Motor Imagery: Using Visualization to Help Mitigate Phantom Limb Pain

Graded Motor Imagery is a three-step, non-invasive treatment option, that can help decrease phantom limb pain for amputees. In addition, it has the added benefit of improving myoelectric prosthetic control in people with upper limb amputations. The three stages of Graded Motor Imagery are:

1. Laterality Reconstruction (left/right discrimination exercises)
2. Motor Imagery
3. Mirror Therapy

In this article, we will discuss how to perform Motor Imagery. However, before delving into Motor Imagery, make sure you’ve mastered the left/right discrimination exercises described in the laterality reconstruction link above.  For best results, we recommend that you be under the care of an occupational therapist who will be able to guide you through the Graded Motor Imagery process and provide extra tips and information. If you are looking for a clinical therapy specialist to work with you, please contact us.

Motor Imagery

1. Perform the exercises in a quiet room where you are unlikely to be interrupted. Put your phone on silent mode.
2. First do a movement with your intact arm. Watch the intact arm go through the movement and then close your eyes and visualize your affected arm going through the same movement. It is important to keep the muscles of your residual limb completely relaxed. Picture the phantom limb going through the movements but do not actually move your affected arm.
3. Start with simple, small movements such as opening and closing your hand, making a fist and relaxing, moving your wrist, turning your palm up and then palm down, bending and straightening your elbow, waving etc.
4. Progress to more complex hand and arm movements. Imagine turning a page of a book, drinking from a cup, writing, carrying objects, picking up coins, turning a doorknob, reaching into a cupboard to grasp a plate etc. You can also use the laterality flashcards, app or online program to look at a hand position and visualize your affected hand being placed in the same position as the hand in the photo.
5. Do the motor imagery activities three to five times a day (perhaps after breakfast, lunch and dinner). Initially you may only be able to concentrate on the movements for short periods of time, say, two to three minutes. Try to gradually increase the duration of each session and continually try more complex movements. You might even try imaging different contexts: temperature, location, smells, tastes, etc. while imagining movements.
6. Once you are able to visualize your affected limb moving through complex movements, progress to mirror therapy, which we will discuss in an upcoming article.

Interestingly, many people with limb loss describe intuitively doing motor imagery. In the context of graded motor imagery, it is a stepping-stone in the three stage process of this pain management approach. Please reach out to us if you are looking for a therapist to help you work through the stages. If you have tried motor imagery and would like to tell your peers about your experience with it, please leave a comment below.

For more information, see related articles here:

• Introduction to Graded Motor Imagery: Reducing Phantom Limb Pain
• Graded Motor Therapy: Mirror Therapy Explanation and Steps
• Introduction to Myoelectric Prostheses
• How We Help Our Patients Learn to Use Their Prosthesis
• Introduction to Phantom Limb Pain and Phantom Sensations