Motor imagery as a cognitive mechanism in interventions for children with developmental coordination disorder: a narrative review.

Introduction: Developmental Coordination Disorder (DCD) is a prevalent neurodevelopmental disorder characterized by significant motor impairments. Traditionally viewed as a deficit in motor execution, it is now increasingly understood to involve disruptions in cognitive processes underpinning motor control, including internal modeling, motor planning, and predictive control. This cognitive reconceptualization suggests the need for a shift in intervention approaches. Methods: This narrative review synthesizes theoretical, neurophysiological, and empirical literature to critically evaluate the role of Motor Imagery (MI)-the mental simulation of action without overt movement-as a cognitive mechanism for intervention in children with DCD. We examine the core cognitive and representational deficits in DCD, outline the neural foundations and theoretical frameworks of MI, and provide a narrative synthesis finding from key intervention studies. Results: Evidence suggests that children with DCD often exhibit impairments in motor imagery ability, reflecting possible disruptions in internal modeling processes. Nonetheless, structured MI-based interventions, particularly when combined with action observation (AOMI), have shown promising, though preliminary, effects in improving motor performance and activities of daily living. MI has been shown to engage neural networks overlapping with those involved in motor execution, and may promote neuroplasticity and support the perception-action cycle by facilitating predictive control and sensorimotor integration. Conclusion: MI may represent not only a therapeutic technique but also a useful window for understanding the cognitive mechanisms underlying DCD. By potentially targeting impaired internal models, MI-based approaches may contribute to functional improvements, although direct causal evidence remains limited. Future research should focus on standardize methodologies, conduct larger-scale trails, and carefully examine emerging technologies to develop personalized and ecologically valid intervention protocols. We propose a forward-looking perspective in which MI may serve as a component of mechanism-driven, technology-augmented, and ecologically valid interventions, potentially contributing to a shift from compensatory training toward more active cognitive-oriented approaches in DCD rehabilitation.