An interventional study of Mirror Therapy and Motor Imagery in Stroke, sponsored by Lahore University of Biological and Applied Sciences. Recruiting at 1 site in Pakistan. Open to participants aged 45 Years to 65 Years. Per ClinicalTrials.gov, last updated 2026-10-28.
Sponsored by Lahore University of Biological and Applied Sciences · Not applicable, Interventional, and Treatment
This study will compare mirror therapy (MT) with motor imagery (MI), each added to routine Bobath-based physical therapy, to assess upper limb motor function and functional independence in patients with subacute middle cerebral artery (MCA) stroke. Upper limb dysfunction is a common and disabling consequence of MCA stroke, affecting reaching, grasping, manipulation and daily activities. Although MT and MI have each shown benefit, it is unclear which adjunct gives greater and longer-lasting improvement. A total of 36 adults aged 45-60 years will be randomly allocated 1:1 into an MT group or an MI group. Both groups will receive 3 supervised sessions per week for 6 weeks, followed by a 6-week home exercise program. Outcomes (Fugl-Meyer Assessment-Upper Extremity, Action Research Arm Test, Box and Block Test, Modified Barthel Index) will be assessed at baseline, post-intervention (Week 6) and follow-up (Week 12). The study aims to determine which intervention gives superior improvement in upper limb recovery.
Stroke is a leading cause of death and disability worldwide, and MCA stroke is the most common subtype, damaging cortical and subcortical motor regions. Upper limb impairment after MCA stroke limits activities of daily living (ADLs), independence, participation and quality of life, and many survivors have persistent deficits despite conventional rehabilitation. Recovery is explained by neuroplasticity and motor learning.
Mirror therapy uses mirror reflection of the unaffected limb to create the illusion of normal movement in the affected limb, activating motor-related cortical areas and mirror neuron systems. Motor imagery is the mental rehearsal of movement without execution and activates networks shared with actual movement. The Bobath concept is widely used but shows no clear superiority over other approaches, which makes it a suitable baseline for adjunct therapies. A recent systematic review found both MT and MI improve motor outcomes, but evidence does not favor one over the other, trials were of low to moderate quality, and most studies mixed stroke types. No study has directly compared them as adjuncts to Bobath-based therapy in MCA stroke specifically.
This is a single-blinded, two-arm, parallel-group randomized clinical trial at the Department of Physical Therapy, Alfalah Medical Center, Lahore, Pakistan. Participants (first-ever MCA stroke, 1-6 months post-onset, with unilateral upper limb impairment) will be recruited by consecutive sampling. A computer-generated sequence will allocate 36 participants (18 per group) 1:1, with concealment through sequentially numbered, opaque, sealed envelopes (SNOSE). The outcome assessor will be blinded to allocation.
Both groups will receive 3 supervised sessions per week for 6 weeks (50 minutes each): 30 minutes of routine Bobath-based physical therapy plus 20 minutes of the assigned intervention. Group A will receive mirror therapy, progressing from visual feedback and simple movements to reaching, grasp and release, and task-oriented training. Group B will receive guided motor imagery, progressing from relaxation and imagery of simple movements to imagined functional reaching, object manipulation and ADLs. After the supervised phase, all participants will follow a standardized 6-week home program (5 days per week, with a logbook and weekly telephone follow-up).
Outcomes will be measured at baseline, Week 6 and Week 12: upper limb motor impairment (FMA-UE), upper limb functional performance (ARAT), gross manual dexterity (Box and Block Test) and independence in ADLs (Modified Barthel Index). Data will be analyzed in SPSS v26 using independent t-tests or Mann-Whitney U tests between groups, and paired t-tests or Wilcoxon signed-rank tests within groups. The findings will provide comparative evidence on the effectiveness and retention of MT versus MI and may help clinicians choose a cost-effective, neuroplasticity-based upper limb rehabilitation approach.
40 studies on the registry are indexed under Infarction, Middle Cerebral Artery; 6 are open to participants now.
This study's planned enrollment of 36 is below the median of 42 across 32 interventional studies indexed under Infarction, Middle Cerebral Artery.
Browse Infarction, Middle Cerebral Artery studies →Lahore University of Biological and Applied Sciences is the lead sponsor of 79 studies on the registry; 55 are open to participants now.
Compared within Infarction, Middle Cerebral Artery, this study's primary condition as ClinicalTrials.gg classifies it; the registry's first condition term is Stroke. The counts are of registry records indexed under each term, refreshed daily. How we classify →
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Exclusion Criteria:
Underlined terms in the criteria open these too. Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Short tests of memory and thinking, each scored out of 30. Lower scores suggest more difficulty; criteria give a range, either to include people with memory problems or to leave them out.
