Motor imagery combined with action observation training optimized for individual motor skills further improves motor skills close to a plateau.

The acquisition of high-level motor skills beyond a "plateau" is important in sports training and rehabilitation. We aimed to investigate whether motor skills close to a plateau state can be improved further by performing motor imagery (MI) training while observing movements with difficulty levels optimized for individual motor skills. The subjects were divided randomly into four groups (n = 10 per group): the control group and three groups of MI combined with action observation (MI + AO) training with varying difficulty levels. The task was to rotate the two cork balls 20 times counterclockwise using the left hand. The subjects performed 30 and 10 successful trials of this task before and after MI + AO training, respectively. In the three training groups, MI training was performed while observing videos showing ball rotation movements adjusted to the same level, a moderately higher level, or a remarkably higher level of difficulty than that achieved by the individual subjects. The improvement rate of the ball rotation time after MI + AO training was significantly higher in the moderate-difficulty than in the control group and remarkably higher level of difficulty group. The other two MI + AO training groups did not differ significantly compared with the control group. The vividness of the MI during MI + AO training was significantly greater in the moderate-difficulty vs. the remarkably-high-difficulty group. These results suggest that performing MI training while observing movement at a level that is moderately higher than an individual's ability can promote improvements in motor skills (close to a plateau state) in rehabilitation and sports training. The vividness of MI may be an important index for determining the difficulty level of the movement to be observed during MI + AO training.