Effectiveness of motor imaginary techniques on improving upper limb function in middle cerebral artery

Background: Middle Cerebral Artery (MCA) strokes are among the most disabling types of cerebrovascular injuries, frequently resulting in profound motor deficits of the upper limb. These impairments disrupt essential daily tasks such as reaching, grasping, lifting, and manipulating objects. Traditional rehabilitation often focuses on physical task practice; however, many MCA-stroke patients struggle to execute meaningful movements due to weakness, poor motor planning, and sensory-loss. Motor Imagery (MI) the cognitive simulation of movement without actual execution—activates motor networks using internal rehearsal. Recent neuroscience research demonstrates that MI engages primary motor cortex, premotor cortex, supplementary motor areas, cerebellum, and parietal regions even in the absence of muscular activity. This makes MI a promising therapeutic strategy for individuals unable to generate effective voluntary movement early after stroke. Objective: To compare the effectiveness of Motor Imagery Therapy (MI) with a conventional Task-Oriented Training (TOT) program on upper-limb motor recovery in patients with MCA stroke. Methods: Thirty-six MCA stroke patients were randomly assigned into two groups: MI (N=18) and TOT (N=18). Both groups underwent a structured 12-week rehabilitation program, receiving daily sessions under therapist supervision. Upper-limb recovery was evaluated using the Fugl-Meyer Assessment-Upper Extremity (FMA-UE), Grip Strength testing, and the Modified Rankin Scale (mRS) for functional disability. Results: The MI group demonstrated significantly larger improvements in FMA-UE scores, grip strength, and functional independence (mRS) compared to the TOT group. Statistical analysis confirmed a clear advantage of MI across all outcome domains. Conclusions: Motor Imagery Therapy is an effective, low-cost, accessible, and neurophysiologically powerful intervention for improving upper-limb recovery after MCA stroke. It is particularly valuable for patients with limited physical movement ability, as it stimulates motor circuits even when overt movement is not possible.