Effectiveness of Motor Imagery Training on Improving Upper Extremity Functional Ability Post Stroke: A Systematic Review
Abstract
Increasingly acknowledged for its ability to improve motor function and neuroplasticity in stroke therapy is motor imagery (MI) training. Variability in techniques and results, however, calls for a methodical assessment to combine the data. Objective: The goal of this study was to assess whether MI training will help stroke patients achieve better motor performance and other rehabilitation results. Method: After a thorough search across five databases using PubMed, Scopus, Google Scholar, Web of Science, and Cochrane Library in line with PRISMA criteria, we took ten works published between 2023 and 2025 under consideration. Resulting in 578 entries and Ultimately 10 studies were included in the review. methodological quality was assessed using JBI critical assessment techniques. Result:Ten research were examined and MI-based therapies clearly improved upper limb function, neuroplasticity, and attentional control. MI with BCI showed improved cortical activation, brain connection, and muscular strength. In severe cases especially, MI combined with TMS enhanced motor recovery. Furthermore, MI training enhanced with virtual reality or voice direction improved psychological well-being and daily life activities. Conclusion: MI-based treatments—especially in conjunction with cutting-edge technologies—effectively enhance motor and cognitive performance in stroke victims. To maximise clinical use, future studies should standardise procedures, investigate reasonably priced delivery strategies, and evaluate long-term advantages.
References
Agostini, F., Pezzi, L., Paoloni, M., Insabella, R., Attanasi, C., Bernetti, A., Saggini, R., Mangone, M., & Paolucci, T. (2021). Motor Imagery: A Resource in the Fatigue Rehabilitation for Return-to-Work in Multiple Sclerosis Patients—A Mini Systematic Review. In Frontiers in Neurology (Vol. 12). Frontiers Media. https://doi.org/10.3389/fneur.2021.696276
Almulla, L., Al‐Naib, I., Ateeq, I. S., & Althobaiti, M. (2022). Observation and motor imagery balance tasks evaluation: An fNIRS feasibility study. PLoS ONE, 17(3). https://doi.org/10.1371/journal.pone.0265898
Angerhöfer, C., Colucci, A., Vermehren, M., Hömberg, V., & Soekadar, S. R. (2021). Post-stroke Rehabilitation of Severe Upper Limb Paresis in Germany – Toward Long-Term Treatment With Brain-Computer Interfaces. In Frontiers in Neurology (Vol. 12). Frontiers Media. https://doi.org/10.3389/fneur.2021.772199
Bovonsunthonchai, S., Aung, N., Hiengkaew, V., & Tretriluxana, J. (2020). A randomized controlled trial of motor imagery combined with structured progressive circuit class therapy on gait in stroke survivors. Scientific Reports, 10(1). https://doi.org/10.1038/s41598-020-63914-8
Ceradini, M., Losanno, E., Micera, S., Bandini, A., & Orlandi, S. (2024). Immersive VR for upper-extremity rehabilitation in patients with neurological disorders: a scoping review. In Journal of NeuroEngineering and Rehabilitation (Vol. 21, Issue 1). BioMed Central. https://doi.org/10.1186/s12984-024-01367-0
Choi, J., & Park, J. (2024). Effect of low-frequency repetitive transcranial magnetic stimulation combined with motor imagery training on upper Limb Motor Recovery and Primary Motor Cortex Activation in Stroke Patients. 1–13.
