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Motor Priming

Original Editor - Youssef Maged Saadeldin Mohamed

Top Contributors - Angeliki Chorti, Youssef Maged Saadeldin Mohamed, Vidya Acharya and Alexandra Stead  

Introduction

Motor priming is defined as an approach that uses a stimulus or activity which aims at changing the motor behaviour of an individual as a result of motor cortex interventions.[1] This term is frequently used in neurorehabilitation as a way to promote the brain's excitability to motor learning[2] and has gained popularity in the last two decades as a motor recovery technique.[1] In a way, it's like turning up the volume on the motor cortex, the part that is responsible for movement, before or during therapy to help with learning and recovery.

Key concepts of motor priming include:

  • Implicit Learning: this means that motor learning is a result of changes that happen without conscious effort, based on prior exposure.
  • Neuroplasticity: motor priming makes the brain more receptive to changes in brain excitability and ultimately, plasticity i.e. the brain's ability to change in structure and function.
  • Preparation for Therapy: as the word implies, priming of the motor system makes it more responsive to motor training interventions, that could ultimately lead to better functional outcomes.

Below you can find some of the interventions that have been used to elicit this type of response targeting at altering motor behaviour in clinical practice.

Stimulation-Based Priming

Non-Invasive Brain Stimulation

Non-invasive brain stimulation works by stimulating the brain in vivo.[3]

Brain-Computer Interfaces

Brain-computer interfaces (BCIs) are about the communication of the brain with computers through technology.[4]BCIs have been used in various applications such as motor imagery and action observation (please see below for a description of these terms) and virtual reality/ robotics providing advantages such as increased engagement and improved accuracy. [5] Evidence supports the use of BCIs as a way to improve cortical excitability in neurological conditions such as stroke and spinal cord injury. [6]

Movement-Based Priming

Movement-based priming is about methods such as using unilateral movements or bilateral movements (e.g., the unaffected limb moving the affected one or aerobic exercise).[7] Movement-based and aerobic exercise-based priming do not have any clear effect on outcomes in stroke patients.[8] However, Active-Passive Bilateral Therapy (APBT) sustained improvements in upper limb motor function in chronic stroke patients and induced specific and sustained changes in motor cortex inhibitory function.[9]

Cognitive / Mental Priming

Motor Imagery

Motor imagery is about mentally rehearsing without executing a movement.[8] When used before task-specific training, this technique may have from small to large effect on activity and motor impairment outcomes in stroke rehabilitation.[8] In multiple sclerosis, a few mental repetitions of an action might be enough for priming to influence the actual execution of the same action.[10]

Action Observation (AO)

Action Observation (AO) motor priming means that simply watching someone perform an action may lead to boosting the brain's capacity to perform that action (e.g. making it easier or faster).[11] It's a way of preparing the brain to do a movement by observing the movement and its potential execution. This phenomenon is relies on the action of motor neurons and shared neural networks, the overlapping brain areas activated during observation and during actual execution.[12][13]

Sensory Priming

Sensory Priming uses sensory input to prepare the motor system; some examples include peripheral nerve stimulation/somatosensory electrical stimulation (PNS/SES), transient functional deafferentation (TFD), and vibration.[14] Studies on sensory priming have indicated that it may have a significant role in upper limb training after stroke.[15]

Motor Priming Trends

Over the last few years, a shift towards multimodal priming has been observed - i.e. combining motor priming techniques for an additive effect.

Li et al.[16] did a pilot study looking at the effectiveness of repeated TMS in combination with Mirror Visual Feedback (MVF) in healthy individuals. Their results indicated that stimulation of brain areas such as the primary motor cortex (M1) and primarily, the dorsolateral prefrontal cortex, led to improvements in embodiment perception when specific TMS patterns were timed with brain activity (like µ-rhythm) and exercises or mirror therapy.[16]

Xia et al.[17]examined the effectiveness of transcranial direct current stimulation with exercise in chronic low back pain. Their systematic review including five RCTs, concluded that anodal tDCS combined with exercise may alter modestly but significantly, pain intensity for patients with chronic low back pain. The duration of the intervention mattered with regard to functional outcomes.[17]

Conclusion

Motor priming is emerging as a promising tool in motor recovery, especially when used in combination with other interventions. However it has yet to prove its value in rehabilitation for various reasons. For example, it is suggested that optimising protocols and addressing individual variability may lead to better functional outcomes. [15] Future research endeavours may turn to biomarker-driven rehabilitation, personalised strategies, and large-scale trials to integrate motor priming into clinical practice.[15]

