Virtual Reality as a Complementary Tool within the Graded Motor Imagery Framework

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Published Oct 24, 2025
DOI: https://doi.org/10.18103/mra.v13i10.6985

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Main Article Content

Gospodin Ionut Ciprian
Step by Step Education, Romania; Step by Step Medical, Romania; Institutul de Educatie Fizica si Sport al Universtatii de Stat din Moldova, Republica Moldova
Gospodin Alice Elena
Step by Step Education, Romania ; Step by Step Medical, Romania
Savitchi Svetlana
Universitatea de Stat de Medicina si Farmacie " Nicolae Testemitanu", Republica Moldova
Eugeniu Agapii
Institutul de Educatie Fizica si Sport al Universtatii de Stat din Moldova, Republica Moldova ; Universitatea Dunărea de jos Galați, Romania

Abstract

Graded Motor Imagery (GMI) is a progressive rehabilitation method designed to reduce pain and restore motor function by stimulating cortical reorganization. Traditionally Graded Motor Imagery consists of three stages: laterality recognition, explicit motor imagery, and mirror therapy. While effective, the classical framework lacks an active, ecologically valid stage that bridges cortical activation with functional reintegration. This study investigates the integration of Virtual Reality as the fourth stage of Graded Motor Imagery —Active Functional VR Reintegration—in the rehabilitation of adhesive capsulitis (frozen shoulder).


A total of 28 patients were enrolled and randomly assigned to either a virtula reality-assisted GMI group (n=14) or a conventional physiotherapy + Graded Motor Imagery group (n=14). Interventions were conducted over 8 weeks, 3 sessions per week. Outcome measures included Visual Analog Scale for pain, range of motion via goniometry, Shoulder Pain and Disability Index (SPADI), Disabilities of the Arm, Shoulder, and Hand, and Manual Muscle Testing (MRC scale). Statistical analyses included paired and independent t-tests, Mann–Whitney U tests, and effect size calculation.


Results demonstrated that virtual reality-assisted Graded Motor Imagery led to greater pain reduction (VAS −4.7 vs. −3.4), improved ROM (abduction +49.2° vs. +33.7°), and superior functional outcomes (SPADI −44.2% vs. −33.8%). Patient adherence was higher in the VR group (96% vs. 82%), highlighting its motivational impact. The findings support virtual reality as a functional extension of Graded Motor Imagery, bridging neurocognitive training with active movement.


This study proposes Virtual reality as the fourth stage of Graded Motor Imagery, enhancing pain modulation, motor recovery, and patient engagement. Clinical adoption of virtual reality-enhanced Graded Motor Imagery may improve rehabilitation outcomes in adhesive capsulitis and other musculoskeletal conditions.

Article Details

How to Cite
CIPRIAN, Gospodin Ionut et al. Virtual Reality as a Complementary Tool within the Graded Motor Imagery Framework. Medical Research Archives, [S.l.], v. 13, n. 10, oct. 2025. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/6985>. Date accessed: 05 dec. 2025. doi: https://doi.org/10.18103/mra.v13i10.6985.
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Issue
Vol 13 No 10 (2025): Vol.13, Issue 10, October 2025
Section
Research Articles

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