Katie and Sheralyn recently attended a workshop presented by NOI Group founder David Butler. NOI Group is an organisation that treats and teaches pain. The course was aimed at presenting the graded motor imagery (GMI) rehabilitation program which can be applied to patients who have Chronic Regional Pain Syndrome (CRPS), phantom limb pain and brachial plexus injuries.

The GMI program is aimed at reducing pain levels through stimulating and training the brain. David informed us that as pain is an output of the brain, it is the target organ of the intervention and through exercising the brain in the right fashion we can improve patient comfort. If moving the limb causes excessive levels of pain the aim of GMI is to stimulate the same areas of the brain used in actual movement but in a very gentle manner.

The first stage of GMI involves assessing implicit motor imagery which is the ability to tell left from right which stimulates the motor cortex in the brain without overloading it. Once the patient become adept at left/right judgements they then can progress to the next stage of the GMI program.

The next stage is explicit motor imagery which increases the demands on the motor cortex of the brain. Through imagining movements in this stage the brain can be stimulated to imagining the limb is moving without causing as much pain as physically moving the limb. Once this stage has been mastered the last and final stage can be implemented.

The final stage is the use of a mirror to use magic to trick the brain into presenting a “normal” limb as the affected limb is hidden from view. Once the brain can cope with the increasing demands, we can then commence real movements of the limb.

If you have been diagnosed with CRPS in your upper limb, had an amputation in the upper limb or a brachial plexus injury, please call Sunshine Coast Hand Therapy to schedule an appointment if you think the GMI program could help you.


“We don’t see the world as it is, we see it as we are” – Ana Nin