Mental imagery of movement is a potentially valuable rehabilitation task, but its therapeutic efficacy may depend on the specific cognitive strategy employed. Individuals use two main strategies to perform the hand mental rotation task, which involves determining whether a visual image depicts a left or right hand. One is the motor imagery strategy, which involves mentally simulating one’s own hand movements. In this case, task performance as measured by response time is subject to a medial–lateral effect wherein the RT is (...) reduced when the fingertips are directed medially, presumably as the actual motion would be easier. The other strategy is to employ visual imagery, which involves mentally rotating the picture and is not subject to this medial–lateral effect. The rehabilitative benefits of the HMRT are thought to depend on the MI strategy, so it is essential to examine the effects of individual factors such as age, image perspective, and innate ability on the strategy adopted. When presented with pictures of the palm, all subjects in the current study used the MI strategy, regardless of age and ability. In contrast, when subjects were presented with pictures of the back of the hand, the VI strategy predominated among the young age group regardless of performance, while the strategy used by middle-age and elderly groups depended on performance ability. In the middle-age and elderly groups, the VI approach predominated in those with high performance skill, whereas the MI strategy predominated among those with low performance skill. Thus, higher-skill middle-aged and elderly individuals may not necessarily form a motion image during the HMRT, potentially limiting rehabilitation efficacy. (shrink)