StrokeNCT07902284
Effects of Mirror Therapy and Motor Imagery on Upper Limb Motor Functions in Middle Cerebral Artery Stroke
A study testing Mirror Therapy, Motor Imagery and Routine Physical Therapy in people with Stroke, run by Lahore University of Biological and Applied Sciences at 1 site in Pakistan.
Trial summary
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. Read more about this study
- Who is it for?
- Ages 45 to 65 years
- Conditions the study is for
- Stroke
- What is being tested?
- Mirror Therapy, Motor Imagery and Routine Physical Therapy
- Type of treatment
- Lifestyle or therapy programme
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 36 participants
- Where
- 1 sitePakistan
- Study dates
- 15 Aug 2026to 30 Jan 2027
- Phase
- Interventional
- Are there results?
- Not yet: the study is under way
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 45 to 65 years
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Patients of both genders aged 45-60 years
- First-ever middle cerebral artery (MCA) stroke (ischemic or hemorrhagic) confirmed by CT/MRI
- Stroke duration of 1-6 months
- Presence of unilateral upper limb motor impairment
- Brunnstrom stage II and above
- Fugl-Meyer Assessment Upper Extremity (FMA-UE) score < 47
Show all 9Show fewer
- Montreal Cognitive Assessment (MoCA) > 24
- Medically stable
- Willing and able to provide written informed consent
Who cannot join
- Pre-existing upper limb dysfunction
- Visual impairment or unilateral neglect
- Severe cognitive impairment or depression
- Other neurological disorders
- Severe musculoskeletal disorders of the upper limb
- Severe spasticity (Modified Ashworth Scale > 3)
Show all 9Show fewer
- Serious uncontrolled medical conditions
- Participation in another clinical trial
- Refusal or inability to provide
Trial locations and contacts
1 site in 1 country. Contact the study team or a site near you to ask about taking part.
Pakistan1 site, 1 recruiting
- Recruiting
Alfalah Medical Center
Lahore, Punjab Province
Dr .Sharafat Ali, DPT, 03064019521, physiosharafat@gmail.com
About this study
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.
Read the detailed description
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.
- Conditions
- Stroke
- Being tested
- Mirror Therapy, Motor Imagery, Routine Physical Therapy
- Keywords
- Mirror Therapy, Motor Imagery, Middle Cerebral Artery Stroke, Upper Limb Motor Function, Bobath Concept,, Neuroplasticity,
- Medical subject headings
- Stroke, Infarction, Middle Cerebral Artery
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Mirror TherapyBehavioural
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.
Motor ImageryBehavioural
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 TherapyBehavioural
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
| Study group | Role | What they receive |
|---|---|---|
| Mirror Therapy Group | Experimental | 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. Receives: Behavioral: Mirror Therapy; Behavioral: Routine Physical Therapy |
| Motor Imagery Group | Active comparator | 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. Receives: Behavioral: Motor Imagery; Behavioral: Routine Physical Therapy |
What is being measured
The primary outcome is the main question the study is designed to answer.
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.
Measured: 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.
Measured: 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.
Measured: 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).
Measured: Baseline (Week 0), post-intervention (Week 6), and follow-up (Week 12)
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted28 Oct 2026
- Study start15 Aug 2026
- Primary completion30 Dec 2026 (estimated)
- Study completion30 Jan 2027 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for StrokeStudies of the same condition, open and under way.
- More trials run by Lahore University of Biological and Applied SciencesThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind
- Who is masked
- Outcomes assessor
- Enrolment
- 36 participants (estimated)
Sponsor and investigators
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Prof. Dr. Shoaib Waqas, Lahore University of Biological and Applied Sciences
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07902284
- Sponsor's protocol ID
- UBAS/ERB/26/07/078
- Status last verified
- Oct 2026
- First submitted
- 21 Oct 2026
- Last updated
- 28 Oct 2026
- Results posted
- No
- Data monitoring committee
- Yes
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Study at a glance
From the registry record, last updated by the sponsor on 28 Oct 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Effects of Mirror Therapy and Motor Imagery on Upper Limb Motor Functions in Middle Cerebral Artery Stroke
- ClinicalTrials.gov ID
- NCT07902284
- Acronym / sponsor ID
- UBAS/ERB/26/07/078
- Conditions
- Stroke
- Keywords
- Mirror Therapy, Motor Imagery, Middle Cerebral Artery Stroke, Upper Limb Motor Function, Bobath Concept,, Neuroplasticity,
- Study type
- Interventional
- Recruitment status
- Recruiting
- Enrolment
- 36 participants (estimated)
- Lead sponsor
- Lahore University of Biological and Applied SciencesUniversity, hospital or other
- Study start
- 15 Aug 2026 (actual)
- Primary completion
- 30 Dec 2026 (estimated)
- Study completion
- 30 Jan 2027 (estimated)
- First posted
- 28 Oct 2026 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
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.
Detailed description
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.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind (outcomes assessor)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Mirror Therapy Group | Experimental | Behavioral: Mirror Therapy, Behavioral: Routine Physical TherapyGroup 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. |
| Motor Imagery Group | Active comparator | Behavioral: Motor Imagery, Behavioral: Routine Physical TherapyGroup 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. |
Who may qualify
- Ages
- 45 to 65 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (9 listed)
- Patients of both genders aged 45-60 years
- First-ever middle cerebral artery (MCA) stroke (ischemic or hemorrhagic) confirmed by CT/MRI
- Stroke duration of 1-6 months
- Presence of unilateral upper limb motor impairment
- Brunnstrom stage II and above
Key exclusion criteria (9 listed)
- Pre-existing upper limb dysfunction
- Visual impairment or unilateral neglect
- Severe cognitive impairment or depression
- Other neurological disorders
- Severe musculoskeletal disorders of the upper limb
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Mirror TherapyParticipants 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. | Behavioural | Mirror Therapy Group |
| Motor ImageryParticipants 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. | Behavioural | Motor Imagery Group |
| Routine Physical TherapyRoutine 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 | Behavioural | Mirror Therapy Group, Motor Imagery Group |
Primary outcome
Upper limb motor impairment (Fugl-Meyer Assessment - Upper Extremity
Time frame: Baseline (Week 0), post-intervention (Week 6), and follow-up (Week 12)
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.
Upper limb functional performance (Action Research Arm Test)
Time frame: Baseline (Week 0), post-intervention (Week 6), and follow-up (Week 12)
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.
Gross manual dexterity (Box and Block Test)
Time frame: Baseline (Week 0), post-intervention (Week 6), and follow-up (Week 12)
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.
Functional independence in activities of daily living (Modified Barthel Index)
Time frame: Baseline (Week 0), post-intervention (Week 6), and follow-up (Week 12)
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).
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 28 Oct 2026.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part.
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Mirror Therapy, Motor Imagery and Routine Physical Therapy in people with Stroke, run by Lahore University of Biological and Applied Sciences at 1 site in Pakistan.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 9 inclusion and 9 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: looking for participants now, as of the sponsor's last update on 28 Oct 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Pakistan. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
Contact Prof.Dr. Shoaib Waqas, PHD (+92 302 4552109, shoaib.waqas@ubas.edu.pk), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Upper limb motor impairment (Fugl-Meyer Assessment - Upper Extremity (time frame: Baseline (Week 0), post-intervention (Week 6), and follow-up (Week 12)). The study lists 4 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 28 Oct 2026.