Left/Right Discrimination Treatment for Chronic Pain/Motor Control (Step 1 of Graded Motor Imagery Training)

Step 1 of Graded Motor Imagery: Left/Right Discrimination or also called Laterality.

Goal is to identify left/right images of the patient's specific body part and increase speed of identification.

Basic Guidelines:

Goal is to improve identification of left and right sides of the body, accuracy and speed

Having baseline information is most important to know when to go to next stage (Motor Imagery)

  • Accuracy of 80% and above.
  • A speed of 1.6 seconds +/- 0.5 sec appears quite normal for necks and backs. Hands and feet are a little slower with an average speed of 2 seconds +/- 0.5 sec. Based on these figures we would suggest that around 2 seconds is quite normal for other body parts such as knees and shoulders.
  • Accuracies and response times should be reasonably equal for the left and right.
  • Results should be stable (eg. they don't fade out with stress) and are consistent for at least a week.
  • Clinical judgment is critical and above guidelines are guidelines and it is most important to see improvements vs strict "normal" numbers.

Practice with your patient by:


  • Focus on the part of the body that the patient is having difficulty moving and/or chronic pain
  • Ask about the pictures as it relates to the person, not the patient themselves:
    • Is this the left or right ______ (body part)?
    • Is this ______ (body part) moving to the right or left?
  • Grade by starting with pictures that have no background and just the body part -> increase background, faces, color, clothes, rotate picture, etc

This is great for homework. Some research supports around 2 hours/day (which can be broken up throughout the day) for 2 weeks, or whenever symptoms reduce.


The clinical application of pain neuroscience, graded motor imagery, and graded activity with complex regional pain syndrome-A case report.

Does evidence support physiotherapy management of adult Complex Regional Pain Syndrome Type One? A systematic review

Graded motor imagery for women at risk for developing type I CRPS following closed treatment of distal radius fractures: a randomized comparative effectiveness trial protocol


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