The potential mechanisms underlying recovery and reorganisation of the motor cortex are described on the basis of functional imaging studies. These were performed in normal subjects and patients over the past years by the Hammersmith group. The mechanisms of motor learning are discussed and altered patterns of activation after suffering from stroke, amyotrophic lateral sclerosis and amputation are described. The potential role of ispilateral cortical representation in the primary motor cortex, as well as the role of opercular premotor cortex, insular cortex and inferior parietal cortex are discussed.