Motor Imaging, Neglect, and Upper Extremity Function in Stroke

Investigation of the Relationship Between Motor Imagery Skill and Neglect Level, Upper Extremity Motor Function, Activities of Daily Living, and Quality of Life in Individuals After Stroke

This study aims to investigate the relationship between motor imagery skills and neglect level, upper extremity motor function, activities of daily living, quality of life, lateralization performance, and mental timer performance in individuals with stroke. Individuals with stroke who meet the inclusion criteria and voluntarily agree to participate will be evaluated. Demographic and clinical information of the participants will be recorded on an assessment form prepared by the researcher. Upper extremity motor functions will be assessed using the Fugl-Meyer Upper Extremity Motor Assessment Scale and the Wolf Motor Function Test; activities of daily living will be assessed using the Modified Barthel Index; and quality of life will be assessed using the Stroke-Specific Quality of Life Scale. Motor imagery skills will be measured using the Kinesthetic and Visual Imagery Questionnaire and a mental timer task; upper extremity lateralization performance will be assessed using the Recognise™ application. Neglect level will be assessed using the Catherine Bergego Scale, the Line Splitting Test, and the Star Erase Test. The data obtained will be statistically analyzed to examine the relationships between motor imagery skills and other clinical variables.

Stroke is a condition characterized by impaired cerebrovascular circulation due to bleeding or blockage, resulting in problems such as weakness on one side of the body, mobility, balance, coordination, and cognitive impairment. Motor impairment, usually restricting movement of the face, arm, and leg on one side of the body, affects approximately 80% of stroke individuals. Upper extremity function is significantly reduced in about 80% of stroke individuals due to spasticity and muscle weakness, which restricts elbow extension movement. Problems with shoulder, arm, hand, and wrist function-in short, upper extremity disorders-are very common after a stroke. These upper extremity disorders generally involve difficulty with arm, hand, and finger movement and coordination, significantly limiting individuals' interaction with their environment and functionality. In addition to motor losses, spatial neglect due to right hemisphere lesions is one of the frequently observed neuropsychological problems after a stroke. Neglect syndrome is characterized by an individual's inability to perceive, direct attention to, or maintain bodily awareness in the spatial area opposite to the damaged hemisphere of the brain. This negatively impacts motor performance and daily living activities, reducing the effectiveness of rehabilitation. In individuals with severe neglect, the use of the affected side decreases, slowing functional recovery. In recent years, motor cognition-based methods have gained increasing importance in post-stroke rehabilitation alongside classical approaches. One of these methods, motor imagery (MI), is the process of mentally visualizing a movement without actually performing it. Neuroimaging studies have shown that the brain regions activated during motor imagery are largely similar to the motor areas activated during actual movement. Therefore, it is suggested that there may be a relationship between motor functions and motor imagery ability in stroke patients. However, the reported results in this area are inconsistent in stroke patients. Although motor impairments do not directly reflect performance in imagery, motor consequences resulting from brain damage negatively affect imagery, and generally, more severe motor impairments have been associated with weaker imagery ability. Research has shown that individuals with high motor imagery skills experience positive effects in terms of motor performance and learning. Conversely, a decrease in imagery capacity or factors affecting the cognitive representation of movement (e.g., neglect or lateralization disorders) can limit the effectiveness of the rehabilitation process. Therefore, it is important to comprehensively investigate the relationships between motor imagery skills and neglect, upper extremity function, activities of daily living, and quality of life in individuals after a stroke. Based on this information, this study aimed to investigate the relationship between motor imagery skills and the level of neglect (neglet), upper extremity motor function, activities of daily living, quality of life, lateralization performance, and mental rotation ability in individuals after a stroke.

Hypotheses:

1. Hypothesis: Motor imagery skills in individuals after a stroke are related to the level of neglect (neglet).
2. Hypothesis: Motor imagery skills in individuals after a stroke are related to the level of upper extremity motor function.
3. Hypothesis: Motor imagery skills in individuals after a stroke are related to activity of daily living performance.

Hypothesis 4: Motor imagery skills in individuals after stroke are related to their quality of life level.

Hypothesis 5: Motor imagery skills in individuals after stroke are related to lateralization performance.

Hypothesis 6: Motor imagery skills in individuals after stroke are related to mental rotation ability.

Inclusion Criteria:

• Individuals who have experienced hemiplegia after an ischemic stroke,
• who actively use their right extremity according to the Edinburgh Hand Preference Questionnaire,
• who have right hemisphere involvement,
• who are 18 years of age or older,
• who have been diagnosed with a stroke at least 1 and at most 6 months ago,
• who have middle cerebral artery involvement,
• who have a Standardized Mini Mental Test score of 24 or higher,
• who are Stage 2b or higher according to Eggers staging,
• who can actively control their hand, wrist, and fingers and perform the release reflex,
• who wish to participate in the study voluntarily, and
• who have given their informed consent will be included in the research.

Exclusion Criteria:

• Individuals with major neurological, orthopedic, or rheumatological disorders affecting upper extremity function other than stroke (Polyneuropathy, Parkinson's Disease, Multiple Sclerosis, Rheumatoid Arthritis, etc.),
• Individuals with upper extremity amputation,
• Individuals with uncontrolled arrhythmia, uncontrolled hypertension, or unstable cardiac conditions,
• Individuals with active malignancy and receiving related chemo/radiotherapy,
• Individuals unable to cooperate due to aphasia or cognitive impairment,
• Individuals with visual and hearing problems,
• Individuals with communication problems that would hinder the evaluation and/or implementation of the treatment program,
• Individuals who are unable to undergo mental assessment, complete the scales, or are illiterate will be excluded from the study.