Three Phases of GMI


Phase 1: Implicit Motor Imagery

This involves a person’s ability to recognize left and right. For some of us, that is hard to do even without pain in the picture, but those in chronic pain will often struggle to locate which side of the body something is happening to as a result of their pain. They may also feel like the affected body part no longer belongs to them, give it a name, or talk about cutting it off. Their ability to accurately recognize left and right as well as their reaction time in doing so can be reduced because of pain. Using left and right discrimination in the form of flashcards, computer apps, and magazines can help to improve this and can also change pain.

Why would looking at pictures affect pain?

Phase 2: Explicit Motor Imagery or Visualization

The second phase of GMI is used to further prepare the patient for pain-free movement. Like athletes, musicians, or performers, they mentally walk through an activity without performing it. Someone with chronic foot pain who always has sharp pain on stairs will picture themselves walking up or downstairs in a smooth, normal fashion without pain. They may need to close their eyes and have someone else give them step by step instructions for performing the task. They can also find a position in a magazine and mentally picture themselves getting into the same position without pain. For those who have difficulty imagining this for themselves, video can also be taken from a first-person perspective and watched repeatedly for the same effect.

Visualization activates more motor cells in the brain and can cause more pain than the left/right discrimination in phase one. Working with their physical therapist, a patient can gradually do more with visualization without increased pain. There will be times when their pain is increased, but knowing that they are sore, but safe, will allow them to adjust and continue to the third phase of GMI.

Our brains do amazing calculations when given visual input and the part of our brain that activates our foot to move will activate on a smaller level just by seeing an image of a foot. Being able to activate that part of our brain without pain can let the brain know that this activity of looking at a foot and determining if it is the left or right is a safe activity, thus reducing the need for a pain signal. This is true for anybody part where there is chronic pain.

Phase 3: Mirror Therapy and Sensory Retraining

Phase 3 of GMI uses mirrors to further help a patient use the painful part of their body normally. If the left foot is the painful side, a mirror can be set up to reflect the right foot as the left. Range of motion activities and other exercises can be performed in a gradual way with the mirrored foot as well as the foot behind the mirror until both can be done without increased pain. Also, sensory input using two-point discrimination (being able to feel where two points are being given pressure input), and touch mapping or localization can be used to help an area that has been desensitized by pain return to a more normal sensory state, further reducing pain input.

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