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What is Graded Motor Imagery?

By Timothy Cocks Graded Motor Imagery 31 Oct 2014

We’ve just released our latest video about GMI onto YouTube. This is in “patient language” and we hope it can be used as an introduction for people considering this treatment approach (and their therapists).

Find more GMI resources and GMI courses for health professionals at

– Tim Cocks


  1. davidbutler0noi

    Thanks for posting this Tim,

    GMI has been an interesting process for us. I have noticed that the take up of GMI has been strongly patient driven, rather than clinician driven. This means that patients and families have become aware of GMI and pushed clinicians to take more notice. The first GMI trials are now 10 years old. Change comes slowly but I think clips like this really help.


  2. Hi all,

    I’d like to see a comparison of GMI and body mindfulness training. I think that would be a very meaningful study.

    I say this because I have always had a feeling that GMI works because the 3 exercises train the client to be mindful of the body (directly or indirectly). I feel like the inability to discriminate left/right is simply a symptom of very poor body awareness. The chronically painful body is rejected by the mind, so no wonder it’s hard to tell left from right.

    What do you guys think of that possibility? Reasonable?

    Some good studies on how body awareness (meditation) affects gene expression and inflammation:


    1. Hey EG

      Such an important point – as Dave mentions – if only there was the money! I think there has to be a component of becoming more aware of the body in the benefits of GMI. I think Alva Noë’s and Kevin O’Regan’s work may be relevant here – notions of consciousness being something that we ‘do’ through ‘skilled access to the world’, which may be disrupted by injury, pain, altered nervous system function and so on. This is perhaps subtly different from the idea that the “chronically painful body is rejected by the mind” (which implies a mind/body dualism. Also i don’t think ‘bodies’ hurt – people hurt…). Pure speculation, but, perhaps an injury that leads to pain and altered nervous system function leads to a reduction in skilled access to the world – a reduced ability to ‘do’ consciousness and a reduced ability to accurately ‘be in the world’ (after Noë). Again, just speculation on my part having read and Noeë and O’Regan and having sympathy for their views. Unfortunately, neither have said much about pain.

      Not quite what you were asking for, but Lorimer has done some clever work with GMI, trying to tease out the mechanisms of benefit. This RCT,, varied the order of the GMI stages to determine whether the effects were due to sustained attention to the effected limb (so moving towards to what you are getting at, but not quite “mindfulness” per se). The results demonstrated that the order of GMI was important, suggesting that it was the progressive activation of the pre-motor cortex then motor cortex that imparts the benefit (in patients with CRPS of the upper limb). Speculating again, perhaps this graded activation of the pre-motor and motor cortices retrains skillful access to the world and skillful ‘be’ing and doing consciousness. Why any of this makes people hurt is perhaps an even curlier question!

      As always, great to have your thought provoking ideas and comments to push and extend my thinking.

      1. Thanks Tim,

        I think that study is very useful. Whilst the underlying mechanisms may relate to attention and re-embodiment, the style and type of attention is obviously important.

        “Everywhere I go, I find a Mosley has been there before me”. Apologies to Freud. ; )


  3. davidbutler0noi

    Hi EG,

    I wish there was research money for all that, but even then there would need to some consensus on what is actually being researched. Re-embodiment is probably the basis of many therapies and the stages of GMI. I find those with mindfulness skills ( and hypnosis, meditation, counselling, coaching etc skills) are really great at the GMI skills especially the explicit motor imagery. I have learnt a lot from skilled psychologists in this field. Someone said to me once during a course demo -“you are doing mindfulness”- “Thanks I said – that will save me going to another course”

    I also think it is the attaching and integration of these re-embodiment strategies to effective education and functional and occupational exposure which is critical.



  4. Thanks Dave,

    I have to use that word a bit more… re-embodiment. It’s a good description. I take your point that maybe this is how traditional physical therapies work. Poking someone’s lower back will cause him to pay attention to the area being poked. Attention should automatically translate into embodiment. So long as the stimulus isn’t painful, then the risk of aversion will be minimized. Attention with a negative evaluation would be aggravating to pain.

    For quite a few years I have used non-painful techniques. Lately I have been wondering about the usefulness of provoking some pain (the idea of “P1/P2” useful here) and asking the client to pay careful attention to the pain without judging it as “bad/wrong”. I have to get back to that and give it another run.

    Regards, EG.

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