Audio narration to be recorded. This practice is particularly well suited to audio — reading it yourself while fatigued is counterproductive. The written script below is included for reference, and for reading aloud by a family member or carer.
Understanding Post-Stroke Fatigue
Post-stroke fatigue is one of the most common and least understood consequences of stroke. Research suggests that between 40 and 70 percent of stroke survivors report significant fatigue in the months following stroke — and for many, it persists for years. Unlike ordinary tiredness, it does not reliably resolve with rest and is not proportional to activity. It can arrive suddenly, be unpredictable in timing, and is frequently described as qualitatively different from anything experienced before the stroke.
The mechanisms are not fully established. Current understanding points to several contributing factors: the additional neural effort required when the brain is rerouting function after injury; disrupted sleep architecture (stroke commonly affects deep sleep and sleep efficiency); the physiological cost of inflammation and repair in the acute phase; and, in some people, depression or mood changes that amplify the subjective experience of fatigue.
What is clearly established is that post-stroke fatigue is not a motivational problem, a character weakness, or a sign that recovery is not progressing. It is a neurological phenomenon that responds to neurological management — including, importantly, deliberate rest at the right moments.
Research on ultradian rhythms — the cycles within a single day — suggests that the brain naturally oscillates between higher and lower arousal states approximately every 90 minutes. These cycles are visible in sleep (as alternating NREM and REM phases) but continue during waking hours as subtle shifts in alertness, concentration, and receptivity.
In a healthy system, brief periods of reduced activity at the trough of each cycle allow the brain to consolidate what has been processed and prepare for the next active phase. After stroke, this natural rhythm is often disrupted, and the cost of ignoring the trough is higher than usual. This practice is designed to support deliberate, high-quality rest at those natural low points — rather than pushing through them, which is counterproductive and costly.
You may notice that your fatigue tends to arrive in waves. If you can identify approximately when your troughs occur (commonly mid-morning and mid-afternoon), those are optimal times for this practice.
How This Practice Differs From the Others
The other four practices in this programme use guided imagery to rehearse motor sequences — reaching, walking, balancing, speaking. This practice does something different. It does not ask you to rehearse a movement. It asks the nervous system to do something that post-stroke fatigue frequently prevents: to rest effectively.
The evidence base here draws primarily from relaxation and mind-body research rather than motor imagery specifically. Guided relaxation interventions for post-stroke fatigue have shown positive results in several trials — including improvements in subjective fatigue severity, mood, and sleep quality — though effect sizes are modest and trials vary in quality. The approach used here (sustained guided relaxation with physiological imagery) has theoretical support from research on the autonomic nervous system and the restorative functions of directed rest.
The Phase II of this practice does not trace a distal motor pathway. Instead, it invites attention to the brainstem arousal system — the reticular activating system and its descending pathways — and to the slow, restorative physiology of genuine rest. The imagery is permissive and downregulating in tone throughout, rather than activating.
The Three Phases of This Practice
The opening of this practice is longer and slower than in the motor practices. Post-stroke fatigue is often accompanied by a paradoxical hypervigilance — a kind of background alertness or anxiety that makes it difficult to settle, even when the body is exhausted. The opening spends time explicitly releasing this vigilance, rather than moving quickly to imagery.
The breath is the primary tool here, used to activate the parasympathetic nervous system — the rest-and-digest branch — through slow exhalation. The body begins to receive the message that it is safe to rest.
The Ideal Being in this practice is not an active version of you performing movements. It is you at rest — genuinely, deeply at rest. This is a subtly different image than it sounds. Many people after stroke feel guilty about resting, or experience rest as failure or passivity. The Ideal Being here is someone for whom rest is skilled and intentional — a practice, not a collapse.
The image might be of you lying comfortably somewhere familiar. Breathing easily. The body heavy and warm. Not asleep, not effortfully awake. In the particular quality of rest that restores.
Rather than a peripheral motor pathway, Phase II invites attention to the deep brain systems that regulate arousal and recovery. The imagery traces the reticular activating system — a network in the brainstem that governs wakefulness and the transition to rest — and the slow restorative processes that occur during genuine downtime: metabolic waste clearance, memory consolidation, neural repair.
