Aim:

Explicit Motor Imagery is the process of thinking about moving without actually moving. By imagining movements, we use similar brain areas as we would when we actually move. The aim of this technique is to exercise the brain toward movement, before actually initiating a movement. This can help patients who struggle to initiate movement or who have a poor quality of movement to achieve better initiation and quality of movement. There are many ways to go through this process, including teaching people to imagine themselves performing specific movements or using guided mental imagery such as body scan meditation.

When to consider:

This treatment technique can be very useful for persons who:

• Report being unsure of where their limb is
• Experience pain when they think about their limb or about moving that limb
• Experience increased pain on initiation of movement
• When mirror treatment has not been tolerated or was found distressing

When not to consider:

If people have experienced significant trauma – imagining movements can sometimes evoke fear and pain. Patients with symptoms of Post traumatic stress disorder should only attempt this with an experienced clinician.

Top Tips:

Patients should be encouraged to first practice in a quiet and comfortable place to allow them to concentrate without distraction. When people begin to feel more comfortable and become skilled with this technique they can be encouraged to practice in different environments such as at work, whilst walking, etc.

People should be encouraged to imagine themselves moving, rather than watching or imagining other people moving.

Asking a patient to imagine movement at the site of pain can sometimes increase pain and become quite traumatic. Therefore, it is often helpful to begin imagined movements on the opposite side, or on the same side away from the site of pain, and gradually move toward the area of the pain.

Patients will sometimes struggle to imagine how it should feel to move the affected limb, in such instances imagined movements should be rehearsed on the unaffected side first to allow the patient to appreciate and attend to the experience. It can also sometimes be helpful for someone else to demonstrate a movement prior to the person practicing an imagined movement themselves. However, the person should always be encouraged to work towards imagining themselves moving rather than watching or imagining other people moving.

Persons should practice this technique regularly and consistently. Practice should be ideally several times a day. Patients should practice for a length of time that they feel they can adequately sustain concentration for; on days where the pain is particularly bad this may require shorter periods.

This type of exercise is often a new experience for patients and there are no right and wrongs in respect to how this should feel. Patients should be steered away from making judgments as to whether they are doing it right or wrong but focus more on what they notice through the experience.

The range of imagined movement requires careful grading. Patients should not begin to imagine large movements which they know their limb is currently unable to perform, but begin with small-amplitude gentle movements.