To evaluate the therapeutic benefits of motor imagery (MI) for the people with spinal cord injury (SCI).
We searched electronic bibliographic databases, trial registers, and relevant reference lists. The review included experimental and quasi-experimental study designs as well as observational studies. For the critical appraisal of the 18 studies retrieved (three RCT, seven quasi-RCT, eight observational), we used instruments from the Joanna Briggs Institute. The primary outcome measure was pain. Secondary outcome measures included motor function and neurophysiological parameters. Adverse effects were extracted if reported in the included studies. Because of data heterogeneity, only a qualitative synthesis is offered.
The included studies involved 282 patients. In most, results were an improvement in motor function and decreased pain; however, some reported no effect or an increase in pain. Although protocols of MI intervention were heterogeneous, sessions of 8–20 min were used for pain treatments, and of 30–60 min were used for motor function improvement. Neurophysiological measurements showed changes in brain region activation and excitability imposed by SCI, which were partially recovered by MI interventions. No serious adverse effects were reported.
High heterogeneity in the SCI population, MI interventions, and outcomes measured makes it difficult to judge the therapeutic effects and best MI intervention protocol, especially for people with SCI with neuropathic pain. Further clinical trials evaluating MI intervention as adjunct therapy for pain in SCI patients are warranted.
Subscribe to Journal
Get full journal access for 1 year
only $30.08 per issue
All prices are NET prices.
VAT will be added later in the checkout.
Rent or Buy article
Get time limited or full article access on ReadCube.
All prices are NET prices.
The datasets generated during the current study are available from the corresponding author upon request.
Finnerup NB. Pain in patients with spinal cord injury. Pain. 2013;154:S71–6.
Mahnig S, Landmann G, Stockinger L, Opsommer E. Pain assessment according to the International Spinal Cord Injury Pain classification in patients with spinal cord injury referred to a multidisciplinary pain center. Spinal Cord. 2016;54:809–15.
Siddall PJ, McClelland JM, Rutkowski SB, Cousins MJ. A longitudinal study of the prevalence and characteristics of pain in the first 5 years following spinal cord injury. Pain. 2003;103:249–57.
Finnerup NB, Baastrup C. Spinal cord injury pain: mechanisms and management. Curr Pain Headache Rep. 2012;16:207–16.
Finnerup NB, Attal N, Haroutounian S, McNicol E, Baron R, Dworkin RH, et al. Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis. Lancet Neurol. 2015;6:70251–0.
Tsubokawa T, Katayama Y, Yamamoto T, Hirayama T, Koyama S. Treatment of thalamic pain by chronic motor cortex stimulation. Pacing Clin Electrophysiol. 1991;14:131–4.
Le Dean Y, Brissebrat B, Castel-Lacanal E, De Boissezon X, Marque P. Management of neuropathic central pain by non-invasive brain stimulation and mirror therapy. Ann Phys Rehabil Med. 2016;59S:e145.
Di Rienzo F, Collet C, Hoyek N, Guillot A. Impact of neurologic deficits on motor imagery: a systematic review of clinical evaluations. Neuropsychol Rev. 2014;24:116–47.
Alkadhi H, Brugger P, Boendermaker SH, Crelier G, Curt A, Hepp-Reymond MC, et al. What disconnection tells about motor imagery: evidence from paraplegic patients. Cereb Cortex. 2005;15:131–40.
Moseley GL. Using visual illusion to reduce at-level neuropathic pain in paraplegia. Pain. 2007;130:294–8.
Gustin SM, Wrigley PJ, Henderson LA, Siddall PJ. Brain circuitry underlying pain in response to imagined movement in people with spinal cord injury. Pain. 2010;148:438–45.
Opsommer E, Korogod N. Mental practice for chronic pain in people with spinal cord injury: a systematic review protocol. JBI database Syst Rev Implement Rep. 2017;15:2004–12.
Barclay-Goddard RE, Stevenson TJ, Poluha W, Thalman L. Mental practice for treating upper extremity deficits in individuals with hemiparesis after stroke. Cochrane Database of Systematic Reviews. 2011;2011:CD005950.
Malouin F, Richards CL. Mental practice for relearning locomotor skills. Phys Ther. 2010;90:240–51.
Dickstein R, Deutsch J. Motor imagery in physical therapist practice. Phys Ther. 2007;87:942–53.
Schuster C, Hilfiker R, Amft O, Scheidhauer A, Andrews B, Butler J, et al. Best practice for motor imagery: a systematic literature review on motor imagery training elements in five different disciplines. BMC Med. 2011;9:75.
Hanakawa T, Immisch I, Toma K, Dimyan MA, Van Gelderen P, Hallett M. Functional properties of brain areas associated with motor execution and imagery. J Neurophysiol. 2003;89:989–1002.
