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GRADED MOTOR IMAGERY
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GMI Clinic · Account
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Use the personal code assigned by your therapist to set up your account.
GMI Clinic · Enrollment
Enter the patient code from your therapist, then create your login. If you opened the link they sent, the code is already filled in.
20 letters and numbers, for example ABCDE-FGHJK-MNPQR-STVWX. Dashes and spaces are optional. Each code works once, for you only.
You opened a clinic-wide enrollment link.
Your account uses a code in the clinic dashboard. Do not enter your name or medical history here.
This account is not linked to a clinic. Enter the patient code from your therapist, or ask the clinic administrator to complete staff setup.
To add patients yourself, turn on “I also treat patients” on the Team tab (uses one seat).
The platform owner sets the clinic name and the seat limit.
For patients without an individual plan, and the starting values for new patients.
GMI Clinic · Staff
Your clinic administrator sent you a personal staff invite link. Create your therapist login below.
Filled in from your invite link: 20 letters and numbers. Each invite works once.
Remap GMI · Platform owner
Create clinics, manage seats, and open the shared photo and imagery-audio tools.
3 to 40 lower-case letters, numbers and dashes. Filled in from the name; it cannot be changed later.
Usually 3 to 15 (1 to 50 allowed). Every active therapist uses one seat. Clinic admins do not use a seat unless they also treat patients, so the first admin can always join.
Code (if the link cannot be opened):
Patient review
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Copy-and-paste notes for the EMR. They use the dates and settings chosen on the Results tab (by default the last 30 days).
Selected review dates · Edit the assessment and plan before copying.
Visible to clinic staff only.
Account status
Recommendations; patients may practice more when comfortable.
Your practice plan for today.
Left/right recognition · Level 1
Clinic starting plan
Note from your therapist
Imagined movement
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Left/right recognition for another body part
Platform owner only. These photos are shared by every clinic. Give each photo a body part, a side and a level.
Patients can practise a level once it has at least 4 labelled photos for that body part, including at least 1 left and 1 right. More photos mean less repetition (sessions use 10–50 trials). Unsaved label changes are not counted.
Choose one or many photos (JPEG, PNG or WebP, up to 10 MB each). Set the body part, side and level for each photo, then upload. Labels found in a file name (for example hand-left-L3.jpg) are filled in for you to check.
Set for every photo in the list
Choose photos to upload, or finish labeling photos below.
Makes a smaller display copy (up to 1800 pixels on the longest side) of each saved photo that does not have one yet, so practice photos load faster. The original photos are kept exactly as they are: nothing is replaced or deleted. You can stop at any time and run it again later; it carries on with the photos still missing a copy. New uploads get their copy straight away.
A file is used only when its name and its exact size match a saved photo, so a different picture can never be attached to a photo.
Photos uploaded without a full set of labels, and photos you chose to relabel, appear here. Fully labelled photos are in the saved library.
All changes saved
Therapist dashboard · Photo library
Choose a body part, then difficulty level, then left or right to see the saved photos.
Removing a staging Firebase photo deletes it from the practice library and Firebase photo storage. Older hosted photos are only removed from the practice library.
Shared library · All clinics
Keyboard: press ← or L for left, → or R for right.
Choose accurately at a comfortable pace. Stop if symptoms rise.
Share lasting changes with your therapist. Responses are not monitored in real time.
Understand · Practice · Progress
A step-by-step approach to practicing movement, starting in your mind.
Graded Motor Imagery, or GMI, is a rehabilitation approach for persistent pain and movement difficulties. Think of it as a step-by-step exercise program for the brain: you begin by recognizing body parts, then imagine movement, and later explore mirror feedback with your therapist.
It draws on neuroplasticity—the brain’s ability to adapt through experience and practice. “Graded” means starting with a manageable task and gradually increasing its complexity, according to your response. The aim is to build confidence and comfortable movement without repeatedly provoking symptoms.
