Investigation of the Effect of Combined Motor Imagery and Activity Observation Therapy on Strengthening the Non-Dominant Hand in Healthy Individuals

NCT07235449 | Not Yet Recruiting

• 1 other identifier: 61351342/020-1391
• Study Type: interventional
• Target: 60
• Locations: 1 country
• Sites: 1

Brief Summary

Introduction: Motor Imagery (MI) and Action Observation (AO) are well-established cognitive training techniques that activate neural networks similar to those involved in actual motor execution. MI involves the mental rehearsal of a movement without physically performing it, while AO relies on observing an action performed by others to stimulate motor-related brain areas. Recent studies suggest that when these methods are combined, they may enhance motor learning, cortical plasticity, and strength gains more effectively than when applied alone. The non-dominant hand, often less trained and weaker in performance compared to the dominant hand, provides an ideal model to examine the effects of these interventions. Strengthening the non-dominant upper limb has implications not only for improving functional balance between the limbs in healthy individuals but also for potential clinical applications in rehabilitation. Aim: The primary aim of this randomized controlled study is to investigate the combined effect of MI and AO on muscular strength and functional performance of the non-dominant hand in healthy university students. Specifically, the study seeks to compare the outcomes of three groups: (1) AO combined with MI, (2) MI only, and (3) a control group with no intervention. It is hypothesized that participants in the AO+MI group will demonstrate greater improvements in grip strength and functional outcomes compared to the other groups. Evaluation: To comprehensively measure the effects of the intervention, several standardized assessment tools will be employed. Motor imagery ability will be evaluated using the Motor Imagery Questionnaire-3 (MIQ-3). Hand dominance will be determined by the Edinburgh Handedness Inventory. Grip strength will be objectively measured using a Hand Grip Dynamometer. The Recognise App will be used to assess laterality recognition and sensorimotor integration, while overall upper limb function will be measured through the Short Musculoskeletal Function Assessment (SMMT). These evaluations will be conducted both before and after the 4-week intervention period to track changes. Treatment: The intervention will span four weeks, with participants attending 2-3 sessions per week. Training protocols will include both cognitive and physical components. In the MI group, participants will engage in guided motor imagery sessions focused on visualizing non-dominant hand exercises. The AO+MI group will observe video demonstrations of the same hand movements, followed by simultaneous motor imagery practice, thereby combining visual and cognitive engagement. Physical strengthening exercises will include dumbbell wrist flexion and handball squeeze, targeting key muscles of the non-dominant hand and forearm. The control group will not undergo any intervention during this period. By integrating AO and MI with specific strengthening exercises, the study aims to determine whether this combined approach enhances neural activation and muscular strength more effectively than MI alone.

Conditions

Hand

Keywords

Motor imagery; Action observation; Non-dominant hand; Strengthening exercises

Outcome Measures

Primary Outcomes (2)

• Handedness was measured using the Edinburgh Handedness Inventory

  Handedness was measured using the Edinburgh Handedness Inventory, a standardized tool that assesses hand preference in 10 everyday activities (e.g., writing, brushing teeth, using scissors). The Laterality Quotient (LQ) is calculated to determine whether a participant is right-handed, left-handed, or ambidextrous. This measure will be used to identify each participant's dominant and non-dominant hand for the study.

  3 minutes

• Standardized Mini-Mental State Test

  The Standardized Mini-Mental State Test (SMMT) is a 30-point cognitive screening tool assessing orientation, memory, attention, language, and visuospatial skills. Scores below 24 indicate cognitive impairment, while scores of 24-30 are considered normal. In this study, the SMMT was used to evaluate cognitive status, and only participants scoring 24 or higher were included.

  5 minutes

Secondary Outcomes (3)

• Movement Imagery Questionnaire (MIQ-3)

  10 minutes

• Grip Strength Using a hand grip Dynamometer

  8 minutes

• Recognize lateralization app

  10 minutes

Study Arms (3)

Experimental: Motor Imager

EXPERIMENTAL

Conservative Treatment + Motor imagery Program

Other: Conservative treatment + Motor imagery program

Experimental: Motor imager + Action Observation

EXPERIMENTAL

Conservative Treatment + Motor imagery and Action observation Program

Other: Conservative treatment + Motor imagery and action observation program

Experimental: Conservative

ACTIVE COMPARATOR

Conservative Treatment Program

Other: Conservative treatment via strengthening exercises

Interventions

Conservative treatment + Motor imagery program OTHER

Participants will perform guided motor imagery of non-dominant hand strengthening exercises (dumbbell wrist flexion and handball squeeze) without video observation, 5 sessions per week for 4 weeks.

Experimental: Motor Imager

Conservative treatment + Motor imagery and action observation program OTHER

Participants will observe videos of non-dominant hand strengthening exercises (dumbbell wrist flexion and handball squeeze) and simultaneously perform guided motor imagery of the same movements, 5 sessions per week for 4 weeks.

Experimental: Motor imager + Action Observation

Conservative treatment via strengthening exercises OTHER

Participants will perform only the physical strengthening exercises (dumbbell wrist flexion and handball squeeze) for the non-dominant hand, 5 sessions per week for 4 weeks, without any motor imagery or action observation.

Experimental: Conservative

Eligibility Criteria

• Age: 18 Years - 65 Years
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Age between 18 and 65 years old
• They agreed to participate
• Having no pathology in hearing and vision
• Having no history of upper limb injury or musculoskeletal
• Having no neurologic disorders
• All subjects had no prior experience with motor imagery
• Having a Standardized Mini-Mental State Test (SMMT) score of more than 24 points

You may not qualify if:

• A score of the Movement Imagery Questionnaire (MIQ-3) was less than ≥5
• Severe cognitive deficits
• Neurological problems
• Left-handedness that was measured using the Edinburgh Handedness Inventory

Sponsors & Collaborators

• Bahçeşehir University: lead

Study Sites (1)

Ammar Mahmoud Ahmed

Istanbul, Turkey (Türkiye)

Location

Related Publications (3)

• Tsukazaki I, Uehara K, Morishita T, Ninomiya M, Funase K. Effect of observation combined with motor imagery of a skilled hand-motor task on motor cortical excitability: difference between novice and expert. Neurosci Lett. 2012 Jun 19;518(2):96-100. doi: 10.1016/j.neulet.2012.04.061. Epub 2012 May 2.

  PMID: 22580208 RESULT

• Aoyama T, Kaneko F, Kohno Y. Motor imagery combined with action observation training optimized for individual motor skills further improves motor skills close to a plateau. Hum Mov Sci. 2020 Oct;73:102683. doi: 10.1016/j.humov.2020.102683. Epub 2020 Sep 16.

  PMID: 32949991 RESULT

• Marshall B, Wright DJ, Holmes PS, Wood G. Combining Action Observation and Motor Imagery Improves Eye-Hand Coordination during Novel Visuomotor Task Performance. J Mot Behav. 2020;52(3):333-341. doi: 10.1080/00222895.2019.1626337. Epub 2019 Jun 11.

  PMID: 31185831 RESULT

MeSH Terms

Interventions

Conservative Treatment

Intervention Hierarchy (Ancestors)

Therapeutics

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: PARTICIPANT
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Principal Investigator

Study Record Dates

• First Submitted: October 2, 2025
• First Posted: November 19, 2025
• Study Start: November 20, 2025
• Primary Completion: January 16, 2026
• Study Completion: January 16, 2026
• Last Updated: November 19, 2025

Record last verified: 2025-10

Locations

TU (1)