Gentili R, Han CE, Schweighofer N, Papaxanthis C. Motor learning without doing: trial-by-trial improvement in motor performance during mental training. J Neurophysiol. 2010;104:774–83.
Cocks M, Moulton CA, Luu S, Cil T. What surgeons can learn from athletes: mental practice in sports and surgery. J surgical Educ. 2014;71:262–9.
Cramer SC, Orr EL, Cohen MJ, Lacourse MG. Effects of motor imagery training after chronic, complete spinal cord injury. Exp brain Res. 2007;177:233–42.
Grangeon M, Guillot A, Sancho PO, Picot M, Revol P, Rode G, et al. Rehabilitation of the elbow extension with motor imagery in a patient with quadriplegia after tendon transfer. Arch Phys Med Rehabil. 2010;91:1143–6.
Braun S, Kleynen M, van Heel T, Kruithof N, Wade D, Beurskens A. The effects of mental practice in neurological rehabilitation; a systematic review and meta-analysis. Front Hum Neurosci. 2013;7:390.
Soler MD, Kumru H, Pelayo R, Vidal J, Tormos JM, Fregni F, et al. Effectiveness of transcranial direct current stimulation and visual illusion on neuropathic pain in spinal cord injury. Brain. 2010;133:2565–77.
Gustin SM, Wrigley PJ, Gandevia SC, Middleton JW, Henderson LA, Siddall PJ. Movement imagery increases pain in people with neuropathic pain following complete thoracic spinal cord injury. Pain. 2008;137:237–44.
Roosink M, Robitaille N, Jackson PL, Bouyer LJ, Mercier C. Interactive virtual feedback improves gait motor imagery after spinal cord injury: an exploratory study. Restor Neurol Neurosci. 2016;34:227–35.
Cohen SP, Mao J. Neuropathic pain: mechanisms and their clinical implications. BMJ. 2014;348:f7656.
Scandola M, Aglioti SM, Pozeg P, Avesani R, Moro V. Motor imagery in spinal cord injured people is modulated by somatotopic coding, perspective taking, and post-lesional chronic pain. J Neuropsychol. 2017;11:305–26. https://doi.org/10.1111/jnp.12098.
Malouin F, Richards CL, Jackson PL, Lafleur MF, Durand A, Doyon J. The Kinesthetic and Visual Imagery Questionnaire (KVIQ) for assessing motor imagery in persons with physical disabilities: a reliability and construct validity study. J Neurol Phys Ther. 2007;31:20–9.
Aikat R, Dua V. Mental imagery in spinal cord injury: a systematic review. J Spine. 2016;5:1–8.
Institute JB. Joanna Briggs institute reviewers’ manual. Adelaide: The Joanna Briggs Institute; 2014.
Dworkin RH, Turk DC, Farrar JT, Haythornthwaite JA, Jensen MP, Katz NP, et al. Core outcome measures for chronic pain clinical trials: IMMPACT recommendations. Pain. 2005;113:9–19.
Grangeon M, Revol P, Guillot A, Rode G, Collet C. Could motor imagery be effective in upper limb rehabilitation of individuals with spinal cord injury? A case study. Spinal Cord. 2012;50:766–71.
Katayama O, Iki H, Sawa S, Osumi M, Morioka S. The effect of virtual visual feedback on supernumerary phantom limb pain in a patient with high cervical cord injury: a single-case design study. Neurocase. 2015;21:786–92.
Kumru H, Soler D, Vidal J, Navarro X, Tormos JM, Pascual-Leone A, et al. The effects of transcranial direct current stimulation with visual illusion in neuropathic pain due to spinal cord injury: an evoked potentials and quantitative thermal testing study. Eur J Pain. 2013;17:55–66.
Mateo S, Di Rienzo F, Reilly KT, Revol P, Delpuech C, Daligault S, et al. Improvement of grasping after motor imagery in C6-C7 tetraplegia: a kinematic and MEG pilot study. Restor Neurol Neurosci. 2015;33:543–55.
Onose G, Grozea C, Anghelescu A, Daia C, Sinescu CJ, Ciurea AV, et al. On the feasibility of using motor imagery EEG-based brain-computer interface in chronic tetraplegics for assistive robotic arm control: a clinical test and long-term post-trial follow-up. Spinal Cord. 2012;50:599–608.
Salisbury DB, Parsons TD, Monden KR, Trost Z, Driver SJ. Brain-computer interface for individuals after spinal cord injury. Rehabil Psychol. 2016;61:435–41.
Sharp KG, Gramer R, Butler L, Cramer SC, Hade E, Page SJ. Effect of overground training augmented by mental practice on gait velocity in chronic, incomplete spinal cord injury. Arch Phys Med Rehabil. 2014;95:615–21.
Sumitani M, Miyauchi S, McCabe CS, Shibata M, Maeda L, Saitoh Y, et al. Mirror visual feedback alleviates deafferentation pain, depending on qualitative aspects of the pain: a preliminary report. Rheumatol. 2008;47:1038–43.
