Efficacy of Graded Motor Imagery in Improving Leg Rotation for Stroke Patients with Hemiplegia: A Randomized Controlled Trial

Background: Chronic stroke survivors often experience persistent lower limb dysfunction, particularly impaired leg rotation, which significantly affects mobility and gait. Graded Motor Imagery (GMI), a neuroscience-based intervention, has shown promise in upper limb rehabilitation but remains understudied for lower limb deficits. Methods: A single-blind randomized controlled trial allocated 60 chronic stroke patients (>6 months post-stroke) with hemiplegia to GMI (n=30; 3-stage protocol targeting leg rotation) or conventional therapy (n=30; task-oriented lower limb training). Outcomes included the Lower Extremity Motor Coordination Test (LEMOCOT), Kinesthetic and Visual Imagery Questionnaire (KVIQ-10), and pain (VAS) at baseline, post-intervention, and 3-month follow-up. Results: The GMI group demonstrated significantly greater improvement in LEMOCOT scores (Δ=12.3 points, p<0.001, Cohen’s d=0.89) and KVIQ-10 (Δ=7.8 points, p=0.002) compared to controls. Pain reduction was 38% in GMI versus 10% (p=0.01). Conclusion: GMI significantly enhances leg rotation and motor imagery ability in chronic stroke patients, with sustained effects at 3 months.