Effectiveness of Modified Graded Motor Imagery Training in Stroke Patients
- Conditions
- Graded Motor ImageryStrokeAction Observation TrainingMotor Imagery
- Interventions
- Other: Conventional Treatment GroupOther: Graded Motor Imagery and Conventional Treatment GroupOther: Modified Graded Motor Imagery and Conventional Treatment Group
- Registration Number
- NCT06326749
- Lead Sponsor
- Inonu University
- Brief Summary
In the study, movement observation training, Modified Graded Motor Imaging Training, which includes upper extremity functional exercises, and Graded Motor Imaging Training, where the standard protocol is applied, will be used in stroke patients to improve their upper extremity motor functions and daily lives. It is aimed to present it on an evidence-based basis by investigating its effects on Daily Living Activity, quality of life, upper extremity-specific right/left lateralization performance, mental stopwatch performance and motor imagery skills.
- Detailed Description
At study is planned as a combination of action observation training, motor imagery and graded motor imagery training, which have come to the fore in recent years and whose importance increases with each passing year. Additionally, its preferability in treatment will be investigated by comparing it with Graded Motor Imagery training, in which the standard protocol is applied. It is anticipated that treatment protocols will shed light on future studies.
The hypotheses of the study are as follows:
Hypothesis 1: Modified Graded Motor Imagery training is more effective than Graded Motor Imagery training and conventional treatment in improving upper extremity motor functions in individuals with stroke.
Hypothesis 2: Modified Graded Motor Imagery training is more effective than Graded Motor Imagery training and conventional treatment in improving daily living activities in individuals with stroke.
Hypothesis 3: Modified Graded Motor Imagery training is more effective than Graded Motor Imagery training and conventional treatment in improving the quality of life in individuals with stroke.
Hypothesis 4: Modified Graded Motor Imagery training is more effective than Graded Motor Imagery training and conventional treatment in improving motor imagery skills in individuals with stroke. Design of the study: The study was designed as a randomized controlled study.
Recruitment & Eligibility
- Status
- NOT_YET_RECRUITING
- Sex
- All
- Target Recruitment
- 21
Hemiplegia was observed after CVO, According to the Edinburgh Handedness Questionnaire, those who actively use their right extremity, Those with right hemisphere involvement, Those aged 18 and over, Having been diagnosed with stroke at least 1 month ago and at most 6 months ago, Middle cerebral artery involvement, Having a Standardized Mini Mental Test score of 24 or above, having a Stage 2b or above according to Eggers staging, Able to actively control hands, wrists and fingers and perform the release reflex Those who want to participate in the study voluntarily and Individuals with informed consent will be included in the study.
Those with major neurological, orthopedic or rheumatological disorders that affect upper extremity function other than stroke (Polyneuropathy, Parkinson's, Multiple Sclerosis, Rheumatoid Arthritis, etc.).
Those with upper extremity amputation, Uncontrolled arrhythmia, uncontrolled hypertension, unstable cardiac status Active malignancy and receiving chemo/radiotherapy related to it Uncooperative due to aphasia or cognitive impairment Individuals with vision and hearing problems Having a communication problem that may prevent implementation of the evaluations and/or treatment program Individuals who do not allow mental evaluation, cannot fill out the scales, and are illiterate will not be included in the study.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Conventional Treatment Group: Conventional Treatment Group Within the scope of the conventional treatment Bobath Method, facilitating movement and functional activities in the upper and lower extremities, activating trunk muscles, facilitating basic functional activities such as turning in bed, coming to sit and standing, improving weight bearing while sitting and standing, postural control, balance and walking. A targeted exercise program will be created. In line with this goal, upper and lower extremity exercises; don't turn around, don't come to sit, don't stand up; Exercises to activate core muscles; such as bridging, functional reaching; weight bearing and balance training; It is planned to implement walking training. Treatment time will be 40-50 minutes. Graded Motor Imagery and Conventional Treatment Group: Graded Motor Imagery and Conventional Treatment Group The DMI program consists of 3 stages: lateralization, open motor imagery and mirror therapy. The program will be implemented for 8 weeks, 3 days a week, under the supervision of a physiotherapist. First, lateralization training will be applied. In the second stage, motor imagery training will be applied. This phase will be carried out in a quiet environment by asking the participants to fully focus on the visualization of the movements. Two methods will be used for the imagined movements. In particular, visuals of the shoulder and hand used in the lateralization phase will be used to visualize movements related to the normal movement of the upper extremity. Participants will also be asked to imagine different activities in daily life. In the final stage, mirror therapy will be applied. The participant will be asked to perform some exercises while watching the reflection of the intact extremity in the mirror. Modified Graded Motor Imagery and Conventional Treatment Group: Modified Graded Motor Imagery and Conventional Treatment Group The modified DMI program consists of 4 stages: lateralization, open motor imagery including action observation training, mirror therapy and upper extremity functional exercise. The program will be implemented for 8 weeks, 3 days a week, under the supervision of a physiotherapist. Lateralization training will be applied in the first 2 weeks. Motor imagery training will be implemented in the 3rd and 4th weeks. For the second stage, the application will be combined with action observation training. As the 3rd stage, mirror therapy will be performed in the 5th and 6th weeks. The participant will be asked to perform some exercises while watching the reflection of the intact extremity in the mirror. In the final stage, they will be asked to physically perform upper extremity functional exercises. The total treatment time will be 40-50 minutes, with patients receiving 20-30 minutes of modified grade motor imagery and 20 minutes of conventional treatment.
