Comparing the Effects of Motor Imagery Training and Conventional Physiotherapy on Neuroplasticity and Motor Recovery in Stroke Patients

Abstract

Background: Stroke frequently results in persistent motor impairment due to damage in neural circuits controlling movement, with conventional physiotherapy often yielding incomplete recovery. Emerging evidence suggests motor imagery training (MIT) may enhance neuroplasticity and functional outcomes by activating motor networks through mental simulation. Objective: To compare the effects of motor imagery training versus conventional physiotherapy on neuroplasticity and motor recovery in patients with chronic stroke. Methods: In this randomized controlled trial, forty stroke patients were assigned to either MIT or conventional physiotherapy, receiving matched 8-week intervention protocols. Neuroplasticity was assessed using functional magnetic resonance imaging (fMRI) to quantify changes in motor cortex activation, while motor function was evaluated with the Fugl-Meyer Assessment (FMA). Statistical analysis included paired and independent t-tests, with effect sizes and 95% confidence intervals calculated for group comparisons. Results: The MIT group demonstrated a significant increase in motor-related brain activation (mean change: 0.17, SD 0.09; p < 0.001) and a larger gain in FMA scores (mean change: 15.1, SD 4.2; p < 0.001) compared to the conventional physiotherapy group (fMRI mean change: 0.05, SD 0.07; p = 0.016; FMA mean change: 7.9, SD 3.8; p < 0.001). Between-group differences were statistically significant for both neuroplasticity and motor recovery (p = 0.002 and p = 0.02, respectively), with large effect sizes favoring MIT. Conclusion: Motor imagery training confers superior neuroplastic and functional benefits over conventional physiotherapy in stroke rehabilitation, supporting its integration into standard post-stroke care.