Rewiring the Brain: The Importance of Motor Imagery for Movement Retraining After a Stroke

In this short video, Registered Nurse Adam Henley briefly reviews the importance of visualization when relearning movement patterns in the first weeks after a stroke.

Many times, people lose the ability to move some part of their body or face after a stroke. The first two weeks are marked by brain inflammation and significant disability. However, in the first month after a stroke, the brain begins a remarkable process of rewiring and reorganizing to regain lost motor functions.

Motor functions include muscle movements, either consciously controlled by the brain or instinctual reflexes. Motor control primarily represents the brain’s regulation of these movements.

One technique that has shown great potential in restoring motor control after a stroke is motor imagery. This blog post delves into the important role for motor imagery after a stroke and explores the underlying neuroscience, particularly the involvement of the pre-motor cortex.

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What is Motor Imagery?

Motor imagery occurs when we mentally rehearse a movement without actually performing it. In this way, it is a thinking (a.k.a. cognitive) process where you mentally simulate a movement or action without physically performing it.

When practicing motor imagery, the brain acts as if the movement was actually being performed. The same neural pathways that guide movement would be activated, whether or not the body moves. That is why this technique is commonly performed in sports and rehabilitation settings to enhance performance and facilitate motor learning.

The Neuroscience of Motor Imagery

The pre-motor cortex is a key area of the brain involved in motor imagery. It is responsible for planning and executing movements and is closely connected to the primary motor cortex (M1), which is responsible for the actual execution of movements.

When an individual engages in motor imagery, the pre-motor cortex is activated, and the same neural networks are engaged as if the movement was being physically performed.

Role of Motor Imagery in Movement Retraining

After a stroke, the brain reorganizes and forms new connections to compensate for the damage incurred. This process is known as neuroplasticity.

Motor imagery plays a crucial role in regaining movement by:

  1. Increasing neuroplasticity: By activating the same neural pathways as physical movement, motor imagery can promote neuroplasticity and help the brain rewire and reorganize more effectively.
  2. Improving motor function: Studies have shown that combining motor imagery with physical therapies can lead to better outcomes in terms of motor function recovery after a stroke. This may be due to the fact that actions can be practiced, even before they can be safely performed in real-life.
  3. Reducing learned non-use: After a stroke, individuals may develop learned non-use (a.k.a. neglect), where they avoid using an affected side or part of the body due to the difficulty and frustration of performing tasks on the ‘weak side’. Motor imagery can help counteract this by mentally rehearsing movements and encouraging the use of the affected limb.

There are several techniques for incorporating motor imagery into movement retraining after a stroke. Some examples include:

  • Mental practice: This involves mentally rehearsing a specific movement or task (like grasping an object or walking) in your imagination.
  • Mirror therapy: This involves using a mirror to create a visual illusion of moving the affected limb normally, which activates neural pathways involved in motor imagery.
  • Guided imagery: A therapist guides the individual through a series of mental visualizations to help them imagine and rehearse movements.

Overall, motor imagery may improve the effectiveness of physical rehabilitation guided by a health professionals after a stroke. The practice harnesses the brain’s ability to rewire and reorganize through neuroplasticity. By engaging the pre-motor cortex and other key areas of the brain, motor imagery can improve motor function and counteract learned non-use. Incorporating motor imagery into other rehabilitation protocols can also result in better outcomes and improved quality of life for stroke survivors.

The information in this presentation is based on research studies and Canadian guidelines for stroke rehabilitation. To request additional resources or supporting references, please feel free to leave general questions in the comments.

Published by Adam Henley

Adam is a Registered Nurse with experience in chronic disease management, symptom measurement, hematology/oncology, primary care behavioural health and geriatrics. He combines counselling, nutrition & exercise with traditional home nursing care. Adam cares to live health together with clients in a manner consistent with Parse’s Theory of Human Becoming. At the heart of his care, Adam offers evidence-based strategies to transform health together.

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