Resources

Motor Priming for Motor Recovery: Neural Mechanisms and Clinical Perspectives (Frontiers in Neurology)

References

  1. ↑ 1.0 1.1 Madhavan S, Stoykov ME. Editorial: Motor Priming for Motor Recovery: Neural Mechanisms and Clinical Perspectives. Front Neurol. 2017 Sep 4;8:448.
  2. ↑ Stoykov ME, Madhavan S. Motor priming in neurorehabilitation. J Neurol Phys Ther. 2015 Jan;39(1):33-42.
  3. ↑ Savelon ECJ, Jordan HT, Stinear CM, Byblow WD. Noninvasive brain stimulation to improve motor outcomes after stroke. Curr Opin Neurol. 2024 Dec 1;37(6):621-628.
  4. ↑ Kumari R, Dybus A, Purcell M, Vučković A. Motor priming to enhance the effect of physical therapy in people with spinal cord injury. J Spinal Cord Med. 2025 Mar;48(2):312-326.
  5. ↑ Wang Z, Yang L, Wang M, Zhou Y, Chen L, Gu B, Liu S, Xu M, He F, Ming D. Motor Imagery and Action Observation Induced Electroencephalographic Activations to Guide Subject-Specific Training Paradigm: A Pilot Study. IEEE Trans Neural Syst Rehabil Eng. 2023;31:2457-67.
  6. ↑ Shah R, Daulat S, Ramu V, Moodley V, Sengupta P, Madathil D, Yao Y, Lakshminarayanan K. Applications of Brain-Computer Interface in Action Observation and Motor Imagery. In: Kashou NH (ed). New Insights in Brain-Computer Interface Systems. Available from: https://www.intechopen.com/chapters/88853 [accessed 4/2/2026]
  7. ↑ Stoykov ME, Corcos DM, Madhavan S. Movement-Based Priming: Clinical Applications and Neural Mechanisms. J Mot Behav. 2017 Jan-Feb;49(1):88-97.
  8. ↑ 8.0 8.1 8.2 Dorsch S, Nicholson V, Roman E, Fanayan E, Chagpar S. Motor imagery priming improves activity and impairment outcomes in people after stroke but the effects of other types of priming are unclear: a systematic review. J Physiother. 2024 Oct;70(4):275-87.
  9. ↑ Stinear CM, Barber PA, Coxon JP, Fleming MK, Byblow WD. Priming the motor system enhances the effects of upper limb therapy in chronic stroke. Brain. 2008 May;131(Pt 5):1381-90.
  10. ↑ Tacchino A, Pedullà L, Podda J, Monti Bragadin M, Battaglia MA, Bisio A, Bove M, Brichetto G. Motor imagery has a priming effect on motor execution in people with multiple sclerosis. Front Hum Neurosci. 2023 Sep 7;17:1179789.
  11. ↑ Edwards MG, Humphreys GW, Castiello U. Motor facilitation following action observation: a behavioural study in prehensile action. Brain Cogn. 2003 Dec;53(3):495-502.
  12. ↑ Mulder T. Motor imagery and action observation: cognitive tools for rehabilitation. J Neural Transm (Vienna). 2007;114(10):1265-78.
  13. ↑ Di Rienzo F, Joassy P, Kanthack T, MacIntyre TE, Debarnot U, Blache Y, Hautier C, Collet C, Guillot A. Effects of Action Observation and Action Observation Combined with Motor Imagery on Maximal Isometric Strength. Neuroscience. 2019 Oct 15;418:82-95.
  14. ↑ Stoykov ME, Heidle C, Kang S, Lodesky L, Maccary LE, Madhavan S. Sensory-Based Priming for Upper Extremity Hemiparesis After Stroke: A Scoping Review. OTJR (Thorofare N J). 2022 Jan;42(1):65-78.
  15. ↑ 15.0 15.1 15.2 Madhavan S. Harnessing Neuroplasticity: The Role of Priming in Enhancing Post Stroke Motor Function. Restor Neurol Neurosci. 2025 Aug 1:9226028251358162.
  16. ↑ 16.0 16.1 Li Y, Li P, Li Y, Wang J, Shen X, Zhang M, Ding L. Effect of motor process-related priming via repeated transcranial magnetic stimulation on embodiment perception during mirror visual feedback: a pilot study. Front Neurosci. 2024 Nov 26;18:1501169.
  17. ↑ 17.0 17.1 Xia R, Lu S, Zhao L. Transcranial direct current stimulation combined with exercise therapy for chronic low back pain: a systematic review and meta-analysis. Front. Hum. Neurosc. 2026; 19:1721182.
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