Tag Archives: Graded motor imagery

21Oct/13
Hippocampus

How do you know where you are? | Neil Burgess speaks

HippocampusIt is useful to know where you are. Neil Burgess spends his time studying this important function by looking at the brain, the hippocampus to be specific.

It would appear that the same brain cells that create our sense of where we are and recalling that information for practical use are also at play when we imagine movement, such as a motor imagery task for a painful condition.

21Oct/12
Strictly come dancing 2012

Groove is in the brain – watching strictly come dancing to exercise those neurons

Strictly Come Dancing is great entertainment. Increasingly I have been drawn into watching the professional dancers and admiring their immense skill and body control. The precision, posturing and awareness, blending with glamour, grace and such defined movement demonstrates perfectly the art of motion to music.

The celebrities have a mix of backgrounds, some clearly having had previous experience of dance. Despite this, they are all having to learn a specific routine that must be taught, learned and practiced. The rehabilitation of a painful condition or injury necessitates training of normal movement and motor control, following a similar pattern to the celebs in many respects.

When we watch the dancers, we are actually being more active than you may think. Our brains are very active and in a way that is similar to when we would actually be moving. In other words, our motor systems are provoked into action by observing someone else move. For those in pain with a certain level of sensitivity, the initiation of activity in the motor areas in this way can be actually be enough to elicit a painful response. As a test, I sometimes ask a patient to watch me move to see how they respond. Not uncommonly they wince, feel a pang of pain or demonstrate an aversive response. And these are all very real experiences that people are having each day. Sitting having a coffee and watching a delivery man carry a box into the cafe may start to prime the nervous and immune systems in relation to movement with resulting discomfort or pain. It may be thought that the sitting position is to blame and indeed this is part of the experience, but so is watching someone else move.

Imagery is used in sport and business for good reason. Research has demonstrated that strength can improve with imagery and Jack Nicklaus famously spoke about his use of imagery for preparation and skill development.  On imagining a movement (motor imagery), the motor system is activated as described above. So either just watching or thinking about the movements of the dancers are not such physically idle activities. Our brains are involved and therefore using opportunities such as watching Strictly or other programmes involving physical activity can form part of the rehabilitation process.

“I never hit a shot even in practice without having a sharp in-focus picture of it in my head. It’s like a colour movie. First, I “see” the ball where I want it to finish, nice and white and sitting up high on the bright green grass. Then the scene quickly changes, and I “see” the ball going there: its path, trajectory, and shape, even its behaviour on landing. Then there’s a sort of fade-out, and the next scene shows me making the kind of swing that will turn the previous images into reality and only at the end of this short private Hollywood spectacular do I select a club and step up to the ball.” Jack Nicklaus

The neurons that underpin this very real experience of observational activity are commonly called ‘mirror neurons’. They were discovered in monkeys a few years ago and have provoked many studies looking at their role in planning movement, watching others, developing relationships and autism. These neurons may make up 30% of the brain. Next time you are chatting to someone, see if either of you start posturing in the same way or indeed yawn together.

When the professionals are demonstrating and teaching the dance moves, see how they position themselves in relation to the celebrity. It makes a difference as some will struggle to ‘see’ and copy the pattern of movement. Watch how they re-orientate themselves in a first person perspective so that the dancer’s right is their right and vice versa. When teaching any new skill we should allow the learner to see from this 1st person perspective, i.e. experience it from their position, e.g. sit alongside so your right is their right. More challenging maybe the 3rd person perspective when they watch you and try and copy the movement having had to manoeuver their body, i.e. watching from the front. This can be used as a progression in rehabilitation, firstly using imagery and then actually performing the exercise.

What is happening? The learner’s brain is mentally rotating their representation of their body (that exists in the cortex) to match that of the teacher. This can be difficult and has certainly been shown to be problematic in certain conditions such as back pain and complex regional pain syndrome (CRPS).

Understanding the activity in the brain when we think about moving, watch others move and actually move allows us to design rehabilitation programmes that fully engage the motor and other allied systems in a range of contexts with progressions to develop the challenge.

So for now, keep on dancing. In your chair.

14Nov/11

Imagery & Mirrors in the news

Many readers will know about mirror box therapy for CRPS and other painful conditions. The Graded Motor Imagery Programme that we use at Specialist Pain Physio is sequential training that starts with laterality, progressing to imagined movements and then to mirror therapy. There is some really good data for the programme and CRPS but it can also be effective with other chronic pains. Interestingly we are now seeing components of GMI being used and written about in the popular press, most recently for Parkinson’s disease and arthritis.

Treat the brain, treat the pain

A brief article in New Scientist describes the Parkinson’s research by David Linden at Cardiff University. 10 subjects were asked to think about movement for 45 minutes whilst they were having brain scans. Five of the subjects were given feedback that showed them how they were activating the brain and all were asked to practice the imagery at home. Two months later rigidity and tremor had reduced some 37% in the feedback group. The thinking is that there is cortical change underpinning this improved function that is feasible.

Mirror therapy for pain

At The Society for Neuroscience annual meeting 2011 a small study was performed with arthritis (OA & RA) patients used mirror therapy. Subjects observed the moving reflection of the researcher’s hand in the mirror whilst producing the same movement themselves with their hidden hand. After 1 minute it was noted that the subjects pain improved. This was reported in The Guardian today.