Imagining: How Graded Motor Imagery Fits
Robert Johnson PT, DPT, OCSImagine having chronic, persistent pain. Twenty to 25% of Americans have it. They cannot find an answer. They have been around the block with their pain, consulting surgeons, therapists, body-workers, chiropractors, acupuncturists, and other specialists. Some have, perhaps, even had their palm read or tried tarot cards. Nothing works for them. No one seems to have the answer. They become confused, angry, frustrated and anxious. The current medical paradigm does not seem to have the answers.
Now imagine a newer medical paradigm, scientifically-based, driven by the emergent psychological and emotional elements of each individual, as well as the physical expressions in the individual’s body. A true body-mind connection. This more recent paradigm combines evidence-based neuroscience, neuro-biology and brain-biology, requiring the need to re-define our current biomedical model to understand chronic, persistent pain.
The nervous system has been inextricably intimately linked to our immune system and inflammatory mechanisms, trying to protect us from ‘threat’. Imagine that. Movement could be considered anti-inflammatory. And yet, most persistent pain patients are afraid to move because it often hurts, even though we all know (deep down) hurt doesn’t equal harm.Imagine Virtual Reality (VR) challenging the nervous system's perception or interpretation of movement, engaging the brain's ‘representation’ of the event: the movement, the sensation or environment. VR combined with a Graded Motor Imagery (GMI) sequence creates the opportunity to ‘therapeutically exercise’ synapses in the brain and spinal cord. This is a top-down approach, changing the systems ‘representation’ of the threat; ultimately, the goal is to change the visual / auditory / cognitive / emotional environment and, thus, the threat of moving. Combining all 3 levels of GMI (laterality, imagery, mirror) into a VR format creates a unique technological application that has great potential in a clinical setting for those with chronic, persistent pain…..Movement is the medicine. Imagine .
Robert Johnson PT, DPT, OCS is Co-Owner of ACHIEVE Manual Physical Therapy in Chicago, IL. He is past Chair of the Orthopedic Specialty Council of the ABPTS, serving on the committee for two consecutive terms from 1999 to 2007. He is a practicing clinician specializing in manual therapy, spinal dysfunction and pain management. He is a former faculty member ofNorthwestern University Medical School. He is Senior lecturer for NOI US, teaching with David Butler / NOI in the area of neurobiology / pain science / clinical neurodynamics and is an advisor to Karuna Labs. Mr. Johnson continues to lead clinically relevant neuro-orthopedic / pain management seminars locally, nationally and internationally.