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NCT Number: NCT07376915

Acute Effect of Graded Motor Imagery on Ankle Rehabilitation: A Pilot Study

The primary aim of this study is to evaluate the immediate and short-term effects of the Graded Motor Imagery (GMI) method on individuals with chronic ankle instability (CAI). In this context, the effects of the Graded Motor Imagery intervention on pain level, muscle stiffness, muscle strength, functional performance, and subjective instability level will be investigated. Additionally, these effects will be comparatively analyzed with an age- and sex-matched control group consisting of healthy individuals.

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Key information

Conditions

Ankle Instability Healthy Controls

Age range

18 year–40 year

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

İstanbul Üniversitesi-Cerrahpaşa

Istanbul, Turkey (Türkiye)

Location status: Recruiting

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • Aged between 18 and 40 years.
  • Diagnosed with chronic ankle instability (CAIT ≤ 24).
  • History of an acute ankle sprain occurring more than 3 months prior to enrollment.
  • Has not received ankle rehabilitation treatment.
  • Voluntarily participated in this study

Exclusion criteria

  • Vestibular or neurological disorders
  • Other lower extremity injuries
  • History of surgery

Treatment and study plan

Graded motor imagery

Other

The Graded Motor Imagery (GMI) program will be applied six consecutive days nd will consist of three progressive stages:

Laterality Training:

Participants will perform right-left ankle discrimination tasks using validated foot and ankle images. Accuracy and response time will be recorded.

Motor Imagery:

Participants will mentally rehearse ankle movements such as dorsiflexion, plantarflexion, inversion, and eversion without performing the motion. Imagery tasks will progress from simple movements to functional patterns based on tolerance.

Mirror Therapy:

A mirror will be placed in the midsagittal plane, allowing participants to view the reflection of the non-affected ankle while performing movements. The visual illusion of normal movement is intended to improve motor control and proprioception.

Primary outcomes

  1. Subjective Instability (CAIT)

    Time frame: baseline

    A valid-reliable questionnaire that questions the perceived instability in daily life and sports activities.

    Clinical Significance: ≥ 3 point increase is considered clinically significant

  2. Subjective Instability (CAIT)

    Time frame: 1-week post-intervention

    A valid-reliable questionnaire that questions the perceived instability in daily life and sports activities.

    Clinical Significance: ≥ 3 point increase is considered clinically significant

  3. Ground Reaction Force & Static Balance (ForceDecks)

    Time frame: baseline

    Device: ForceDecks dual force platform.

    • Single-Leg Jump Test* Values: Net vertical ground reaction force (N·kg-¹), flight time (ms), asymmetry (%).
    • Single-Leg Static Balance* Values: Total sway path (mm), ellipse area (mm²).

    Clinical Importance:* Captures short-term changes in neuromuscular control and explosive strength in a detailed manner.

  4. Ground Reaction Force & Static Balance (ForceDecks)

    Time frame: 1-week post-intervention

    Device: ForceDecks dual force platform.

    • Single-Leg Jump Test* Values: Net vertical ground reaction force (N·kg-¹), flight time (ms), asymmetry (%).
    • Single-Leg Static Balance* Values: Total sway path (mm), ellipse area (mm²).

    Clinical Importance:* Captures short-term changes in neuromuscular control and explosive strength in a detailed manner.

Secondary outcomes

  1. Muscle Stiffness (Myoton PRO)

    Time frame: baseline

    Tonic stiffness (N·m-¹) reflects the passive mechanical properties of muscle tissue. The device applies a 0.4 N mechanical impulse to the skin and records the resulting tissue oscillation response. In this study, data will be recorded as the average of 3 impulses.

    Clinical Importance: Acute changes in stiffness are considered an indirect indicator of neuroplastic responses in proprioception and motor control.

  2. Muscle Stiffness (Myoton PRO)

    Time frame: 1-week post-intervention

    Tonic stiffness (N·m-¹) reflects the passive mechanical properties of muscle tissue. The device applies a 0.4 N mechanical impulse to the skin and records the resulting tissue oscillation response. In this study, data will be recorded as the average of 3 impulses.

    Clinical Importance: Acute changes in stiffness are considered an indirect indicator of neuroplastic responses in proprioception and motor control.

  3. Muscle Strength Assessment - Isokinetic dynamometer (Isoforce)

    Time frame: baseline

    Parameter: Concentric inversion-eversion peak torque (Nm) at 60°·s-¹ Objectively measures agonist-antagonist muscle performance around the ankle joint.

    Clinical Significance:* Improvements in strength contribute to functional stability and a reduced risk of re-injury.

  4. Muscle Strength Assessment - Isokinetic dynamometer (Isoforce)

    Time frame: 1-week post-intervention

    Parameter: Concentric inversion-eversion peak torque (Nm) at 60°·s-¹ Objectively measures agonist-antagonist muscle performance around the ankle joint.

    Clinical Significance:* Improvements in strength contribute to functional stability and a reduced risk of re-injury.

  5. Pain Level

    Time frame: baseline

    Visual Analog Scale (VAS, 0-10 cm): 0 = "no pain," 10 = "unbearable pain"; the participant marks the scale before and after the session.

  6. Pain Level

    Time frame: 1-week post-intervention

    Visual Analog Scale (VAS, 0-10 cm): 0 = "no pain," 10 = "unbearable pain"; the participant marks the scale before and after the session.

  7. Functional Performance

    Time frame: baseline

    Star Excursion Balance Test (SEBT) Parameter: Normalized reach distance in three primary directions (anteromedial, medial, posteromedial), expressed as a percentage of leg length.

    Clinical Significance: Assesses dynamic balance and lateral load-transfer capacity; asymmetries in individuals with chronic ankle instability (CAI) may serve as prognostic indicators.

  8. Functional Performance

    Time frame: 1-week post-intervention

    Star Excursion Balance Test (SEBT) Parameter: Normalized reach distance in three primary directions (anteromedial, medial, posteromedial), expressed as a percentage of leg length.

    Clinical Significance: Assesses dynamic balance and lateral load-transfer capacity; asymmetries in individuals with chronic ankle instability (CAI) may serve as prognostic indicators.

Study contacts

Contact information is provided by the study sponsor or research team.

SEDA ATEŞ, Bachelor degree

CONTACT

[email protected]

90+ 5388543087

Sponsors and collaborators

Lead sponsor

Istanbul University - Cerrahpasa

Other

Registry information

Official study title

The Acute Effect of Graded Motor Imagery-Based Mental Preparation on Ankle Rehabilitation: A Pilot Clinical Study

Important dates

Study start
2026
Primary completion
2026
Study completion
2026
First posted
Jan 29, 2026
Registry last updated
Feb 11, 2026

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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