Choi, J., Yang, S.-W., & Ma, S.-R. (2022). The Effect of Action Observation Combined with Motor Imagery Training on Upper Extremity Function and Corticospinal Excitability in Stroke Patients: A Randomized Controlled Trial. International Journal of Environmental Research and Public Health, 19(19), 12048. https://doi.org/10.3390/ijerph191912048
Danilo, D., Farì, G., Giorgi, F., Marvulli, R., Quarta, F., Bernetti, A., & Tedeschi, R. (2024). Efficacy of Motor Imagery in the Rehabilitation of Stroke Patients: A Scope Review. OBM Neurobiology, 8(3). https://doi.org/10.21926/obm.neurobiol.2403236
Eaves, D., Hodges, N. J., Buckingham, G., Buccino, G., & Vogt, S. (2022). Enhancing motor imagery practice using synchronous action observation. In Psychological Research (Vol. 88, Issue 6, pp. 1891–1907). Springer Science+Business Media. https://doi.org/10.1007/s00426-022-01768-7
Emerson, J., Scott, M. W., Schaik, P. van, Butcher, N., Kenny, R., & Eaves, D. (2022). A neural signature for combined action observation and motor imagery? An fNIRS study into prefrontal activation, automatic imitation, and self–other perceptions. Brain and Behavior, 12(2). https://doi.org/10.1002/brb3.2407
Feng, N., Hu, F., Wang, H., & Gouda, M. A. (2020). Decoding of voluntary and involuntary upper-limb motor imagery based on graph fourier transform and cross-frequency coupling coefficients. Journal of Neural Engineering, 17(5), 23587. https://doi.org/10.1088/1741-2552/abc024
Guo, Z., Yu, J., Bai, X., Jiang, B., He, L., McClure, M. A., & Mu, Q. (2021). Distinction of High- and Low-Frequency Repetitive Transcranial Magnetic Stimulation on the Functional Reorganization of the Motor Network in Stroke Patients. Neural Plasticity, 2021, 1–11. https://doi.org/10.1155/2021/8873221
Hu, Y.-Q., Gao, T., Li, J., Tao, J.-C., Bai, Y., & Lu, R. (2021). Motor Imagery-Based Brain-Computer Interface Combined with Multimodal Feedback to Promote Upper Limb Motor Function after Stroke: A Preliminary Study. Evidence-Based Complementary and Alternative Medicine, 2021, 1–10. https://doi.org/10.1155/2021/1116126
Kang, J. H., Kim, M.-W., Park, K. H., & Choi, Y. (2021). The effects of additional electrical stimulation combined with repetitive transcranial magnetic stimulation and motor imagery on upper extremity motor recovery in the subacute period after stroke. Medicine, 100(35). https://doi.org/10.1097/md.0000000000027170
Kashif, M., Ahmad, A., Bandpei, M. A. M., Gilani, S. A., Hanif, A., & Iram, H. (2022). Combined effects of virtual reality techniques and motor imagery on balance, motor function and activities of daily living in patients with Parkinson’s disease: a randomized controlled trial. BMC Geriatrics, 22(1). https://doi.org/10.1186/s12877-022-03035-1
Kim, M. S., Park, H., Kwon, I., An, K. O., Kim, H., Park, G., Hyung, W., Im, C. H., & Shin, J. H. (2025). Efficacy of brain-computer interface training with motor imagery-contingent feedback in improving upper limb function and neuroplasticity among persons with chronic stroke: a double-blinded, parallel-group, randomized controlled trial. Journal of NeuroEngineering and Rehabilitation, 22(1), 1–13. https://doi.org/10.1186/s12984-024-01535-2
Kusano, K., Hayashi, M., Iwama, S., & Ushiba, J. (2024). Improved motor imagery skills after repetitive passive somatosensory stimulation: a parallel-group, pre-registered study. Frontiers in Neural Circuits, 18(January). https://doi.org/10.3389/fncir.2024.1510324
Lakshminarayanan, K., Shah, R., Daulat, S. R., Moodley, V., Yao, Y., & Madathil, D. (2023). The effect of combining action observation in virtual reality with kinesthetic motor imagery on cortical activity. Frontiers in Neuroscience, 17. https://doi.org/10.3389/fnins.2023.1201865
