Left-Right Discrimination for Patients with a Stroke

Left-Right Discrimination - step 1 in Graded Motor Imagery Training.

Ever have a patient that had a stroke, try mirror therapy with them and wonder "why am I doing this?" because it never seemed to work?🙋

I have (more times than I'd like to admit)!

It's super frustrating, especially since the evidence shows that mirror therapy can have a positive effect on motor function, buuuut after years of courses (thanks Medbridge!) and trying different techniques in the clinic, I basically realized I was doing it all wrong. 😁

 

Not actual video of patient performing mirror therapy...😹

I wasn't teaching the the actual mirror therapy techniques incorrect per se, but I wasn't applying the entire Graded Motor Imagery continuum into my patient's treatment plan.

Basically, I was putting the horse 🐎  before the cart.

Graded Motor Imagery is a set of 3 different, sequential (but flexible) treatment techniques using "top down" cortical central processing to improve movement difficulties or complex pain.

The Steps of Graded Motor Imagery Include:

1️⃣ Laterality Training (aka Left/Right Discrimination)

2️⃣ Explicit Motor Imagery Exercises (aka Imagery)

3️⃣ Mirror Therapy (see how I used to just skip the 1st two steps and expect amazing results?!?)

I have given step-by-step instructions and supporting research on how to complete both Imagery Training and Mirror Therapy in the Learning Lab membership, but I am going to dig into and share with you step 1 ⬇️⬇️

Laterality Training (aka Left/Right Discrimination)

Left-Right Discrimination helps us be able to identify one side of our body from the other, as well as determine if our body part is moving to the right or the left.

If I have my eyes closed, can I tell that I am turning my head to the right?

Or if I have my eyes closed and someone externally rotates my right arm, can I identify that it has been moved to the right?

Or even can I look at a picture and determine which is left/right or turing which direction?

What should you have your patient do?

✅ Look through magazines, identifying body parts and what direction they are in

✅ Have the patient download and use the Recognise™ app (good for metrics, but a little limited on pictures

 

✅ Use body part flash cards and play games

When I do this activity with my patients that have hemipegia, I always give these cards to them for homework, having them do the arm, shoulder, neck and trunk flashcards as well as this makes for holistic intervention (the other body part cards, instructions & how to grade can be accessed in the Learning Lab membership).

I also made a📽️  video on Instagram going over these steps

Have you ever used Left-Right Discrimination with your patients that have had a stroke (it works great for chronic pain too!) and have had good results?

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