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MMSE and MoCA
Short tests of memory and thinking, each scored out of 30. Lower scores suggest more difficulty; criteria give a range, either to include people with memory problems or to leave them out.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Informed consent
Before you join, the study team explains what taking part involves — its purpose, what happens, the risks and possible benefits — and answers your questions, so you can decide freely. Consent is usually recorded on a form (the informed consent form, ICF) signed by you or, where the law allows, by someone legally authorised to decide for you.
You can keep asking questions during the study, you are told of new information that matters, and you can choose to leave at any time.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Group A will receive mirror therapy plus routine Bobath-based physical therapy for 6 weeks (3 sessions per week, 50 minutes each), followed by a 6-week home exercise program.
Behavioral: Mirror Therapy · Behavioral: Routine Physical Therapy
Group B will receive motor imagery plus routine Bobath-based physical therapy for 6 weeks (3 sessions per week, 50 minutes each), followed by a 6-week home exercise program.
Behavioral: Motor Imagery · Behavioral: Routine Physical Therapy
Participants sit with a mirror placed in the midsagittal plane, the affected limb hidden behind it and the unaffected limb reflected to create the illusion of normal movement. Therapist-guided training for 20 minutes per session (10 repetitions per task × 2 sets) progresses from simple shoulder, elbow, forearm and hand movements (Weeks 1-2), to reaching, grasp and release, and object manipulation (Weeks 3-4), to functional reaching, fine hand tasks, and speed and accuracy training (Weeks 5-6). It is combined with 30 minutes of routine Bobath-based physical therapy.
Participants sit with eyes closed and mentally rehearse movements of the affected upper limb without physically performing them, using visual and kinesthetic imagery with standardized verbal cues. Sessions last 20 minutes (10 imagery trials per task × 2 sets) and progress from relaxation and imagery of simple movements (Weeks 1-2), to imagined reaching, grasp and release, and object manipulation (Weeks 3-4), to functional reaching, fine hand activities, ADL rehearsal and error correction (Weeks 5-6). It is combined with 30 minutes of routine Bobath-based physical therapy.
Routine physical therapy based on the Bobath concept, given to all participants for 30 minutes per session, 3 times per week for 6 weeks. It focuses on normalizing tone, facilitating normal movement patterns, weight shifting, postural control and functional upper limb activities while inhibiting abnormal movement patterns. Weeks 1-2: scapular mobilization, weight-bearing, trunk control, assisted ROM, sensory stimulation. Weeks 3-4: active-assisted reaching, elbow extension, wrist and hand opening, grasp and release. Weeks 5-6: task-oriented reaching, functional grasp, object manipulation, ADL-based practice. After 6 weeks, all participants follow a 6-week home exercise program. Routine physical therapy based on the Bobath concept, given to all participants for 30 minutes per session, 3 times per week for 6 weeks. It focuses on normalizing tone, facilitating normal movement patterns, weight shifting, postural control and functional upper limb activities while inhibiting abnormal movemen
Upper limb motor impairment (Fugl-Meyer Assessment - Upper Extremity
The Fugl-Meyer Assessment - Upper Extremity (FMA-UE) is a stroke-specific measure of upper limb motor impairment covering reflex activity, voluntary movement, coordination and wrist/hand function. It has 33 items, each scored 0 (cannot perform), 1 (performs partially) or 2 (performs fully). Total score ranges from 0 to 66, with higher scores indicating better upper limb motor function.
Time frame: Baseline (Week 0), post-intervention (Week 6), and follow-up (Week 12)
Upper limb functional performance (Action Research Arm Test)
The Action Research Arm Test (ARAT) assesses upper limb functional ability in four domains: grasp, grip, pinch and gross movement. It has 19 items, each scored 0 to 3 (0 = cannot perform any part of the task, 3 = performs the task normally). Total score ranges from 0 to 57, with higher scores indicating better arm function.
Time frame: Baseline (Week 0), post-intervention (Week 6), and follow-up (Week 12)
Gross manual dexterity (Box and Block Test)
The Box and Block Test measures unilateral gross manual dexterity. The participant transfers as many wooden blocks as possible from one compartment of a box to the other within 60 seconds, using one hand at a time. The score is the number of blocks transferred, with higher scores indicating better manual dexterity.
Time frame: Baseline (Week 0), post-intervention (Week 6), and follow-up (Week 12)
Functional independence in activities of daily living (Modified Barthel Index)
The Modified Barthel Index assesses independence in activities of daily living, including feeding, bathing, grooming, dressing, toileting, transfers, mobility and stair climbing. Total score ranges from 0 to 100, with higher scores indicating greater independence (0-20 total dependence, 21-60 severe, 61-90 moderate, 91-99 slight, 100 independence).
Time frame: Baseline (Week 0), post-intervention (Week 6), and follow-up (Week 12)
Plan to share: No
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Started Aug 2026 (actual). Primary completion is estimated for Dec 2026, 4 months after the start.
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Lahore University of Biological and Applied Sciences