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Graded Motor Imagery (GMI)

  • Ant
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2 years 2 months ago - 2 years 2 months ago #24164 by Ant
Ant created the topic: Graded Motor Imagery (GMI)
Hi all,

During the coffee meetup I found out that GMI might not be common knowledge such as the "new" Laterality or Mirror Training and they can be easily done as self help to get a bit of relief as long as imagined movements aren't painful. Probably good to run it past your medical team first. Other parts of treatment might be important first or this may not be relevant to you.

I have used Orientate Free (as the name implies, no cost!) on the apple app store and cheap mirrors such as those at the bargain stores as long as the picture is accurate. It involves recognition of left or right sided hands/feet (and limbs/spine etc in other apps) which can be a bit difficult when we are in pain so often. This might help in and of itself as our internal body image has been linked to pain (what hasn't, though?! ;) ) or as a bridge to tolerating Mirror Therapy if that is initially painful... I didn't have troubles but if Mirror Therapy is unable to be tolerated you should really consult your medical team!!

Basically for Mirror Therapy what you do is place the mirror so it reflects the pain-free limb as a barrier to block view of the painful limb and you see two "pain free" limbs. This helps the brain adapt to "reduce" some pain adaptations... sensationalistic claims aside, I did find it helped to give some sustained relief.

Often these mirrors are made into boxes and used for phantom limb pain but very new research shows it might be useful in Chronic Pain, too.
The movements are basic, gentle and slow, performed the same on both sides, starting with something that you can tolerate and then moving on but not progressing if any flare-ups occur and certainly not working into pain increases during the sessions. This part I found is tricky because I often just ignore the pain and that isn't the goal of the therapy. Getting distracted by thoughts or spacing out is also something that takes practice to avoid!
Positioning and concentrating on watching the reflected image as my other limb was weird at first but after some time and adjusting it became more comfortable.

So for example on the first day I would perhaps rotate my hand to and fro if moving my fingers is painful and then over days or weeks I would gradually move towards bending and straightening my fingers and lightly touching and/or rubbing them together.

The el'cheapo long and light cardboard mirrors can be used for the lower limbs because hopefully one can sit or lean in a way with the least discomfort and get some movements in without tiring out the upper body or having to develop a weird contraption to hold a mirror - I had trouble finding a box for a hand-sized mirror so it took me a while to get something comfortable going!
A tip I learned is that because I don't tolerate constant leaning, is to break up sessions into maybe a minute or two at a time and then add as tolerated... I use a neck soft collar or two to help.

Please let me know about your experiences or if what I've written is unclear... I had a hard time finding links to info that wasn't commercial or in some way biased/jargony.
Last Edit: 2 years 2 months ago by Ant.

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2 years 2 months ago #24167 by jo.m
jo.m replied the topic: Graded Motor Imagery (GMI)
Thank you Ant

I too have been doing GMI training and Mirror Box Therapy for some months now. The App on my phone is 'recognise' by the NOI group and you can google it to find out information.
Unlike Ant the one I have did cost me but I have found it helpful. Due to multiple areas I have pain I have been doing three different areas on the App. Each one being a separate download.

With the mirrorbox I had similar flare ups and had to really work on pacing and building up to the time I could sit and the most important thing was position.

As well as the usual GMI training I have also been doing the exercises in a hydrotherapy pool. The way is works is a bit different and the exercises are done with eyes open then with them closed. My physio and OT have been working hard with me and I can certainly say the work I have done this year with my rehab has improved my management and strengthened my mind for sure.

It can seem a bit of a wacky theory but it works if you practice it regularly.

Good luck :)

"Just thinkin' about tomorrow
Clears away the cobwebs and the sorrow 'til there's none

When I'm stuck with a day that's grey and lonely
I just stick out my chin and grin and say, oh

The sun will come out tomorrow
So you gotta hang on
'til tomorrow, come what may!"

Annie - The Movie

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2 years 2 months ago #24170 by Ant
Ant replied the topic: Graded Motor Imagery (GMI)
Hi Jo!
Seems wacky indeed! I think it's important to note that this therapy doesn't imply "it's all in the mind" as the evidence shows it doesn't fix everything. It seems like it really only targets the consequences of injury/disease/pain.

The pay-for apps are great because they have much more resources to draw from in terms of complexity and diversity... I'm just not sure it's worth me putting heaps of time and money into Laterality as I didn't notice as much benefit as through Mirror training. We're all different and so it's interesting to read that you also had trouble with positioning!
I ended up getting the NOI mirror box as it's light and easy to position. Unfortunately heavy on the wallet, though! But... cheaper than meds in the long-run if benefit persists.

The visualisation stuff isn't something I felt confident in writing about as I think that's way more individual (I suck at it and never had symptoms from it) so likely better to have a trained therapist work with people who may benefit from that.
Great that you've found help from it and I think might be useful for many if we have the perspective like you have of strengthening the mind to overcome obstacles.

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2 years 2 months ago - 2 years 2 months ago #24184 by Marley
Marley replied the topic: Graded Motor Imagery (GMI)
Hi Ant

I wonder if this is is a variation of when I did some nasty tendon damage to my hand and the hand OT put my good hand in a fancy shoe box with angled mirrors.

I moved both hands at the same time, same movement but watched my good hand in the mirror which blocked any view of my bad hand.

It was to increase flexibility and movement not beyond the twinge of pain. (As you said concentration and not ignoring the pain was hardest)
Marley

Once I could laugh with everyone
Once I could see the good to me
Holding the world inside
Now the world is grey to me
Nobody can see you gotta believe it
Oh oh the night comes down
And I get afraid of losing my way
Oh oh the night comes down
And it’s dark again
“The Night Comes Down” Queen
Last Edit: 2 years 2 months ago by Marley. Reason: Clarity

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2 years 2 months ago #24185 by Ant
Ant replied the topic: Graded Motor Imagery (GMI)
Hi Marley,
Sounds like pretty much the same thing?
I imagine there'd be lots of ways people like to do it and most of the stuff I saw online was for hands, too!
How did it go for you?

Cheers!

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2 years 2 months ago - 2 years 2 months ago #24186 by Marley
Marley replied the topic: Graded Motor Imagery (GMI)
Hi Ant

It was a long slow frustrating process. I couldn't rig up my own box as I only had 1 hand! Dumb OT. So homework wasn't done with a box.

I thought for hands, feet, wrists & ankles the theory behind it had great potential because they easily fit into boxes. Ultimately for me frustration won and I went it alone.
Marley

Once I could laugh with everyone
Once I could see the good to me
Holding the world inside
Now the world is grey to me
Nobody can see you gotta believe it
Oh oh the night comes down
And I get afraid of losing my way
Oh oh the night comes down
And it’s dark again
“The Night Comes Down” Queen
Last Edit: 2 years 2 months ago by Marley.

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