What is the effectiveness of first-person and third-person motor imagery in relearning daily hand tasks for people with chronic stroke?

Study settings Occupational Therapy Unit at: 1. Colombo North Teaching Hospital, Ragama 2. Rheumatology and Rehabilitation Hospital,Ragama 3. The National Hospital of Si Lanka, Colombo 10 4. Colombo South Teaching Hospital, Kalubowila

Method of randomisation
Simple randomisation using a computer-generated randomization table by an independent research person.

Details of the intervention
There will be three study arms:
1. First-person imagery group
2. Third-person imagery group
3. Conventional occupational therapy (control) group

All participants will receive individual training on daily hand tasks such as turning pages of a newspaper, eating a biscuit, using comb etc. The program will be conducted 45 minutes a day, two times a week for 6 weeks. The intervention will be conducted in the occupational therapy unit or in a quiet area free of distraction.

Arm 1 (First-person imagery group): Participants will imagine themselves doing the task and then actually perform the task in the first-person imagery group.

Arm 2 (Third-person imagery group): Participants will imagine a person doing the task and then actually perform the task in the third-person imagery group.

Arm 3 (Control group): Participants will receive conventional occupational therapy which encompasses actual practice of the daily hand tasks for 45 minutes. The frequency, duration, number of sessions, and the sequence and training schedule will be the same as for the intervention groups.

Details on blinding
• An independent research person will conduct the randomisation.
• The participants are blinded to which group they are assigned.
• Two occupational therapists not involved in treatment will conduct the assessment for blinding purpose
• The investigators (including the PI) who are involved in data analysis will be blinded to the conditions and group allocation of the participants during analysis of data.
• One investigator who will not be involved in data analysis will rename the groups for data analysis

1. Age between 18 and 80 years
2. A diagnosis of hemiplegia due to stroke (infarct or hemorrhage)
3. Stroke experienced more than 3 months prior to enrollment (Summers et al., 2007)
4. Able to complete Advanced Hand Activities 1, 2 and 3 of Motor Assessment Scale (Carr, et al.,1985)
5. Score of more than 24 points on the Mini-Mental State Exam (dictates no cognitive deficits) (Folstein, et al., 1975)
6. Able to give voluntary consent to participate in the study.

1. Visual and perceptual problems including hemianopia and unilateral neglect
2. Excessive pain in the affected arm as measured by score of more than 4 on a 10-point Visual Analog Scale (Scott & Huskisson, 1976)
3. Spasticity of more than 3 on Modified Ashworth Scale (Bohannon & Smith, 1987)
4. Pre-existing musculoskeletal, neurological (apart from stroke) or other conditions that may affect upper limb function.