noigroup logo

Flashback Fridays -Laterality intact, but a touch of dysynchiria

By Timothy Cocks Uncategorized 20 Jun 2014

Laterality intact, but a touch of dysynchiria

Our friend Hardy the fireman, fell through a plate glass window and managed slice up his RIGHT forearm including a few tendons and the median nerve. His arm has been surgically repaired and is looking good at the 4 week stage. I was interested to see if there were any laterality deficits.

We ran the Recognise Online laterality programme. I ran it 3 times with 20 vanilla hand images by 5 seconds (therefore randomly picked left and right images came up sequentially on the screen to be identified as left or right).

Hardy did well. By the third test he was equal left and right in speed and accuracy of recognition. In the first two trials it took him longer to recognise LEFT hand images (over 1 second difference) and he was inaccurate recognizing LEFT sided images (60% LEFT compared with 90% RIGHT).

These results are worth a thought. In a CRPS state the opposite would be expected, i.e. difficulty and slowness recognizing an image of the painful/injured side (G. L. Moseley, 2004; Schwoebel et al., 2002) so I initially expected Hardy would have had similar responses if there was any left/right variation. Interestingly, in studies of acute experimental pain (G. L. Moseley et al., 2005), and expectation of pain responses (Hudson et al., 2006), this also occurs, suggesting a focus on the injured/painful side as opposed to the neglect often seen in CRPS.

Hardy was pretty cool with the whole arm problem, and although he was off work, he was not that concerned by it and could see he was making progress, or said another way, I thought that he wasn’t letting it get to him.

While it would be nice to know what these findings meant in terms of outcomes via research, my initial thoughts were that at this stage that Hardy didn’t need any graded motor imagery and he was progressing quite “normally”.

We tried a mirror box and noted that he experienced pain in the injured hand which was not moved (i.e. the one hidden in the mirror box). This phenomenon is called dysynchiria and its probably the best example of pain really being in the brain (Acerra & Moseley, 2005). I will discuss dysynchiria in later blogs.

David Butler

September 12 2007

Check the original post for a list of mentioned references


Dysynchiria is a pretty amazing phenomenon when you think about it. While it’s not pleasant, and can be a bit frightening and off putting for the person experiencing it (and the therapist), as David mentioned in his post, it can be a powerful example of the notion of pain as an output, pain as a construct of a human being.

There’s powerful therapeutic narrative here too; understanding dysynchiria and being able to tell the story of the brain in pain, neurotags and brain changes may very well power-up a GMI intervention – it might even act as a “convincer” for a client still a little skeptical about how “looking at pictures of hands is going to help my pain.”

-Tim Cocks



David Butler and Graded Motor Imagery hit Adelaide on 18 July 2014 – check out the course flyer. Our  noigroup courses page let’s you search for course type and region and of course you can access the finest Explain Pain and GMI resources at our products page.


  1. Timely flashback, Tim; thanks! I have a veteran now, with CRPS, using the mirror. While many other variables are certainly at play as well, he had noticed increases in pain to his unaffected foot and hip (he is performing mirror movements for his foot, but does have ipsilateral hip and low back pain).

    Would dysynchria refer only to sensations felt during mirrored movement, or could the pain surely continue on beyond the mirrored movements… potentially creating mirror pain(s)?

    1. In my clinical experiences Wesley yes……In my reality, the brain is “A free spirit” and, quite honestly can create what ever it wants. How else would we have got to the moon, or already be on our way home from the World Cup !!!!!!! It comes back to the fact that what ever the patient experiences it is their truth, happening in their world, created by their “Self” protection …….
      DB London

Your email address will not be published. Required fields are marked *


Product was added to cart.