Lambert, K. J. M., Hoar, C., Houle, J., Motley, C., Ball, N., & Leung, A. W. S. (2023). Motor imagery as an intervention to improve activities of daily living post-stroke: A systematic review of randomized controlled trials. British Journal of Occupational Therapy, 86(5), 335–348. https://doi.org/10.1177/03080226221145441
Liao, W., Li, J., Zhang, X., & Li, C. (2023). Motor imagery brain–computer interface rehabilitation system enhances upper limb performance and improves brain activity in stroke patients: A clinical study. Frontiers in Human Neuroscience, 17(March), 1–9. https://doi.org/10.3389/fnhum.2023.1117670
Liu, X., Zhang, W., Li, W., Zhang, S., Lv, P., & Yin, Y. (2023). Effects of motor imagery based brain-computer interface on upper limb function and attention in stroke patients with hemiplegia: a randomized controlled trial. BMC Neurology, 23(1), 1–14. https://doi.org/10.1186/s12883-023-03150-5
Ma, Z., Wu, J., Cao, Z., Hua, X., Zheng, M., Xing, X., Ma, J., & Xu, J. (2024). Motor imagery-based brain–computer interface rehabilitation programs enhance upper extremity performance and cortical activation in stroke patients. Journal of NeuroEngineering and Rehabilitation, 21(1). https://doi.org/10.1186/s12984-024-01387-w
Ma, Z. Z., Wu, J. J., Cao, Z., Hua, X. Y., Zheng, M. X., Xing, X. X., Ma, J., & Xu, J. G. (2024). Motor imagery-based brain–computer interface rehabilitation programs enhance upper extremity performance and cortical activation in stroke patients. Journal of NeuroEngineering and Rehabilitation, 21(1), 1–14. https://doi.org/10.1186/s12984-024-01387-w
Narayanan, S. (2022). Ophthalmic simulation: The need of the times. Kerala Journal of Ophthalmology, 34(2), 89. https://doi.org/10.4103/kjo.kjo_62_22
Olczak, A., Carvalho, R., & St, A. (2025). The Influence of Therapy Enriched with the Erigo ® Pro Table and Motor Imagery on the Body Balance of Patients After Stroke — A Randomized Observational Study. 1–14.
Sebastián-Romagosa, M., Cho, W., Ortner, R., Murovec, N., Oertzen, T. J. von, Kamada, K., Allison, B. Z., & Guger, C. (2020). Brain Computer Interface Treatment for Motor Rehabilitation of Upper Extremity of Stroke Patients—A Feasibility Study. Frontiers in Neuroscience, 14. https://doi.org/10.3389/fnins.2020.591435
Temporiti, F., Calcagno, A., Coelli, S., Marino, G., Gatti, R., Bianchi, A. M., & Galli, M. (2023). Early sleep after action observation and motor imagery training boosts improvements in manual dexterity. Scientific Reports, 13(1). https://doi.org/10.1038/s41598-023-29820-5
Vavoulis, A., Figueiredo, P., & Vourvopoulos, A. (2023). A Review of Online Classification Performance in Motor Imagery-Based Brain–Computer Interfaces for Stroke Neurorehabilitation. In Signals (Vol. 4, Issue 1, pp. 73–86). Multidisciplinary Digital Publishing Institute. https://doi.org/10.3390/signals4010004
Wang, Z., Cao, C., Chen, L., Gu, B., Liu, S., Xu, M., He, F., & Ming, D. (2022). Multimodal Neural Response and Effect Assessment During a BCI-Based Neurofeedback Training After Stroke. Frontiers in Neuroscience, 16. https://doi.org/10.3389/fnins.2022.884420
Xia, X., Wang, H., Wang, C., & Chen, Y. (2023). Progress in the application of motor imagery training for full-cycle upper limb function rehabilitation of stroke patients. Shanghai Journal of Preventive Medicine, 35(5), 508–512. https://doi.org/10.19428/j.cnki.sjpm.2023.22544
Zhang, W., Li, W., Liu, X., Zhao, Q., Gao, M., Li, Z., Lv, P., & Yin, Y. (2024). Examining the effectiveness of motor imagery combined with non-invasive brain stimulation for upper limb recovery in stroke patients: a systematic review and meta-analysis of randomized clinical trials. Journal of Neuroengineering and Rehabilitation, 21(1), 209. https://doi.org/10.1186/s12984-024-01491-x.
Copyright (c) 2025 Indonesian Journal of Global Health Research

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.



