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

Official title

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

Overview

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.

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.

Interventions

• 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).
• 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.

Primary outcome measures

• Change in Movement Smoothness (Number of Velocity Peaks) [Time frame: Immediately before the intervention (baseline) and immediately after the single 25-minute intervention session.]

Secondary outcome measures (5)

• Shoulder Girdle Elevation (Compensatory Strategy) [Time frame: Immediately before and immediately after the 25-minute intervention session.]
• Trunk Displacement (Compensatory Strategy) [Time frame: Immediately before and immediately after the 25-minute intervention session.]
• Gross Manual Dexterity - Box and Block Test (BBT) [Time frame: Immediately before and immediately after the 25-minute intervention session.]
• Pain - Visual Analog Scale (VAS) [Time frame: Immediately before and immediately after the 25-minute intervention session.]
• Movement Imagery Ability - Movement Imagery Questionnaire-3 (MIQ-3) [Time frame: Immediately before and immediately after the 25-minute intervention session.]

Eligibility criteria

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.

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

Randomized

Model

Parallel assignment

Masking

Single blind

Primary purpose

Treatment

Study locations

Center list to be confirmed — check the primary protocol.

Identifiers

NCT: NCT07507552 · 2026/56

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