Left/right discrimination
Explicit motor imagery
Mirror therapy

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What is graded motor imagery?

GMI is a rehabilitation process used to treat pain and movement problems related to altered nervous systems by exercising the brain in measured and monitored steps which increase in difficulty as progress is made.

The three different treatment techniques include left/right discrimination training, motor imagery exercises and mirror therapy. These techniques are delivered sequentially but require a flexible approach from the patient and clinician to move forwards, backwards and sideways in the treatment process to suit the individual.

Who is it for?

We recommend that anybody with a chronic pain state learns more about the GMI process and talks to their clinician about options to include brain training exercises as part of a comprehensive rehabilitation programme.

Research shows people in pain often lose the ability to identify left or right images of their painful body part(s) (i.e. when viewing pictures of body parts they are slower and/or less accurate than somebody without pain at determining whether the image is a Left or Right).

This ability appears to be important for normal recovery from pain. The good news is that the brain is plastic and changeable, if given the right training for long enough. So with the appropriate tools, a bit of work, patience and persistence, it is possible to improve the ability (speed and accuracy) to discriminate between Left and Right body parts and movements.

Explicit motor imagery is essentially thinking about moving without actually moving. Imagined movements can actually be hard work if you are in pain. This is most likely because 25 percent of the neurones in your brain are 'mirror neurones' and start firing when you think of moving or even watch someone else move (this is why you can feel exhausted after watching an action movie).

By imagining movements, you use similar brain areas as you would when you actually move. This is why sports people imagine an activity before they do it. It's exercising the brain before the rest of the body which is what you will be trying to do with the explicit motor imagery part of the GMI process.

There are many ways to go through this process but the most common way used in GMI is to imagine yourself moving rather than watching or imagining other people moving.

If you put your left hand behind a mirror and right hand in front, you can trick your brain into believing that the reflection of your right hand in the mirror is your left. You are now exercising your left hand in the brain, particularly if you start to move your right hand. Sounds tricky!

Mirrors can sometimes be used by themselves but often it is best to do once you have a good ability to discriminate your Lefts from your Rights and imagine movements, i.e. the first two stages of GMI.

p.s. mirrors are cheap and you may not need drugs.

Graded Motor Imagery - David Butler in Denmark

NOI 2010 Conference, Tim Beames (NOI UK)

David Butler's introduction to mirror therapy

These sets of 48 cards (24 left and 24 right) are ideal for left/right discrimination exercises and further motor imagery tasks. Instructions and fun game suggestions to add context to your training are all included. Currently available as: Hands, feet, backs, necks and shoulders.

Simple and portable applications for left/right discrimination exercises with test options and accurately stored results. Available for hands and feet on iphone and android.

Thoughtfully designed for mirror therapy, the NOI Mirror Box is light, portable, hygienic and safe. Sturdy Perspex mirror 300mm x 300mm. Comes with explanations and instructions.

This is a comprehensive left/right discrimination and motor imagery training program. Join up and access your personal account anywhere in the world with a computer and internet connection to perform a range of brain training exercises, gradually increasing the difficulty of tasks as you improve.

Finally! A handbook arising from the last 15 years of neuroscience, clinical trials and clinical reasoning science is here for both clinicians and pain sufferers. Learn some of the basic neuroscience and psychology fundamentals and how to implement GMI from contributing experts.

Set yourself up with a complete toolbox developed over years of research, clinical and anecdotal experience to get the most out of graded motor imagery. GMI Pack includes The Graded Motor Imagery Handbook, 2 months immediate access to Recognise, 1 x set of Hand Flash Cards (please specify otherwise), 1 x NOI Mirror Box.

1. Is it a Left or Right? When doing these exercises with hands, feet, knees and shoulders your aim will be to determine whether the body part is from the left or the right side. For example the question is: is it a left shoulder or a right shoulder?
2. Have they moved to the left or right? For all spinal and facial exercises (backs, necks, faces) you want to answer whether the body part has twisted, turned or moved to the left or right. For example the question is: have they turned to the left or right?
3. Some useful tools for training in left/right discrimination are the online Recognise software, Recognise Apps, Recognise Flash Cards and other readily available tools such as magazines (with people pictures), Google images, Facebook photos, photo albums.
4. See 'what is normal' for our current ideas on the level of results you should aim for.

1. Heighten your motor imagery experience with elements such as warmth, breezes, textures, smells, sounds, the weight of your limb, the space around you, the touch of your clothes, your environment (clinic, beach, park, home, school, work). Remember it is entirely what you imagine it to be!
2. This process can be quite potent and sometimes evoke fear and pain. Be wary of the power of the brain and take your time here.
3. It can also be useful to maintain your left/right discrimination exercises during this time.

1. 'Mirror boxes' are relatively easy to build and large, custom mirrors may be required for pain states in the lower limbs and shoulders. NOI recommends using sturdy Perspex mirrors to avoid any glass injuries.
2. Start with exercises involving no or little movement – just watch your unaffected hand. Gradually increase the difficulty of exercises in front of and behind the mirror. See the video and our posters for more detail.
3. Take care with mirror therapy. Remember it is the final part of the entire GMI process and offers potent brain stimulation. You may need to consult a health professional.

13th April 2013

Chicago, IL, United States of America

Robert Johnson

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2nd May 2013

Derby, England

Ben Davies

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6th May 2013

Hamilton, New Zealand

David Butler

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11th May 2013

London, England

Tim Beames

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12th October 2013

Crewe, England

Tim Beames

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19th October 2013

London, England

Tim Beames

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26th October 2013

Oldham, England

Tim Beames

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16th November 2013

Warners Bay, Australia

David Butler

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30th November 2013

Carlisle, England

Ben Davies

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