Graded Motor Imagery (GMI) and Mirror Therapy are emerging therapeutic strategies for both musculoskeletal and neurovascular consequences of injury. They integrate established principles of graded exposure and response prevention with the current theories in the neuroscience of pain and neuroplasticity. Graded Motor Imagery is a sequential process consisting of laterality training, imagery and mirror therapy. These techniques are delivered sequentially but require a flexible approach from the patient and clinician to move forwards, backwards and sideways in the treatment process to suit the individual, which targets the synapsis in the brain. These strategies are supported by new evidence, showing the cortical reorganization of the brain improving with Graded Motor Imagery. The interplay between the brain and the body is most important to understand and to assist in designing a rehabilitation technique that can “rewire the brain”. This lecture will present a model to understand the role of the brain and ways to use a “top down’’ treatment program to treat the changes that occur in the brain.
Susan W. Stralka, PT, DPT, MS, is a licensed physical therapist with many years of experience treating both musculoskeletal and neurovascular consequences of injury. She earned her bachelor's degree, master's degree, and Doctorate in Physical Therapy from The University of Tennessee Health Sciences Center in Memphis, Tennessee (UTHSC). She has a strong clinical background in treating neurological and musculoskeletal consequences of injury. Susan has presented nationally and internationally in upper and lower extremity dysfunctions as well as pain management. Susan has written articles on a wide variety of topics related to physical therapy for many national publications and health journals. Her most recent publications are “Graded Motor Imagery” in the Journal of Hand Therapy 2011 and a chapter on "Thoracic Outlet Syndrome" in the book entitled Neck and Arm Pain Syndromes by Elsevier in 2011. Ms. Stralka is very active in the community with the Germantown Chamber of Commerce, Germantown Rotary Club and Girls Inc. as well as with many other civic organizations. She has held numerous state and national offices with the American Physical Therapy Association (APTA) and the Arthritis Association. In 2009, Susan was recognized by the Arthritis Association as Volunteer of the Year. With the goal of providing the best rehabilitative care to patients, Stralka continually recruits and supports innovative clinical programs to benefit future patients.
Recognize neuroplasticity as a potential target for therapist to utilize in developing treatment for persistent pain. Outline the events showing that pain is an output of the brain. Correlate Melzack’s Neuromatrix when developing therapeutic goals.
Critique why pain is a complex process. Compare the pain mechanisms with clinical symptoms. Identify the ways to differentiate allodynia from hyperalgesia.
Explain the Bio-psycho-social approach involved in patient care. Compare the bio-psycho –social approach with the biological medical approach.
Identify the practical application of Graded Motor Imagery for various neurovascular and musculoskeletal injuries. Integrate the use of laterality or right/left identification, imagery, and mirror therapy into plan for retraining the brain. Verify the progression of moving from laterality to imagery.
Connect the clinical evidence of utilization of Graded Motor Imagery in retraining the brain. Recognize the clinical patterns of central sensitization. Analyze why Graded Motor Imagery is a therapeutic model to use for treating Phantom Limb Pain.
Describe why therapeutic neuroscience education is necessary in understanding a patient’s diagnosis. Compare top down education to bottom up education in achieving therapeutic goals.