Graded Motor Imagery

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add text here to describe the intervention here

n an effort to target those with longstanding CRPS, Moseley et al. designed a graded motor imagery (GMI) program to sequentially activate the premotor and primary motor cortices through limb laterality recognition, motor imagery, and lastly mirror therapy. This program appeared to be particularly useful, in that, the premotor cortex may be activated without setting off other cortical networks involved with movement he mechanisms that underlie any benefits of MVF and GMI are still somewhat unclear. Many researchers believe that this process is partially influenced by forced attention to the affected extremity, decrease in kinesiophobia, increase in large fiber inhibition, and the reconciliation of sensorimotor incongruence [1]

Moseley’s GMI program extends over a 6-week period (2 weeks spent in each phase of treatment) and begins with limb laterality recognition using pictures. Secondly, the participant views a picture of an extremity and is asked to imagine moving into that position. The third and final stage involves viewing the reflected image of the unaffected extremity moving through different planes of movement [75]. This process is available on mobile applications like RecogniseTM Apps and often used in CRPS treatment programs. Both researchers identify contraindications to these programs, including the inability to establish ownership of the mirrored extremity, increase in pain, and any increase in movement disorders.[1]

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add text here relating to the indication for the intervention

Clinical Presentation[edit | edit source]

add text here relating to the clinical presentation of the condition, including pre- and post- intervention assessment measures. 

1. Laterality Training[edit | edit source]

Left/right discrimination is the process of recognising one side of the body as district from the other[2]and is trained by reviewing images of left and right limbs. The inability to recognise the affected limb accurately is related to disrupted sensory and motor pathways.

The patient is shown s sequence of images of the affected limb, and asked to identify each image as a right or left limb. The normal recognitions speed is about 2-2.5sec for hands and feet. You can use Recognise Apps or flash cards (NOI group) or magazines.

Should practise x4 per dat

2. Explicit Motor Imagery[edit | edit source]

The process of thinking about moving without actually moving. By imagining movements, we activate similar brain areas as we would with actual movement. Thus, imaginary movements can help train the brain towards movement. This is very useful for patients who struggle to initiate movement, or who have poor quality of movement. Indications include:[2]

  • Patient reports being unsure about where the limb is
  • Experiences pain by just thinking about moving the limb
  • Pain increases with movement initiation
  • Avoid if patient has experienced significant trauma or has symptoms of PTSD


  • Progress from quiet place to busier environments
  • Patient should imagine themselves moving
  • Begin imagined movements on the opposite side, or same side away from the painful site and gradually move towards the painful area. Begin with small amplitude movements, gradually progressing to larger movements
  • Should be practised 7 times per day

3. Mirror Visual Feedback[edit | edit source]

Completely conceal the affected limb, and the patient should be well supported and comfortable. Both limbs should start in the same position. Slowly start congruent movements of both limbs whilst looking at the reflection. Start with larger, pain free movements and progress to more complex movements

At least 5min, max 10min; 4-9 times daily

Do's Dont's
Warn patient that is may feel strange and they can stop any time Sit too far back, resulting in both arms being visible
Remove jewellery/ watch Continue if symptoms worsen
Allow time for patient to look at the reflection until they are convinced of the illusion and feel comfortable with it Perform unilateral/ asynchronous movements

Resources[edit | edit source]

EFIC guide to treating CRPS

NOI group website

References[edit | edit source]