I had a vivid visualisation last night before bed that I was playing the fife again. I used to play in a Boys’ Brigade bugle and fife marching band in my youth and quite enjoyed plying the instruments. Even the index finger of my right hand started moving and the less mobile fingers were twitching. I realised as I woke up this morning that this movement has persisted. I think the weight bearing exercises that I did in physiotherapy yesterday and at home helped as well.

This method of vivid visualisation and Mental Imagery is commonly used in hypnosis in conjunction with physiotherapy and occupational therapy to help aid neuroplasticity and post-stroke recovery of movement. Hypnosis is, of course, just an exercise in guided focused concentration and isn’t the only wat mental imagery is utiised.

Mental or motor imagery is a form of therapy that can be used to strengthen the arms, hands, feet and legs which may be weakened by stroke. In motor imagery, we mentally rehearse the movement of the affected body parts, without ever actually attempting to perform the movement.

There’s been quite a few studies (Kho, A.Y., Liu, K.P.Y. and Chung, R.C.K.; 2014, Carrasco, D.G., Cantalapiedra, J.A.; 2016, Braun S, Kleynen M, van Heel T, Kruithof N, Wade D, Beurskens A.; 2013, Cha YJ, Yoo EY, Jung MY, Park SH, Park JH; 2012) that show the efficacy of mental imagery in improving the recovery of movement in stroke survivors when used in conjunction with more conventional therapies like physiotherapy and occupational therapy.

The primary theoretical interest of mental imagery is, when we mentally rehearse an activity, the same muscles are activated as if we are performing the activity. So, over time, the mental rehearsal of such activities would induce some degree of motor learning as seen while physically rehearsing a task. Motor imagery can be started in the acute phase, subacute phase or chronic phase of rehabilitation.

Practicing an exercise consistently helps the brain reinforce the importance of that movement and strengthen the associated neural connections. For example, the more you practice lifting your hand to your mouth (as if eating), the more the brain will strengthen that movement pattern, eventually making it easier to reach your hand to your mouth. For this reason, high repetition of targeted exercises and activities is important to stimulate neuroplasticity.

While there are many ways to practice mental imagery, every individual is encouraged to experiment with different techniques to find something that is fun and effective for them. Studies show the more you enjoy rehabilitation exercises, the more likely you are to stay consistent and motivated during your recovery process.

Therefore, it’s important to find stroke visualisation exercises that you enjoy and can help you reach your goals. Your therapist may also be able to provide you with stroke visualisation exercises that specifically target your affected muscles.

To help you get started, here are some mental practice techniques you can try:

• Short & long visualisations: The more time you spend visualizing your recovery, the more neuroplasticity is stimulated, and the higher the chances of seeing promising results. Try to spend about 3-5 minutes mentally practicing a task before physically practicing it. For an added challenge, try to practice up to 20 minutes or more.

• Rehabilitation exercises & activities of daily living: If you’re working on specific exercises during your therapy sessions, you can mentally practice those exercises before physically performing them. For instance, if you’re practicing activities of daily living like eating, you can mentally practice relevant tasks such as using a fork or spoon.

• Improvised & recorded: You can improvise mental imagery by simply closing your eyes and visualising the task that draws your attention that day. Because the brain needs consistency and repetition to rewire itself, it’s important to stick to the same exercises or activities for at least a week. For even more stimulation, you can make yourself an audio recording where you guide yourself through a visualisation exercise.

• Internal & external: You can practice internal mental imagery by visualising yourself from the first-person point of view and looking at your surroundings. Or you can practice it externally from the third-person point of view, looking outward-in. Both internal and external practice help stimulate the brain and activate neuroplasticity.

• Simple & complex: The more senses you engage in your visualisation, the more powerful it will be. Try to think about all the things you feel, smell, and hear as you mentally practice a task. For example, if you’re visualising yourself getting dressed, try to focus on the texture of the fabric and how the clothes may feel.

 
Because mental imagey is most beneficial when combined with physical rehabilitation exercises, it’s important to establish a home therapy program. This can help you stay motivated to achieve massed practice regularly and help you reach your recovery goals more swiftly.

Mental imagery is an effective, evidence-based therapy that can help survivors during all stages of recovery. Visualising stroke recovery exercises helps stimulate neuroplasticity, which is necessary to improve mobility after stroke, even for survivors with paralysis.

Before you begin your stroke recovery exercises, try setting aside time to visualise some of the movements that you want to improve. Utilizing mental imagery beforehand can provide extra stimulation to the brain and help boost your results.

While athletes and musicians have long known the benefits of the mental imagery which is proven to be useful and well documented in improving their performance and thereby enhancing their sports training and other skills, this therapy is pretty unheard of in Malaysia both by conventional therapists as well as even many trained and certified hypnotherapists that I know of and is not part of any systematic rehabilitation regime.

I personally use a pre-recorded Hypnotherapy for Stroke Movement Recovery session by Uncommon Knowledge and it has been very helpful in my journey. It is an audio hypnosis session developed by psychologists that focuses precisely on what to imagine and how to utilise the effects to maximise the extent of physical recovery. The carefully crafted hypnotic suggestions taps directly into the unconscious mind and activate its innate ability to build new models of function based on remembered experience,  remap damaged areas of the brain, create new ‘blueprints’ of healthy functioning, influence micro-motor movement, and creatively learn and adapt to make the most of present circumstances.

I also found the Improving Visualisation audio very helpful at the beginning when I was having trouble visualising. You might want to try both out as they are actually way cheaer than a single in-person session (about RM 70 compared to RM 200). If you prefer a more face to face experience, you can engage licensed hypnotherapists here at the Association Of Hypnotherapy Practitioners Malaysia or here at the London College of Clinical Hypnosis. Nonetheless, I do hope the neuroscience and hypnotherapy community in Malaysia start making this practice more mainstream.