followed by physical performance.	Behavioral: PETTLEP-based Action Observation and Motor Imagery (AOMI); A mental practice protocol involving sensory priming, action observation, and motor imagery of a reach-to-grasp task with selective functional constraints (Smoothness, Dissociation/Glued Back, and Relaxed Shoulder).
Sham Comparator: Control Group: Cognitive and Somatic Control; Participants will engage in a time-matched 25-minute session of non-motor tasks. This includes body scanning (paying attention to breathing and somatic sensations) and visuospatial navigation (a mental "Home Tour") to stimulate the visuospatial system without involving the motor system.	Behavioral: Cognitive and Somatic Control Tasks; Structured operations including somatic attention (body scanning) and visuospatial control (spatial navigation) timed and paired to exhaust attention without motor system participation.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Movement Smoothness (Number of Velocity Peaks)	Movement smoothness of the affected upper limb will be evaluated using the OpenCap system (a markerless 3D motion capture system). It is calculated by the Number of Velocity Peaks (NVP) derived from the hand marker (3rd Metacarpal head) velocity profile during a standardized reach-to-grasp task. A reduction in NVP indicates increased movement smoothness and better motor control.	Immediately before the intervention (baseline) and immediately after the single 25-minute intervention session.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Shoulder Girdle Elevation (Compensatory Strategy)	Calculated by measuring the relative vertical (Y axis) displacement of the Shoulder marker with respect to the Neck marker during movement using the OpenCap system.	Immediately before and immediately after the 25-minute intervention session.
Trunk Displacement (Compensatory Strategy)	Calculated by measuring the change in the Lumbar Extension angle in the sagittal plane during the reaching phase, obtained from the OpenSim kinematic model.	Immediately before and immediately after the 25-minute intervention session.
Gross Manual Dexterity - Box and Block Test (BBT)	Participants are asked to move as many blocks as they can from one side of a wooden box to the other in 60 seconds using their affected hand. The score is the number of blocks moved successfully.	Immediately before and immediately after the 25-minute intervention session.
Pain - Visual Analog Scale (VAS)	Participants indicate their pain intensity by placing a mark on a 10-cm horizontal line. The left side is labeled "no pain" (0) and the right side is labeled "worst pain imaginable".	Immediately before and immediately after the 25-minute intervention session.
Movement Imagery Ability - Movement Imagery Questionnaire-3 (MIQ-3)	Evaluates the participant's capacity for movement imagery within three subscales: Kinesthetic, Internal Visual and External Visual. Participants evaluate the vividness of imagery on a Likert scale (higher scores signify greater vividness).	Immediately before and immediately after the 25-minute intervention session.

Collaborators and Investigators

• Sponsor: Istinye University
• Investigators: Study Director: Begüm Kara Kaya, Asst. Prof, Istinye University

Study record dates

Study Major Dates

• Study Start (Estimated): April 1, 2026
• Primary Completion (Estimated): March 20, 2027
• Study Completion (Estimated): March 20, 2027

Study Registration Dates

• First Submitted: March 27, 2026
• First Submitted That Met QC Criteria: March 27, 2026
• First Posted (Actual): April 2, 2026

Study Record Updates

• Last Update Posted (Actual): April 9, 2026
• Last Update Submitted That Met QC Criteria: April 5, 2026
• Last Verified: March 1, 2026

More Information

Terms related to this study

• Keywords: Stroke; Kinematics; Motor imagery; Action observation; Upper limb rehabilitation; OpenCap
• Additional Relevant MeSH Terms: Neurologic Manifestations; Cerebrovascular Disorders; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Vascular Diseases; Cardiovascular Diseases; Paralysis; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Stroke; Hemiplegia
• Other Study ID Numbers: 2026/56

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Individual participant data (IPD) will not be shared to ensure the strict privacy and confidentiality of the stroke survivors participating in this study. The data collected involves specific clinical and kinematic assessments conducted for an academic Master's thesis. The informed consent obtained from participants covers the use of their data for this specific research project and allows for publication in aggregate form only. It does not explicitly grant permission for open public data sharing. Therefore, only summary and aggregate data will be reported in the final thesis and any resulting peer-reviewed publications.

Drug and device information, study documents

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