The goal is to reduce pain and help you use your body more confidently. Persistent pain can involve a more protective nervous system and changes in how a body part feels, is recognized, or is imagined moving. People sometimes describe this as a “smudged body map.” That is a useful analogy, not a diagnosis or a sign that the pain is imaginary. [8]
The somatosensory cortex helps process touch and body position. It is one part of the brain’s body-mapping system. GMI aims to help this system and connected movement networks work more normally. Repeated, manageable practice may help movement feel more familiar and less threatening, potentially contributing to pain relief. [12]
After amputation, the brain can still represent the missing limb, even though its sensory input has changed. Research shows that this representation can remain stable. GMI does not require us to assume that everyone’s map is damaged or that pain relief depends on “repairing” it. [9]
The three stages
Your therapist can tailor the sequence and pace to your needs. These stages gradually introduce recognition, mental rehearsal, and visual feedback.
Recognize · Left/right recognition
Look at a picture of a hand, foot, or shoulder and decide whether it is left or right. You do this without moving the affected body part. The task engages body-recognition and movement-planning networks and gives them a manageable starting exercise.
Some people with persistent pain find these judgments slower or harder. Practice prepares you for imagined movement; a score alone does not tell us whether your body map is normal. [8]
Imagine · Rehearse movement
Imagine moving your affected body part while the actual limb rests. For example, picture opening your hand, turning your palm, or feeling your fingers curl around a cup. Try to imagine the feel of a familiar, comfortable movement—not just watch yourself from a distance.
Imagined and actual movement activate overlapping brain networks. Imagining how a movement feels can also engage somatosensory areas. The activation patterns are similar in some respects, but are not identical. [10]
Reflect · Explore visual feedback
A mirror hides the affected or missing limb and reflects the other limb. Watching its reflection can create the impression that the affected side is moving comfortably. This provides a different combination of visual and movement information for the brain to process.
Your therapist helps you position the mirror and choose suitable movements. Mirror therapy may support pain relief or movement recovery, but the response varies. Guided mirror practice in this app is still being developed. [1]
A familiar example: athletes. Athletes mentally rehearse the timing, position, and feel of a basketball shot or volleyball serve before performing it. This rehearsal uses some of the same brain networks as physical movement. GMI applies a similar idea to everyday actions: practicing movement in your mind before building toward physical activity. Athletic studies illustrate mental rehearsal; they do not establish pain-treatment benefits. [11]
Patience, repeatable practice, and regular conversations with your therapist help you find an approach that fits. Progress is about everyday comfort and function, not completing stages on a deadline.
GMI targets how sensory and movement networks process a body part. Brain-imaging studies have found differences in somatosensory and motor processing in some people with persistent pain. However, findings vary across conditions and people; a single “smudged map” explanation does not account for everyone’s pain. [8][9]
Laterality exercises engage recognition and movement planning. Explicit imagery rehearses a movement without performing it. Mirror therapy provides visual feedback that may help the brain integrate what it sees with movement intention and body sensation. These are plausible, overlapping mechanisms; mirror neurons alone do not explain all of GMI’s effects. [10]
A small randomized crossover study in CRPS found that six weeks of GMI reduced movement pain alongside changes in somatosensory activity and hand representation. This supports the idea that sensory and movement processing can change during rehabilitation. It does not establish that cortical “normalization” caused the pain relief, or that everyone needs the same brain changes to improve. [12]
GMI is a rehabilitation option for CRPS. Small trials and reviews report improvements in pain and disability, sometimes persisting at follow-up. Donati and colleagues’ 2024 review reported benefits from GMI and mirror therapy, while noting small samples and variable study designs. [13]
Confidence in the size of benefit differs between reviews. A 2024 motor-imagery review was more favorable, while the broader 2022 Cochrane review rated the physiotherapy evidence as very uncertain. Swelling has improved in some studies, but GMI is not an established stand-alone edema treatment. We cannot promise a particular reduction in pain, swelling, or disability. [2][3]
Mirror therapy has a broader research base for stroke-related movement difficulties than the complete three-stage GMI program. A Cochrane review found moderate-quality evidence of improved motor function and daily activities when mirror therapy was compared with other interventions. It can supplement conventional rehabilitation; findings for mirror therapy should not automatically be attributed to GMI as a whole. [15]
Studies include people at different stages of recovery. Vision, attention, comprehension, fatigue, and movement ability affect how practice should be adapted. Evidence does not establish one best schedule for every stroke survivor.
