Guided Motor Imagery in Occupational Therapy for Patients with a Stroke

Graded Motor Imagery – Step 2: Explicit Motor Imagery Results

Explicit Motor Imagery (aka Imagery) – step 2 in the Graded Motor Imagery training continuum.

I previously discussed step 1, Left/Right Discrimination in this blog post here and it all started with the reflections I have had as an occupational therapy practitioner trying to use mirror therapy with my patient and not having good results.

I was super frustrated, especially since the evidence shows that mirror therapy can have a positive effect on motor function, but what I realized I was that I was doing it all wrong. 😁 I wasn’t following the continuum and progression and was initially trying to use it as a standalone stroke intervention.

This study states that, 

“combined with conventional rehabilitation, mirror therapy is an effective method for the recovery of functionality after stroke.”

We have reviewed Left-Right Discrimination and Mirror Therapy in previous blog posts and if you are an OT Flourish Membership Member, we have given step-by-step instructions and supporting research on how to complete these techniques, but today, I am going to dig in and share some examples with you Step 2 ⬇️⬇️

Explicit Motor Imagery

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What is Graded Motor Imagery?

Graded motor Imagery a set of 3 different, sequential (but flexible) treatment techniques using “top down” cortical central processing to improve movement difficulties or complex pain in occupational therapy.

1️⃣ Laterality Training (aka Left/Right Discrimination)
2️⃣ Explicit Motor Imagery Exercises (aka Imagery)
3️⃣ Mirror Therapy (see how I used to just skip the 1st two steps and expected amazing results?!?)


Learn how to use explicit motor imagery with our OT patients that have had stroke or pain to get great results! |

What is Explicit Motor Imagery?


Explicit motor imagery is basically imagining yourself moving without actually moving. We have a mirror neuron system that “mirrors” action and movement – which is why top coaches have professional athletes imagine shooting hoops or making a goal in a soccer match.

Imagine the process of brushing your teeth in the morning.

Imagine pouring your dog’s dog food into it’s bowl.

Imagine sitting down at your computer and writing an email.

How Do I Instruct My Patients in This Step?

✅ Pick tasks and occupations that they do regularly.
✅ Have them imagine the task completion.
✅ Break down the task as needed per patient experience with pain or movement
✅ Progress with minimal context and sensation to rich contextual tasks and occupations, one step at a time.                

Have the patient imagining opening a jar of marinara sauce and progress the steps until you have the patient imagine the sound of the jar popping open while they are physically turning the lid and absorbing the smell of the marinara sauce filling their nose.

Open jars of marinara example to help you learn how to use step 2 of the graded motor imagery continuum, explicit motor imagery, with our OT patients that have had stroke or pain to get great results! |


Is this imagery clear toYOU?

🔑 One key is having the patient successfully complete step 1, Laterality Training, before moving on to step 2, Explicit Motor Imagery in the Graded Motor Imagery Continuum.

⬇️ Learn Practical Examples of How to Use Explicit Motor Imagery With Your OT Patients!

In the OT Flourish membership, we go over step-by-step how to integrate this strategy into your occupational therapy practice to get even better results with your patients that have had a stroke – check out the membership here


Ji EK, Wang HH, Jung SJ, et al. Graded motor imagery training as a home exercise program for upper limb motor function in patients with chronic stroke: A randomized controlled trial. Medicine (Baltimore). 2021;100(3):e24351. doi:10.1097/MD.0000000000024351

Neural plasticity during motor learning with motor imagery practice: Review and perspectives

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