training the brain 5 recent developments bodily awareness
DESCRIPTION
Part of training the brain series focused on Complex Regional Pain Syndrome (CRPS) but relevant to all types of pain.TRANSCRIPT
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Lorimer MoseleyNHMRC Senior Research FellowPrince of Wales Medical Research Institute & Faculty of Medicine, University of NSW, Sydney, Australia
CRPS Rehabilitation (or training the brain)
www.bodyinmind.com.au Copyright GL Moseley 2009 Complex Regional Pain
Syndrome
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Why train the brain?
CRPS as an extreme protective response.
www.bodyinmind.com.au Copyright GL Moseley 2009
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Why train the brain?
Cognitive
Understanding the problem
Other threatening cues are relevant
Educate & explain
Behavioural
Function & movement hierarchy
‘training the brain part 1’
Brain changes
S1 reorganisation
Reorganisation elsewhere?
‘training the brain part 2’
Recent developments
Neglect and ownership
Disrupted bodily awareness
Disruption of high-order cognitive
representations.
www.bodyinmind.com.au Copyright GL Moseley 2009
Our approach to treating CRPS
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Why train the brain?
Disrupted bodily awareness
Disruption of high-order cognitive
representations.
www.bodyinmind.com.au Copyright GL Moseley 2009
Recent developments
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Experiment: Do patients with CRPS actually think their
affected limb is bigger than it is?
Moseley 2004 Neurology 65
www.bodyinmind.com.au Copyright GL Moseley 2009
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32 CRPS patients 18 non-CRPS chronic hand pain patients
Digital photo
affected
www.bodyinmind.com.au Copyright GL Moseley 2009
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32 CRPS patients 18 non-CRPS chronic hand pain patients
affected
Expanded or condensed
www.bodyinmind.com.au Copyright GL Moseley 2009
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32 CRPS patients 18 non-CRPS chronic hand pain patients
affected
Expanded to 115%
www.bodyinmind.com.au Copyright GL Moseley 2009
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32 CRPS patients 18 non-CRPS chronic hand pain patients
affected
Condensed to 85%
www.bodyinmind.com.au Copyright GL Moseley 2009
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“Which of these is a true picture?”
www.bodyinmind.com.au Copyright GL Moseley 2009
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“Which of these are chicken feet?”
www.bodyinmind.com.au Copyright GL Moseley 2009
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Proportion of sample
50%
0%90% 95% 100% 105% 110% 115%
Size of affected limb as a proportion of true size
85%
Normal controls
Moseley 2004 Neurology 65, 773
www.bodyinmind.com.au Copyright GL Moseley 2009
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Proportion of sample
50%
0%90% 95% 100% 105% 110% 115%
Size of affected limb as a proportion of true size
85%
Normal controlsPatients with non-CRPS1 pain
Moseley 2004 Neurology 65, 773
www.bodyinmind.com.au Copyright GL Moseley 2009
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Proportion of sample
50%
0%90% 95% 100% 105% 110% 115%
Size of affected limb as a proportion of true size
Patients with CRPS1
85%
Normal controlsPatients with non-CRPS1 pain
Moseley 2004 Neurology 65, 773
www.bodyinmind.com.au Copyright GL Moseley 2009
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Proportion of sample
50%
0%90% 95% 100% 105% 110% 115%
Size of affected limb as a proportion of true size
Patients with CRPS1
85%
Normal controlsPatients with non-CRPS1 pain
Moseley 2004 Neurology 65, 773
www.bodyinmind.com.au Copyright GL Moseley 2009
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Why might that be?
This also happens after anaesthetic
www.bodyinmind.com.au Copyright GL Moseley 2009
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www.bodyinmind.com.au Copyright GL Moseley 2009
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www.bodyinmind.com.au Copyright GL Moseley 2009
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Could distorted body image be contributing
to symptoms?
www.bodyinmind.com.au Copyright GL Moseley 2009
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Design
10 patients with CRPS of one hand Random allocation
Control Clear Magnified Minified
www.bodyinmind.com.au Copyright GL Moseley 2009
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Moseley, Parsons & Spence 2008 Current Biology 18, 1047-8
www.bodyinmind.com.au Copyright GL Moseley 2009
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0
40
10 200
Change in pain
(100 mm VAS)
M R
Trial time (minutes)
Control
www.bodyinmind.com.au Copyright GL Moseley 2009
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0
40
10 200
Change in pain
(100 mm VAS)
M R
Trial time (minutes)
Control Clear
www.bodyinmind.com.au Copyright GL Moseley 2009
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0
40
10 200
Change in pain
(100 mm VAS)
M R
Trial time (minutes)
Control Clear Magnified
www.bodyinmind.com.au Copyright GL Moseley 2009
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0
100
Peak pain(100 mm
VAS)
Ctrl Clear Mag.Recovery time (minutes)
200
*
*
Ctrl
Clear
Mag.
A B
0.8
1.2
Post-task swelling(aff/unaff)
*
Control Clear Magnified
* *
*
www.bodyinmind.com.au Copyright GL Moseley 2009
Moseley, Parsons & Spence 2008 Current Biology 18, 1047-8
![Page 26: Training The Brain 5 Recent Developments Bodily Awareness](https://reader035.vdocuments.net/reader035/viewer/2022070317/55653bded8b42a313f8b503f/html5/thumbnails/26.jpg)
Why train the brain?
Cognitive
Understanding the problem
Other threatening cues are relevant
Educate & explain
Behavioural
Function & movement hierarchy
‘training the brain part 1’
Brain changes
S1 reorganisation
Reorganisation elsewhere?
‘training the brain part 2’
Recent developments
Neglect and ownership
Disrupted bodily awareness
Disruption of high-order cognitive
representations.
www.bodyinmind.com.au Copyright GL Moseley 2009
Our approach to treating CRPS
![Page 27: Training The Brain 5 Recent Developments Bodily Awareness](https://reader035.vdocuments.net/reader035/viewer/2022070317/55653bded8b42a313f8b503f/html5/thumbnails/27.jpg)
DAVID
BUTLER | LO
RIMER M
OSELEY | ART SU
NYATA
www.noigroup.comwww.OPTP.comwww.physiouk.co.uk
www.noigroup.comwww.physiouk.co.uk
www.OPTP.com
resources
www.amazon.com