I deliver a lot of talks on the mind-body connection. During these, I often share research on the use of visualisation to speed up recovery from a stroke.
I first became acutely interested in the whole subject while I worked in R&D in the pharmaceutical industry. I worked in the fields of cardiovascular medicine and cancer, but I had a personal interest in the placebo effect.
When I was a child, my mum had suffered from post-natal (partum) depression after my youngest sister was born and mental practice tools helped her a lot. She and I often discussed the ‘power of the mind’.
As an adult and working in R&D, I longed to understand why some people improved on drug trials when they received a sugar tablet (placebo). Most people just ignored it at the time. They assumed that any improvement in someone receiving a placebo was just the natural course of an illness.
But it turns out that the placebo effect is much more. It’s a powerful phenomenon that harnesses the potency of expectation and belief to alter brain chemistry.
How placebos work
It works like this: when you take a placebo but believe it’s the real drug, your brain does what it needs to do to meet your expectations.
Let me explain what this means. Say you had a headache and took a placebo that you believed was a painkiller; your expectation would be that the pain would reduce or go away. This is when the magic happens. Your brain then does what it needs to do to meet that expectation.
In real terms, this means that your brain produces its own natural painkillers. They’re known as endogenous opioids. Their production is how your brain meets your expectation of reducing pain.
This was fascinating to me and was one of the factors that catalysed my leaving the industry a few years later to write books and educate people on how they could harness their mind and emotions to improve their health. I loved my job and was very good at it, but my greater desire lay in teaching.
So how does understanding the placebo effect relate to recovery from stroke?
Well, it forms part of the research that led to a wider understanding of the mind-body connection and how we could tap into it using specific mental practices.
One of these practices is visualisation.
The brain doesn’t distinguish real from imaginary
Athletes have used visualisation to enhance their performances for decades, but few ordinary people knew about the techniques. For example, Billy Mills, an American Olympian who won gold in the 10,000 meters at the 1964 Tokyo Olympics, credited visualisation as a key factor in his victory. He would repeatedly imagine himself sprinting past his competitors and crossing the finish line to win gold and it helped him achieve a historic upset victory. Prior to the race he had been a virtual unknown.
I chatted with an Olympic gold medallist at a conference we both presented at a few years ago. It was Sally Gunnell, the 400 metres hurdles Olympic champion in 1992. Her presentation focused on how she used visualisation to achieve her goal. My presentation, which was right after hers, focused on the mind-body connection and how visualisation could impact the brain and body.
Sally said that visualisation was crucial to her success. Specifically, every day for months leading up to the Olympics, she would visualise every stride of the race and visualise herself clearing all the hurdles with ease.
One of the foundational pieces of research that helps explain why visualisation is so effective was conducted by Alvaro Pascual-Leone, a professor of neurology at Harvard Medical School.
He invited a group of volunteers to play a short sequence of piano notes each day for 5 days, while a separate group visualised playing the notes instead. He took brain scans of everyone and discovered that the changes that occurred in the brains of the people who visualised playing the notes matched the changes in those who actually played the notes.
The team wrote that, “Mental practice alone led to the same plastic changes in the motor system as those occurring with the acquisition of the skill by repeated physical practice.”
Placing the scans side-by-side shows the same amount of change each day. And if you removed the labels from the scans, you wouldn’t be able to tell who played the notes for real and who visualised playing them. Incredibly, on this level, the brain didn’t seem to be distinguishing real from imaginary.
At the Lerner Research Institute in Cleveland, they took a slightly different approach, building on the idea that visualization alone can create measurable physical changes. They asked volunteers to extend and contract their little finger each day for 12 weeks. Other volunteers were instructed to visualise the finger movements instead. At the start and end of the 12 weeks, each person had their finger strength measured.
Those who physically did the finger exercises had gained 53% strength, but incredibly, those who imagined doing the exercises were 35% stronger, having not technically lifted a finger.
A stroke of insight
Given all this, some researchers wondered if visualisation could help people who have suffered a stroke. Might the practice increase strength and movement after brain injury?
In 2005, researchers at the Department of Physical Medicine and Rehabilitation at the University of Cincinnati College of Medicine conducted a small study where stroke patients (who had a stroke between 1 and 4 years earlier) were given physical therapy two days a week for 6 weeks.
After each session, half were led through a guided relaxation procedure while the other half practiced visualisation, where they imagined moving their impaired limb in a similar way to what they had done during the physical therapy sessions, like reaching for and grasping objects.
At the end of the 6 weeks, those who had practiced the visualisation had improved use of their affected limb, in comparison with those who didn’t visualise, who only showed nominal improvement due to physical therapy alone.
The same researchers led a larger study two years later, this time a randomised, placebo-controlled trial involving many more patients, each of whom had arm impairment with an average time since having a stroke of three and a half years.
Again, those who did visualisation had significant increases in daily arm use and much reduced arm impairment compared with those who didn’t practice visualisation.
Since then, even more researchers have studied the use of visualisation in aiding recovery from a stroke and reported similar results. A 2014 meta-analysis confirmed these findings and noted that, “Mental imagery could be a viable intervention for stroke patients given its benefits of being safe, cost-effective and rendering multiple and unlimited practice opportunities.”
New Tech
With the advent of new tech, things have now progressed even farther.
Researchers have been able to place devices on the scalp that detect brain signals when a patient visualises movement.
The devices are known as Brain-Computer Interfaces (BCIs), and they utilise the fact that visualisation of different movements – like left and right – impacts different brain areas.
A computer records which brain regions are activated and can therefore tell how a patient imagined moving; whether they imagined moving an arm left, right, up, down, etc.
They can then combine this with electrical stimulation of the limb. So if a patient imagines reaching for a cup, for example, then the BCI detects the movement they were imagining and electrically stimulates the arm to help facilitate the physical arm movement.
Many studies have now shown that the practice can significantly improve arm movement in acute and chronic stroke patients.
For instance, a stroke patient named James regained partial use of his arm through a Brain-Computer Interface (BCI) system. By visualising movements like grasping and reaching, the BCI detected his brain signals and combined them with electrical stimulation to assist his physical movements, significantly improving his recovery.
Since the research is still relatively new, though, researchers have not yet been able to determine long-term effects, but the results so far seem both promising and exciting.
Final thoughts
So, as you can see, research in the broad area of the mind-body connection has come quite far in the past few years. We’ve come from assuming that the placebo effect wasn’t real to understanding that expectation shifts brain chemistry, to understanding how the brain changes when we visualise, to learning how to harness this fact to increase strength through visualisation, and now even to improving recovery from stroke with visualisation combined with advanced technology.
This progress offers immense hope for future rehabilitation techniques. If you or someone you know is recovering from a stroke, consider exploring visualisation techniques as part of the recovery journey—it might just be the key to unlocking new possibilities for healing from stroke.
Resources
I discuss much of this subject and more in my book, ‘How Your Mind Can Heal Your Body‘ (The link takes you to the UK version, but it’s available everywhere)
You might also like the new book by Maya Raichoora, ‘Visualise‘ (March, 2025) (The link takes you to the UK version but it’s available everywhere)
Thank you