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Hand Therapy; Complex Regional Pain Syndrome
Transcript of Hand Therapy; Complex Regional Pain Syndrome
By Becky Robertson-Bown
Occupational Therapy Level 5
A Guide For Student Occupational Therapists
What is CRPS?
Assessments & Outcome-measures
Severe, unrelenting, disproportionate pain
Usually occurs after an injury or operation
no nerve injury
However, it is unknown exactly why this happens
Linked to the pain matrix
Pro-longed pain alters antinociception mechanisms
Disruption between motor planning and sensory feedback pathways
Between 5.4 - 26.2 per 100,000 will have CRPS
Upper limb is twice as likely to be affected
Women more likely to be affected than men
It can occur in any age
Changes to peripheral and central nervous systems
Loss of roles
Two-point discrimination test
Early intervention is paramount
Avoid contractures and atrophy
Neural retraining of sensory pathways
Can inhibit recovery
Should only be used for chronic CRPS
HUGE, V. et al. (2011). Complex interaction of sensory and motor signs and symptoms in chronic CRPS. PLOS ONE, 6 (4), 1-13.
MCCABE, C. et al. (2003). A controlled pilot study of the utility of mirror visual feedback in the treatment of complex regional pain syndrome (type 1). Rheumatology, 42, 97-101.
MOS, M. et al. (2007). The incidence of complex regional pain syndrome: a population based survey. Pain, 129, 12-20.
MOSELEY, G. (2004). Graded motor imagery is effective for long-standing complex regional pain syndrome: a randomised controlled trial. Pain, 108, 192-8.
MOSELEY, G. et al. (2008). Thinking about movement hurts: the effect of motor imagery on pain and swelling in people with chronic arm pain. American College of Rheumatology, 59 (5), 623-31.
MOSELEY, G. and WIECH, K. (2009). The effect of tactile discrimination training is enhanced when patients watch the reflected image of their unaffected limb during training. Pain, 144 (3), 314-19.
NATUSCH, D. (2012). Complex regional pain syndrome. Orthopaedics and trauma, 26 (6), 405-9.
ROYAL COLLEGE OF PHYSICIANS (2012). Complex regional pain syndrome in adults: UK guidelines for diagnosis, referral management in primary and secondary care. London, Royal College of Physicians.
SANDORINI, P. et al. (2003). Complex regional pain syndrome type 1: incidence and prevalence in Olmstead county: a population based survey. Pain, 103, 199-207.
TURNER-STOKES, L. and GOEBEL, A. (2011). Complex regional pain syndrome in adults: concise guidance. Clinical Medicine, 11, 596-600.
Follow-up sessions to ensure results are long-lasting
Disabilities of the Arm Shoulder and Hand (DASH)
Canadian Outcome Performance Measure (COPM)
It is a neurological condition
a psychological condition
Imagined imagery can activate primary motor area
Severely affects occupational performance
The importance of rapport
Patient experiences and narratives
Activities of daily living
Controls pain suppression
Normal sensations are painful
50% will develop long-term symptoms
Measure perceived pain levels
Measure changes in hand functioning and somatosensory ability
Measure changes in swelling
Measure changes in movement and function
Increases range of motion
Improve somatosensory ability
Reconcile motor output and sensory feedback
By utilising visual feedback
Manipulate meaningful objects
Patient facilitation at home
Opens-up practice constraint boundaries
First developed by Ramachandran
Effective treatment for stroke and phantom limb pain
Can incorporate tactile discrimination training and stereognosis
Hand Therapy Groups
Usually affects localised areas of the limbs
However, some patients report pain across their whole bodies
Causing damage to the peripheral and central nervous system
It can occur without trauma
However, emerging research suggests that Type 1 could also involve nerve injuries
There have only been two studies which have explored the prevalence of CRPS
Symptoms are split into
Some people have had the condition for 10 years
Identify personalised goals and meaningful interventions
The patient can practice this at home
Touching different textures, shapes and objects on the hand
provide pain relief and
maintain functional position
Reflect the unaffected arm onto the painful arm
Important for the patient to maintain a good position and posture
Remove all jewellery and watches
Place a mirror vertically down the mid-plane of the body
The painful arm is covered
Disordered movement caused by repetitive muscle contractions, twisting movements and abnormal posture
Wearing jewellery and clothing can be unbearable
Bathing can be agonising
It can impact upon everything
Identify treatment priorities
Watches should be removed
Focus on the reflected hand
Manipulate something meaningful
Mirror placed centrally
Enables further rehabilitation opportunities