A reader Tim asks this intriguing question:
I have a chronic pain condition similar to CRPS, along with some nasty allodynia. Most mornings I feel like I’m 120 years old. I’m a big believer in graded motor imagery (GMI). However, I’m one of many people out there who have never seen a visual image in my mind. Almost always when somebody says “imagine”, they mean “visualize”. When someone asks me to imagine something, I have no idea what they’re talking about. This certainly gets in the way of any kind of motor imagery tasks.
I’m working with a very competent physical therapist, but this problem is intractable for him also. I have contacted Lorimer Moseley, and he doesn’t have any ideas on this either. Can you provide any guidance, information, etc. towards resolving this?
Thanks, Tim, for your really interesting question. I have several thoughts about it.
First, as you know, graded motor imagery is a step-wise program to retrain the brain away from pain. The steps are: 1) right/left discrimination, 2) imagining movement, and finally, 3) actually performing movement. It sounds like you’re asking how to do step #2 when it seems you can’t imagine movement.
When I prepare patients for step 2, I tell to look at, let’s say, their hand, and to imagine what it would feel like to move their hand into a certain position. When I do this myself, it’s sort of like the feeling of “willing” my hand to move, but without actually moving it. I try to “feel” the movement, more than imagine it. The looking at your body part is also an important part of the exercise - this step gives your brain reinforcement about paying attention to the part of your body, and being aware of where it is in space.
This step is not about looking off and imagining some abstract hand moving into position, and not really about imagining movement in your mind’s eye. So it really is imagining the movement itself, not visualizing movement. You may be more able to do step #2 with these instructions.
2. If imagining movement was still hard for you, however, I would ask you to imagine doing a specific, well-known activity which is similar to the position you’re supposed to imagine. Let’s say you were using this picture for step #2 in GMI.
I might ask you to imagine raising your hand in class to answer a question. That gives you more of a context to use as guidance. You could even add specifics:
- notice how much you’re imagining your shoulder stretching when you raise your hand
- notice how far apart you’re imagining your fingers to be
A patient I worked with had a hard time imagining some movements. So I asked what movements were second nature to her, very well ingrained. She had played the piano for years and years, so we used particular movements involved with playing the piano. This was much easier for her to “feel”.
3. Lastly, there are other paths to get where you want to go besides “visualizing.” For example:
- I would also have you do work in other brain re-training techniques, such as tactile discrimination, using repetitive normal movement, using a mirror, etc. This can get you some of the same benefit as GMI.
- You can use other senses, such as hearing and touch. If you’re doing relaxation exercises, instead of “seeing” a beach, you could imagine bird sounds, or the sounds of the beach.
I’d be interested in your response. Thanks again for your question.
10/18 Update: Body in Mind is taking a look at this, too.