Graded Motor Imagery | Physiosimplified

GRADED MOTOR IMAGERY

Introduction

Graded motor imagery (GMI) evolved as a treatment approach born from the growing understanding of the underlying neuroplasticity of complex pain states such as phantom limb pain and CRPS (Moseley 2006).
The term “graded motor imagery” broadly means that in rehabilitation the focus is placed on synaptic exercise and health.
The exercising of synapses assumes that the brain is changeable and easily adaptable and gives hope to people with difficult pain states. – It involves the use of:
- Computers
- Flashcards
- Imagined movements
- Education
- Mirror visual feedback
- A lot of time and hard work!

Links the unconscious brain representation of a person’s body part and/or movement of it. It is to be done as quickly as possible in order to access deep movement planning areas in the brain.
- Is it left or right?
- Has it moved to the left or right?
Interventions
- RecogniseTM App
  - Available on iTunes for iOS and Android
    - Feet, knees, hands, necks and backs
- Flash Cards
  - Easy to use in different contexts
- Magazines
  - Ones you like, ones you don’t like
- Creativity and Imagination
Normal ranges :
- Response Time
  - 1.6 sec +/- .05 sec = necks and backs
  - 2.0 sec +/- .05 sec = hands and feet
- Accuracy of Judgments
  - 80% or above
- Side to Side Difference
  - Response time and accuracy should be equal

Imagined Movement.
Start by having the patient imagine a movement away from the affected area so that they can experience the task and obtain feedback on how it should feel. Progress on working toward the affected area.
Procedure
- Find a partner
- Pick a script on the table.
- Take turns guiding each other through the activity.
- For the “therapist” speak slowly as you give the instructions.
- For the “patient” concentrate on the directions, focus on feeling the body part.

Correcting the sensorimotor incongruence by visualising the unaffected limb in the felt position of the affected limb.
Procedure :
- Position the involved limb with the uninvolved limb parallel to to mirror. Be sure and remove all jewellery watches for other objects that might confuse the brain.
- Have the patient look into the mirror to see the reflection of the limb, which will give the illusion that they are looking at the limb that is hidden.
- Begin by keeping both limb still, progress to moving the limb outside the box while keeping the hidden one still. To progress further, move the hidden limb within its limit while taking the uninvolved limb through large movements. The final progression would be to move both the limbs equally.