The tone here is like a tide going out — gradual, inevitable, safe. The imagery does not demand attention in the way the motor practices do. It gently accompanies whatever level of wakefulness is present, and allows the session to deepen into genuine rest if that is what the body needs. Falling asleep during this practice is not a failure. It is sometimes the correct outcome.
The Written Script
This script is written to be read aloud to you, or listened to via audio narration. If you need to read it yourself, read it very slowly — more slowly than feels normal. Allow long pauses between paragraphs. The quality of attention this practice requires is soft rather than focused.
People imagine in different ways. Some see pictures; some feel movement without seeing anything. Pick the one that fits you and the words below will change to suit. Not sure? Take the five-minute check first.
Showing the standard wording.
Opening · Breath and Letting Go
Find a place to rest. Lying down is best for this practice — in bed, on a couch, or on the floor if that is comfortable. If lying down is not possible, a supported chair is fine. Close the curtains if the light is bright. Loosen anything that presses or constricts.
Let the weight of your body settle. You do not need to hold anything up. The surface beneath you will do that.
Allow your eyes to close.
For a moment, just notice. The sound of your own breathing. The warmth of the room. The surface you are resting on against your back, or your side. The small sounds in and around the building. None of these require a response. They are simply the texture of the moment you are in.
Now bring attention to the breath. Not to change it — just to notice it is happening. The small rise and fall. The slight pause. The release. The body already knows how to breathe. It has been breathing this whole time without your attention, and it will continue to. You are simply arriving alongside it.
Begin to lengthen the breath out. Not by forcing it — simply by letting the exhale take a little longer than before. As if sighing, but quietly. Let the out-breath become a release.
With each out-breath, something softens. The muscles around the eyes. The jaw — let it drop slightly, releasing whatever it has been holding. The neck and shoulders. The hands — uncurled, open, resting.
There is nothing you need to do right now. No task to complete, no performance to give. The only thing this time asks of you is to be here, and to rest. You are allowed to rest. The brain cannot repair and recover if you do not allow it to rest. This is not inactivity. This is the work.
Continue with slow, easy breathing for a few moments. Let each out-breath be a little fuller. Notice the body growing heavier and warmer with each breath. This is the correct direction.
Phase One · The Ideal Being
Bring to mind yourself — simply yourself — resting. You may see it, or simply sense it; either is right. Not ill, not recovering, not struggling. Just resting, as if rest were the most natural thing in the world. Because it is.
You are lying or sitting somewhere comfortable and familiar. The breath, slow. The body, warm and heavy. The face, smooth — nothing tightening around the eyes, no clench in the jaw. The hands, open and still.
This is not inactivity. This is a version of you engaged in something important: allowing the nervous system to do what it does when it is not being demanded of. Consolidating the learning of the day. Clearing the by-products of sustained effort. Restoring the capacity to re-engage.
Notice what it is like in the body to rest like this. Perhaps a small settling — a slight deepening of the breath, a release in the belly or the chest. Allow it. The body recognises rest, even in imagination, and begins to move toward it.
If the sense of it is vague — if you cannot easily find yourself at rest — that is fine. Simply rest in what is here. The warmth. The weight. The slowing. The permission.
Phase Two · The Restorative System
Now, very gently, bring attention to the inside of your head. Not to any particular thought. To the sense of the brain — warm, complex, working, even now.
Deep in the centre of the brain, in the brainstem — the oldest, deepest part of the nervous system — there are structures whose job is to manage the shift between waking and rest. A network threaded through the brainstem like a net, setting the level of alertness of the whole brain above it.
That system is beginning to slow. Not stopping. Slowing. Like a river moving from open water into still, deep pools. The signals that have been firing all day — the alertness, the monitoring, the effort — beginning, very gradually, to ease their pace.
The brain does not stop working when you rest. It shifts into a different kind of work. Its waste-clearance system becomes more active in rest and sleep than in waking. The channels between the cells widen slightly, and the by-products of a day's effort are gently flushed through and carried away. The brain is cleaning itself. This is what rest is for.