GMI and mirror therapy may reduce phantom limb pain for some people. A 2023 systematic review found promising effects, but the certainty was very low. Mirror therapy did not show a clear advantage over a covered-mirror control in the pooled comparison, and imagined movement alone did not show a clear benefit. These findings leave uncertainty about which components help most and why. [14]
Some individual trials have reported benefit from repeated mirror practice. The full program remains an option to discuss, rather than a guaranteed treatment or proof that the missing limb’s map must be restored. [16][9]
Research on GMI alone is limited. A larger trial of graded sensorimotor retraining reported improved pain, but its program combined education, sensory training, imagery, and functional movement practice. We cannot assume the same result from laterality or imagery alone. [17]
Early studies suggest possible benefits when GMI is added to rehabilitation. A small frozen-shoulder pilot trial examined GMI alongside conventional physiotherapy. Such findings are encouraging, but small studies cannot establish reliable long-term benefit or the best protocol for all shoulder conditions. [18]
Evidence is developing. A knee-osteoarthritis trial studied GMI alongside exercises and reported benefits in selected outcomes compared with another treatment plus exercises. That does not establish GMI as a replacement for physical rehabilitation, nor does a knee study establish the same benefit for hip arthritis or recovery after joint replacement. [19]
GMI and mirror therapy are useful options to discuss within rehabilitation. Benefits and evidence certainty differ by condition. The complete program, its individual components, and this app are not interchangeable: these specific app exercises have not been clinically validated. The aim is a manageable path toward better function, with your response guiding adjustments.
Make practice part of your day
Build a plan with your therapist that you can repeat consistently. Research uses a wide range of schedules and has not established one ideal dose—or a safe daily repetition limit—for everyone. Studied schedules are examples, not targets you must meet. [4]
A suggested laterality starting plan is 4–6 short sessions each day, 2–5 minutes each, with around 30–50 images. Your therapist can adjust the plan. Image count and time are separate guides; more is not automatically better.
Consider symptoms during practice and later that day. Increase one element at a time with your therapist’s guidance. A laterality score alone does not decide readiness.
Link practice to a regular break or daily habit. Start in a quiet setting. As agreed with your therapist, vary familiar safe settings and naturally occurring moods once comfortable. Do not deliberately create distress or practice while driving.
Note what you practiced, how long, and how you felt afterward. Review comfort and everyday function with your therapist—not just speed or accuracy.
About 30–50 images per session, 4–6 short sessions daily. A suggested starting plan your therapist can adjust, not a standard. Image count and session time are separate measures.
1–2 minutes, once or twice daily. You might begin with 3–5 imagined movement cycles, with pauses, or less if needed.
These are adaptable app starting examples, not research-validated prescriptions or safety limits. Follow your clinician’s plan. There is no need to finish a target when symptoms rise.
Even imagined movement can sometimes increase pain or swelling. Pause or stop if pain builds, or if dizziness, confusion, distress, or a sense of disconnection develops. Let symptoms settle and discuss a shorter task, simpler movement, or earlier tolerated stage with your therapist.
Contact your therapist before progressing if practice causes repeated flares or lasting worsening. New or unusual symptoms, marked swelling, or new weakness need clinical assessment. Follow surgical, fracture, and movement precautions throughout. [6][7][5]
Open only the sections relevant to you. These describe research examples and clinical considerations, not an individual prescription.