- Primary Outcome Measures
Name Time Method Fugl-Meyer Upper Extremity Motor Rating Scale before treatment, 2 months, 4 months The scale is a widely used, reliable and valid test to evaluate paretic upper extremity motor impairment in stroke patients. From this scale, where each parameter is scored between 0-2 points, a maximum score of 66 can be obtained, and high scores indicate good motor functions.
Stroke-Specific Quality of Life Scale before treatment, 2 months, 4 months It consists of a total of 49 items for 12 subcategories (mobility, fitness, upper extremity functionality, work/productivity, mood, self-care, social roles, family roles, language, vision, thinking and personality) that evaluate the quality of life of individuals with stroke. The higher the total score, the better the stroke individual's quality of life.
Wolf Motor Function Test (WMFT) before treatment, 2 months, 4 months WMFT is used to evaluate motor skill in patients with upper extremity motor dysfunction. The 15 functional activities evaluated are scored between 0-5 points and the functional skill score is calculated by taking the average of the total score. Higher scores indicate better functional ability. In the performance time section, how long each activity took is recorded. A maximum of 120 seconds is allowed to complete an activity. If the activity cannot be completed within this time, the performance time is recorded as 120 seconds.
Modified Barthel Index before treatment, 2 months, 4 months MBI, which is used to measure the independence of individuals in daily living activities, emerged by modifying the Barthel Index. MBI includes 10 items related to activities of daily living. Total score is between 0-100. As the score increases, individuals' independence in daily living activities increases.
- Secondary Outcome Measures
Name Time Method Lateralization Assessment before treatment, 2 months, 4 months Right/left lateralization performance of the upper extremity will be evaluated with the "Recognise™" application developed by the Neuro Orthapedic Institute. The "Recognise™ Hand" and "Recognise™ Shoulder" sections of this application and the "Vanilla" part of these sections will be used. Accuracy rates and reaction time in the application will be recorded. An increase in the accuracy rate indicates that lateralization performance has improved.
Kinesthetic and Visual Imagery Questionnaire (KGIA) before treatment, 2 months, 4 months CSIA will be used to evaluate motor imagery skills. After experiencing the movement in reality, he will be asked to imagine himself watching the same movement as if it were actually performed. Participants will evaluate the quality of the image in the visualization by giving points between 1 and 5, including "1 (no image)" and "5 (clear as the original)". An increase in the score indicates improvement.
Mental Chronometry Time before treatment, 2 months, 4 months It will be used to evaluate the chronometric aspect of motor imagery. You will be given the task of wearing and folding a T-shirt for the mental stopwatch period.First, the motor imagery task will be performed. The time written on the screen is recorded by the observer. For the physical phase of the test, the same application is actually carried out and the time is recorded with the help of a stopwatch. Mental stopwatch rate will be calculated.
Mental stopwatch ratio = (Time in which the movement is physically performed - Time in which the movement is performed with imagination) / Time in which the movement is physically performed.
Trial Locations
- Locations (1)
Inonu University
🇹🇷Malatya, Turkey