Stroke is one of the leading causes of mortality and disability worldwide. A proportion of individuals who experience a stroke fail to achieve the desired level of motor recovery in the affected upper extremity following rehabilitation, resulting in significant limitations in activities of daily living. After stroke, rehabilitation programs are essential to reduce disability and enhance functional outcomes.
This study aims to evaluate whether the addition of Motor Imagery (MI) to a standard rehabilitation program contributes to improvements in upper extremity motor function in individuals with stroke. MI is a mental practice technique in which individuals cognitively rehearse movements without physically performing them. Although the movement is not executed, the brain regions involved in the movement are activated.
Eligible participants will be randomly assigned to three groups. All groups will receive a standard physical therapy and rehabilitation program. The first group will receive only standard physical therapy and rehabilitation. The second group will receive, in addition to conventional therapy, 15 minutes of MI training three days per week, while the third group will receive 15 minutes of MI training five days per week. The total treatment duration for all groups is planned as 30 sessions.
Assessments will be conducted at baseline, at the end of the treatment period, and again at the 12th week. This study is based on the hypothesis that adding MI practice to a conventional upper extremity rehabilitation program after stroke will contribute to improvements in activities of daily living and functional recovery, and that these effects may be associated with the frequency of the intervention.
Being aged 18 years or older
Having a diagnosis of ischemic or hemorrhagic stroke confirmed by computed tomography (CT) or magnetic resonance imaging (MRI)
Being in the late subacute phase (more than 3 months post-stroke) or chronic phase (more than 6 months post-stroke) following stroke onset
Presence of unilateral extremity hemiparesis
Severe spasticity in the affected upper extremity, defined as a Modified Ashworth Scale score > 2
Presence of impaired consciousness, or severe hearing, visual impairment or global aphasia.
Musculoskeletal disorders affecting upper extremity motor function, such as fracture or arthritis in the affected upper limb
Parallel
Conventional Rehabilitation
BehavioralA physiotherapy program comprising range of motion exercises, stretching, strengthening exercises, neuromuscular facilitation techniques, and neurophysiological approaches such as Brunnstrom and Bobath.
Motor Imagery Training 1
BehavioralA structured motor imagery program, applied in addition to conventional rehabilitation, consisting of visual and kinesthetic mental rehearsal of functional movements, delivered for 15 minutes per session, three days per week.
Motor Imagery Training 2
BehavioralA structured motor imagery program, applied in addition to conventional rehabilitation, consisting of visual and kinesthetic mental rehearsal of functional movements, delivered for 15 minutes per session, five days per week.
Change in the Fugl-Meyer Assessment of Upper Extremity (FMA-UE) score from baseline assessment
The Fugl-Meyer Assessment for Upper Extremity (FMA-UE) is a stroke-specific, performance-based impairment index designed to assess motor function of the upper extremity. The scale evaluates movement, coordination, and reflex activity of the shoulder, elbow, forearm, wrist, and hand. Scores range from 0 to 66, with higher scores indicating better motor function
Change in the Modified Barthel Index (MBI) score from baseline assessment.
The Modified Barthel Index (MBI) is used to assess functional independence in activities of daily living (ADL), including feeding, bathing, grooming, dressing, toileting, transfers, mobility, and stair use. The total score ranges from 0 to 100, with higher scores indicating greater independence
Change in the Wolf Motor Function Test (WMFT) score from baseline assessment
The Wolf Motor Function Test (WMFT) is used to assess upper extremity motor ability through timed and functional tasks. It includes 15 tasks evaluating movement and object manipulation. Performance is measured by the time required to complete each task (in seconds) and a functional ability scale ranging from 0 to 5, where higher scores indicate better motor performance.
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