Vuckovic A, Hasan M, Osuagwu B, Fraser M, Allan D, Conway B, et al. The influence of central neuropathic pain in paraplegic patients on performance of a motor imagery based Brain Computer Interface. Clin Neurophysiol. 2015;126:2170–80.
Xu R, Jiang N, Vuckovic A, Hasan M, Mrachacz-Kersting N, Allan D et al. Movement-related cortical potentials in paraplegic patients: abnormal patterns and considerations for BCI-rehabilitation. Front Neuroeng. 2014;7:35. https://doi.org/10.3389/fneng.2014.00035.
Richardson EJ, McKinley EC, Rahman A, Klebine P, Redden DT, Richards JS. Effects of virtual walking on spinal cord injury-related neuropathic pain: a randomized, controlled trial. Rehabil Psychol. 2019;64:13–24.
Siddall P, Yezierski BKJR, Loeser JD. Taxonomy and epidemiology of spinal cord injury pain. In: Yezierski B, editor. Progress in pain research and management. vol. 23. Seattle: IAP Press; 2002. p. 9–23.
Bryce TN, Ragnarsson KT. Pain after spinal cord injury. Phys Med Rehabil Clin North Am. 2000;11:157–68.
Guillot A, Di Rienzo F, Collet C. The neurofunctional architecture of motor imagery. In: Advanced brain neuroimaging topics in health and disease—methods and applications. London: IntechOpen; 2014. p. 433–56. https://www.intechopen.com/books/advanced-brain-neuroimaging-topics-in-health-and-disease-methods-and-applications/the-neurofunctional-architecture-of-motor-imagery.
Kasess CH, Windischberger C, Cunnington R, Lanzenberger R, Pezawas L, Moser E. The suppressive influence of SMA on M1 in motor imagery revealed by fMRI and dynamic causal modeling. NeuroImage. 2008;40:828–37.
Ferchichi S, Opsommer E. La pratique mentale pour la rééducation suite à un accident vasculaire cérébral. Un complément aux interventions conventionnelles pour la récupération de la fonction. Kinésithér Rev. 2015;15:38–44.
Jensen MP, Karoly P. Self-report scales and procedures for assessing pain in adults. In: Turk DC, Melzack RE, editors. Handbook of pain assessment. New York, NY, US: The Guilford Press; 2011. p. 11–44.
Yap BWD, Lim ECW. The effects of motor imagery on pain and range of motion in musculoskeletal disorders: a systematic review using meta-analysis. Clin J Pain. 2019;35:87–99.
Bryce TN, Biering-Sorensen F, Finnerup NB, Cardenas DD, Defrin R, Lundeberg T, et al. International spinal cord injury pain classification: part I. Backgr Description Spinal Cord. 2012;50:413–7.
Landmann G, Berger MF, Stockinger L, Opsommer E. Usefulness of laser-evoked potentials and quantitative sensory testing in the diagnosis of neuropathic spinal cord injury pain: a multiple case study. Spinal Cord. 2017;55:575–82.
Tabrizi YM, Mazhari S, Nazari MA, Zangiabadi N, Sheibani V. Abnormalities of motor imagery and relationship with depressive symptoms in mildly disabling relapsing-remitting multiple sclerosis. J Neurol Phys Ther. 2014;38:111–8.
Bennabi D, Monnin J, Haffen E, Carvalho N, Vandel P, Pozzo T, et al. Motor imagery in unipolar major depression. Front Behav Neurosci. 2014;8:413.
Thomschewski A, Strohlein A, Langthaler PB, Schmid E, Potthoff J, Holler P, et al. Imagine there is no plegia. mental motor imagery difficulties in patients with traumatic spinal cord injury. Front Neurosci. 2017;11:689.
Harris AJ. Cortical origin of pathological pain. Lancet. 1999;354:1464–6.
Haanpää M, Attal N, Backonja M, Baron R, Bennett M, Bouhassira D, et al. NeuPSIG guidelines on neuropathic pain assessment. PAIN. 2011;152:14–27.
Olbrich S, Arns M. EEG biomarkers in major depressive disorder: discriminative power and prediction of treatment response. Int Rev Psychiatry. 2013;25:604–18.
Milton J, Small SL, Solodkin A. Imaging motor imagery: methodological issues related to expertise. Methods. 2008;45:336–41.
The study was in part supported by a grant from the University of Applied Sciences and Arts Western Switzerland//HES-SO (scientific commission of health) to Emmanuelle Opsommer (73642/S-RAD17–04).
Conflict of interest
The authors declare that they have no conflict of interest.
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Opsommer, E., Chevalley, O. & Korogod, N. Motor imagery for pain and motor function after spinal cord injury: a systematic review. Spinal Cord (2019) doi:10.1038/s41393-019-0390-1