Tuesday, August 14, 2007


Motor imagery, i.e. visualizing yourself in a particular posture or movement has been around for ages. It is known to improve athletic performance. It has had a rebirth with the advent of brain imaging tools such as functional MRI which created an awareness of how changeable and plastic the brain is. In addition, the discovery of mirror neurones which are active when you watch a person move provides a secure base for graded motor imagery studies and therapy.

The graded motor imagery programme (GMI) takes this concept further. It consists of a programme of laterality reconstruction, motor imagery and mirror work and it appears to work best if carried out in that order.

So far there is evidence of efficacy for its use in Complex Region Pain Syndrome and phantom limb pain Moseley, GL (2006) Neurology 67: 1-6. However, as the blog progresses we will share anecdotal clinical knowledge on the use of the programme for other pain states and make readers aware of emerging associated scientific literature.

Laterality reconstruction is the restoration of the brain's concept of left and right. If you look at another person’s hand and then try and imagine your own hand in that position, can you see that the brain first has to identify if it is a left or right hand. If it can’t then there will be synaptic stress and perhaps more pain. Perhaps removal of laterality identification is a defense to close down motor output. We will discuss this in later blog entries. At NOI, we use two tools to asses and treat laterality deficits – flash cards and the Recognise programme.

Motor imagery is conscious access to brain parts involved in intention, preparation and carrying out movement. Brain mapping studies have revealed great overlap of brain regions involved in actual or imagined movements. (e.g. Grezes J., Decety J. 2001 Human Brain Mapping 12:1-19). Motor imagery could be watching an activity, imagining your own body in a static posture or imagining it moving. We will discuss this, including clinical practicalities in further postings.

Mirror therapy is where the brain is tricked into thinking that the limb is actually better than

the brain thinks it is. Note in the image, that if the affected limb is “hidden” inside a box with a mirror on one side, use of the good limb will inform the brain, via the reverse image, that the painful and disabled limb can be moved.

While literature such as Moseley’s recent randomized clinical trial (cited above) provides welcome support for the use of neuromatrix training, the clinical world is always different to the research world. As these blogs progress, we will share clinical experiences, discuss the neuroscience basis of GMI and always link to emerging research.

To conclude for now, to achieve synaptic strength and linkages, activity (including thought) has to be repeated, graded, conquered and context enriched.