That process, now. Warm, slow, fluid. The space between cells widening, just slightly. A gentle, internal tide of clearing and renewal — so quiet as to be nearly imperceptible, and utterly fundamental.
The learning of the day is being consolidated — what was practised is being laid down, organised, made more available. The pathways you rehearsed in your other practices today are being reinforced now, in the rest. Rest is not the opposite of learning. It is the completion of it.
Let the breath continue — slow, involuntary, complete. Let the body be heavy. Let the mind wander if it wishes, without following it. Let thoughts pass like cloud shadows on still water — present, then moving on, without disturbing the surface.
There is no requirement to stay awake. If sleep comes, allow it. If the mind stays gently present, allow that too. Both are rest. Both are correct.
Stay here as long as the practice allows — five minutes, ten, whatever your circumstances permit. The longer and more complete this rest, the more restorative it is. Twenty minutes of deliberate, guided rest is a different thing from twenty minutes of lying down while worrying. The difference is in the state of the nervous system — and that state is what you have been cultivating throughout.
Closing · Return
When you are ready to return — and there is no urgency — let the breath deepen slightly. Not forcing a return. Simply becoming a little more present to the body and the room.
Bring awareness gently to the surface you are resting on. The temperature of the air. Any sounds that are present.
Begin to move, very slowly — a small movement of the fingers or toes. A gentle shift of weight. No need to move quickly. The transition from rest to activity, made slowly, is itself part of the practice.
When you are ready, let the eyes open — softly, without snapping back to alertness. Let the light come in gradually.
Before you stand or take on any task, take three slow breaths and allow a moment of orientation. Notice how you feel. You may feel groggy and heavy, which is normal and will pass. You may feel lighter than before. Both are valid. What matters is that the rest window happened — that the nervous system was given the opportunity it needed.
That is the practice. Take it at the pace your body asks for. There is no performance here.
When to Use This Practice
The most effective time is when you first notice the onset of fatigue — not when you are already depleted. For most people, natural low points occur mid-morning (around 90–120 minutes after waking) and mid-afternoon. Resting before exhaustion, not after, is the principle.
Following any of the other four guided imagery exercises, or any sustained physical or cognitive effort, a shorter version of the opening and Phase II of this practice supports consolidation. Even ten minutes of deliberate downregulation after active practice improves learning retention.
This practice can also serve as a pre-sleep wind-down. Post-stroke sleep disruption is common. A deliberate nervous-system downregulation protocol before bed — rather than passive screen exposure — can improve sleep onset and the quality of early sleep stages. Falling asleep during the practice is welcome.
A Note on Guilt and Rest
Many people after stroke describe feeling guilty about resting — as if resting were surrendering to the injury, or slowing down recovery. This is understandable but neurobiologically backwards. Recovery from brain injury depends on rest as much as on active rehabilitation. The plasticity mechanisms that make recovery possible — the sprouting of new connections, the reassignment of function to new regions — are metabolically expensive processes that happen largely during rest and sleep.
If you have family members or carers who find it difficult to see you resting, sharing this page with them may be useful. Resting after stroke, deliberately and regularly, is not passive. It is an active component of recovery.
This practice differs from the other four in its evidence base. The motor imagery literature — which underpins the arm, walking, balance, and speech practices — is not the primary source here. For fatigue specifically, the evidence points toward relaxation, rest management, and psychological interventions (including mindfulness and cognitive behavioural approaches) rather than motor imagery per se.
The practice draws on research into guided relaxation for post-stroke fatigue (which is positive but modest), the physiology of ultradian rest cycles, and the neuroscience of glymphatic clearance during rest. The brainstem arousal imagery in Phase II is an adaptation of the three-phase structure used across this programme — grounded in neurophysiology but not itself a clinically tested protocol.
If your fatigue is severe or is significantly affecting your quality of life, a conversation with your medical team is warranted. Treatable contributing factors — including depression, sleep disorders, anaemia, and thyroid dysfunction — should be ruled out before assuming the fatigue is purely neurological in origin.