Research example: a six-week program with two weeks each of laterality, explicit imagery, and mirror therapy. Some original trials used frequent short practice periods, including every waking hour. This intensive schedule is not a starting requirement. [1] [4]
Discuss which stage is manageable and how to adapt daily practice. Do not advance just because two weeks have passed. Your therapist may reduce exposure or return to an earlier tolerated stage if symptoms repeatedly increase.
Research example: the stroke mirror-therapy studies averaged about 30 minutes per session, five days weekly, over four weeks, with substantial variation. This describes mirror therapy, not a proven dose for all three GMI stages. [15]
A stroke rehabilitation clinician should adapt practice to vision, attention, comprehension, fatigue, and movement ability. Shorter supported sessions may be appropriate; the study average is not a required starting dose.
Research example: one small upper-limb mirror-therapy trial used 15 minutes daily, five days weekly, for four weeks. This is a studied schedule, not a guaranteed effective or safe dose for everyone. [16]
Work with your therapist on whether to begin with laterality, imagery, or mirror feedback. Start with simple, familiar movements and adjust if pain or emotional distress increases. Imagery means mentally rehearsing movement; it does not require forceful phantom movement.
No established GMI-only schedule. Research on broader sensorimotor retraining includes multiple treatments, so its results cannot be assigned to imagery alone. [17]
Your therapist can decide whether imagery fits alongside education and physical rehabilitation. This app currently has hand, shoulder, and foot practice; it does not provide a back-specific training program.
Research example: a small frozen-shoulder pilot trial added GMI to conventional physiotherapy three times weekly for three weeks. It does not establish an optimal home-practice dose. [18]
Begin with an imagined action that feels manageable, such as a supported reach. Your therapist should adapt the plan to your diagnosis and movement restrictions. Imagery supplements the shoulder rehabilitation plan rather than replacing it.
Research example: a knee-OA trial studied an eight-week program with exercises in both treatment groups. This does not establish a universal daily dose or the same effect for hip OA. [19]
Your therapist can advise whether movement imagery fits your exercise plan. This app does not yet include dedicated knee or hip exercises. After joint replacement, follow your surgical precautions and prescribed rehabilitation.
Need help following the plan? Bring your notes to your therapist and choose a smaller, repeatable routine together. A missed session is a reason to resume your usual plan, not to double the next session.
References are provided for transparency. Trials, reviews, and patient guidance answer different questions; a published schedule is not an individualized prescription.
Content reviewed September 2026.
Ready for your next manageable step?
A plan that fits you
Enter the range you discussed with your therapist, or use these examples as a starting point for that discussion. You can do extra laterality sessions when comfortable.
Your choices and today’s laterality count are saved in this browser for this account. They do not appear on another device and are not sent to your therapist. Imagery sessions and check-ins are not saved.
YOUR GUIDED PRACTICE
Choose your body part. Find a recording. Take a moment for yourself.
Levels describe complexity, not a required recovery ladder. Advanced does not mean stronger, faster, or a larger movement.
These answers stay in this page only. They are not saved or monitored by a clinician.
Imagine · Rest · Notice
A moment to settle
Press Play when you are ready. Nothing plays until you do.
0:00 of 0:00
Keep the actual limb at rest. You may finish at any time.
Notice your response
The session time is saved to your history, and your therapist can see it. Your symptom responses are saved separately when syncing succeeds. Share lasting changes with your therapist directly; these logs are not monitored in real time.
Mirror therapy · Visual feedback
Mirror therapy uses the reflection of a more comfortable or intact limb to create the appearance of movement on the affected or missing side. For example, a mirror between the hands can make the reflected hand look like the other hand.
This visual feedback is used in rehabilitation to explore movement and may help some people with CRPS or phantom limb pain. It is commonly introduced after laterality and imagined movement in GMI. Benefits vary, and the exact reasons it helps are still being studied. Read the GMI trial.
Ask your therapist to help with mirror positioning and the right starting task. Looking at a comfortable reflection may be the first step; movement is not something to force. Continue to follow your medical and movement precautions.
This page is an introduction. Step-by-step mirror sessions are not available in this version.