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The Graded Motor Imagery Handbook G The Graded Motor Imagery Handbook G. Lorimer Moseley David S. Butler Timothy B. Beames Thomas J. Giles G. Lorimer Moseley Lorimer’s interests lie in the role of the brain and mind in chronic pain. He is a clinical scientist with a PhD from Sydney University. After posts at Oxford University, UK, and Neuroscience Research Australia, Sydney, he is now Professor of Clinical Neurosciences and the Inaugural Chair in Physiotherapy at the University of South Australia, Adelaide. He has given over 50 plenary talks in 25 countries and has published over 100 scholarly works. David S. Butler David is an educationalist, author and clinician who dabbles in research. He is a director of NOI, has taught regularly around the world for 25 years and is author of four pain related textbooks. He has an education doctorate from Flinders University and has a particular interest in changing professional and public views on pain treatment. Timothy B. Beames Tim is the principal NOI instructor in the UK and a zappy speaker. With a Masters in Pain: Sciences and Society from King’s College, London, he aims to bring a better understanding of pain and the interaction of biological, psychological and social elements with an individual’s pain experience to patients, clinicians and the public. Thomas J. Giles Tom is an integral part of the GMI toolbox development team and is the NOI go-to man for users who want to get the best out of the programme. A part-time nerd, he also has an international marketing degree and he continues to refine and develop the programme, assist with facilitating research and informing the public about GMI. The Graded Motor Imagery Handbook G. Lorimer Moseley David S. Butler Timothy B. Beames Thomas J. Giles Noigroup Publications Adelaide, Australia, 2012 www.noigroup.com www.gradedmotorimagery.com www.noigroup.com/recognise Published by Noigroup Publications for NOI Australasia, Pty Ltd. Printed and bound in Adelaide, Australia. Copyright © 2012 Noigroup Publications. Noigroup Publications NOI Australasia Pty Ltd All rights reserved. No part of this publication may be reproduced, 19 North Street, Adelaide City West, stored in a retrieval system or transmitted in any form or by South Australia 5000 any means, electronic, mechanical, photocopying, recording or www.noigroup.com otherwise, without the prior written permission from the publisher, Telephone +61 (0)8 8211 6388 except for brief quotations embodied in critical articles and reviews. Facsimile +61 (0)8 8211 8909 The procedures and practices described in this book should be [email protected] implemented in a manner consistent with professional standards set for the circumstances that apply in each situation. Every effort has been made to confirm accuracy of the information presented and to correctly relate generally accepted practices. The authors, editor and publisher cannot accept responsibility for errors or exclusions or for the outcome of the application of the material presented herein. There is no expressed or implied warranty of this book or information imparted by it. National Library of Australia A catalogue record for this book is available from the National Library of Australia State Library of South Australia A catalogue record for this book is available from the State Library of South Australia. Moseley, G. Lorimer, Butler, David S., Beames, Tim B., Giles, Tom J. The Graded Motor Imagery Handbook First edition 2012 Includes index ISBN 978-0-9872467-5-2 Paper stock credentials: Barry Bleach board 285gsm, Impact 135gsm Acknowledgements We would like to thank the production team at NOI HQ – the design team Paula Filippone and Ariane Allchurch, editor Juliet Gore, research Kat Waterman, accounts Karin Kosiol, dispatch and customer service Tara Gagliardi, as well as Dan Tomkins for his great artwork and Halton Stewart for his ongoing enthusiasm and innovation in developing computer-based tools. But mostly, we want to thank the very large number of patients who tried out various forms of GMI during its development, or who participated in experiments and clinical trials on it once it was developed and the community of clinicians who continually feed back their experiences of GMI in the real world so that we can keep working towards better outcomes for people in pain. page 1 Knowledge – The power behind Graded Motor Imagery David S. Butler Contents page 21 Background, theory and evidence for Graded Motor Imagery G. Lorimer Moseley page 57 Treatment through Graded Motor Imagery Timothy B. Beames page 99 Helping the Graded Motor Imagery process with stories and metaphors David S. Butler page 121 The Graded Motor Imagery toolbox Thomas J. Giles page 146 Index 1 Introduction page 3 1.1 Knowledge and reasoning Knowledge – The power behind Graded Motor Imagery David S. Butler 2 A special kind of knowledge for GMI users page 5 2.1 What is in the handbook? 2.2 The paradigms that underpin our work 3 The idea of knowledge as context page 7 4 Some science behind gaining knowledge page 7 4.1 Knowledge enrichment and conceptual challenges 4.2 Grains of unhelpful and incorrect information 4.3 Deep knowledge is better than superficial knowledge 4.4 ‘Out of the shadows learning’ 5 A knowledge contract page 15 References page 16 1. INTRODUCTION vulnerable to misuse. It can be hard work. The treatment C1 requires careful tailoring to individual patients and cannot I’m a physiotherapist by trade and ever since I graduated 3 exist alone without education, interdisciplinary support and www.noigroup.com knowledge - The power behind Graded Motor Imagery back in 1978, I have encountered a group of patients who an effective therapeutic relationship. have defied any therapeutic attempts – be they surgical, pharmacological or any of the numerous strategies that This handbook is aimed at clinicians, those suffering with the rehabilitation world offers. And as if to taunt me they neuropathic pain, their friends and family and those who would say things like ‘my arm doesn’t feel like mine’ pay the bills. We have written this handbook because or ‘it hurts when I think of moving’ or the pain would we know from basic sciences, clinical trials and repeated move around their body and you could never catch it. anecdotal reports that GMI is a worthwhile treatment. Vagueness was a symptom in itself and it was difficult to While it is a complex technique, we want you the user see past my frustration to what lay behind the patient’s (clinician and patient) to do it as well as you can. Let’s start vagueness. I am glad I am still a physio, still involved in by helping you build a platform of powerful knowledge on rehabilitation because I believe I have just caught a new which to base the treatment. era in rehabilitation science – a refreshed biopsychosocial approach increasingly powered by the neuroimmune science revolution. Graded Motor Imagery (GMI) is now 1.1 KNOWLEDGE AND REASONING a part of that revolution, not only as a series of novel Now Lorimer is a smart chap – you can see that by all treatment strategies, but also an increasing reminder his writings and research and musings and the fact that that the representation of body in the brain should be we have come far enough to write a GMI handbook GMI hand considered in all patients. It also informs us that we is due to his research, the research work of those who book (clinicians and patients) can and must lift our expectations came earlier11,12,15 and the many who he has encouraged of outcome. to research. I also know he gets a bit ratty with me for Graded Motor Imagery is a complex series of treatments wanting to take research into the clinic as soon as possible. including graded left/right judgement exercises, imagined Researchers love to say ‘this requires more research’ after movements and use of mirrors targeting neuropathic pain their papers, or ‘this shouldn’t be taken to the clinic just problems. These problems include states such as complex yet’. Such a cautious lot - And as if we can wait! There is regional pain syndrome (CRPS) where in the past there other science however that we (patients and clinicians) was little effective therapy to offer. But the GMI treatments can use and this is clinical reasoning science. Tim has had (let’s not call it a programme as they are not preset) are classical training and vast experience in clinical decision making related to the use of GMI and you can see this C1 in his chapter. All contributors to this manual argue that and the gaining of this knowledge is the real power behind 4 in the absence of a great deal of research which guides the reasoning and GMI outcomes. While there are no trials Knowledge - The power behind Graded Motor Imagery www.noigroup.com clinical practice, we require a high level of clinical decision available (yet) which support the notion that knowledge making skills to get the best out of GMI. In other words, for influences the outcomes of GMI, all contributors to this many chronic pain states we are a long way from having handbook believe that the amount, quality and use of clear guidelines or a simple recipe to follow. For example, knowledge is critical. While a positive relationship between there are clear guidelines available for the management of knowledge and outcome may be common sense, it is also diabetes or rheumatoid arthritis but this is not so for some supported by studies which show that explaining biology of the persistent pain states that readers have to deal with. such as we do in Explain Pain1, can have a beneficial It is all made more difficult too, as the clinical presentations outcome on exercise10.
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