Thoracic Outlet Syndrome Thoracic Outlet Syndrome/Brachial Plexopathy. In Memory Of DeAnne Marie.


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Old 03-30-2008, 11:10 AM #1
lisa_tos lisa_tos is offline
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Join Date: Jun 2007
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lisa_tos lisa_tos is offline
Junior Member
 
Join Date: Jun 2007
Posts: 91
15 yr Member
Default easy exercises based on new brain research to decrease pain and improve hand function

This was designed for CRPS not TOS but my PT gave it to me for my TOS and I am getting good results, lower pain and better hand function. Also I used to fail propreciptive tests with my left hand (tests to see if you can tell where your hand is without looking) and now I do well at them.

Basically the idea is that pain has disrupted the representation of your hand in your brain and by correcting that, you can improve function. The exercises don’t involve moving your hand so you can do them if you are very injuried. You look at pictures of left and right hands in weird positions and work on being able to recognize them quickly visually without trying to move your hand in that position. It’s harder than it looks. Interestingly, I found I had an esp. hard time with the pictures that only showed the three fingers that don’t work so well for me, which shows the brain was more messed up for them.

You can get the equipment (i.e. pictures, mirror box, instructions) at


http://www.noigroup.com/Product.php?...iable&Variable[ProductCodeID]=RFC

I am just using flash cards, not the rest of the stuff

Here are the scientific articles on this

Pain. 2004 Mar;108(1-2):192-8. Links
Graded motor imagery is effective for long-standing complex regional pain syndrome: a randomised controlled trial.
Moseley GL.
Department of Physiotherapy, The University of Queensland and Royal Brisbane and Women's Hospital, Herston, 4029 Brisbane, Qld, Australia. l.moseley@mailbox.uq.edu.au
Complex regional pain syndrome type 1 (CRPS1) involves cortical abnormalities similar to those observed in phantom pain and after stroke. In those groups, treatment is aimed at activation of cortical networks that subserve the affected limb, for example mirror therapy. However, mirror therapy is not effective for chronic CRPS1, possibly because movement of the limb evokes intolerable pain. It was hypothesised that preceding mirror therapy with activation of cortical networks without limb movement would reduce pain and swelling in patients with chronic CRPS1. Thirteen chronic CRPS1 patients were randomly allocated to a motor imagery program (MIP) or to ongoing management. The MIP consisted of two weeks each of a hand laterality recognition task, imagined hand movements and mirror therapy. After 12 weeks, the control group was crossed-over to MIP. There was a main effect of treatment group (F(1, 11) = 57, P < 0.01) and an effect size of approximately 25 points on the Neuropathic pain scale. The number needed to treat for a 50% reduction in NPS score was approximately 2. The effect of treatment was replicated in the crossed-over control subjects. The results uphold the hypothesis that a MIP initially not involving limb movement is effective for CRPS1 and support the involvement of cortical abnormalities in the development of this disorder. Although the mechanisms of effect of the MIP are not clear, possible explanations are sequential activation of cortical pre-motor and motor networks, or sustained and focussed attention on the affected limb, or both.


Neurology. 2006 Dec 26;67(12):2129-34. Epub 2006 Nov 2. Links
Comment in:
Neurology. 2006 Dec 26;67(12):2115-6.
Graded motor imagery for pathologic pain: a randomized controlled trial.
Moseley GL.
Department of Physiology, Anatomy & Genetics & fMRIB Centre, University of Oxford, South Parks Road, Oxford OX1 3QX, UK. lorimer.moseley@ndm.ox.ac.uk
BACKGROUND: Phantom limb and complex regional pain syndrome type 1 (CRPS1) are characterized by changes in cortical processing and organization, perceptual disturbances, and poor response to conventional treatments. Graded motor imagery is effective for a small subset of patients with CRPS1. OBJECTIVE: To investigate whether graded motor imagery would reduce pain and disability for a more general CRPS1 population and for people with phantom limb pain. METHODS: Fifty-one patients with phantom limb pain or CRPS1 were randomly allocated to motor imagery, consisting of 2 weeks each of limb laterality recognition, imagined movements, and mirror movements, or to physical therapy and ongoing medical care. RESULTS: There was a main statistical effect of treatment group, but not diagnostic group, on pain and function. The mean (95% CI) decrease in pain between pre- and post-treatment (100 mm visual analogue scale) was 23.4 mm (16.2 to 30.4 mm) for the motor imagery group and 10.5 mm (1.9 to 19.2 mm) for the control group. Improvement in function was similar and gains were maintained at 6-month follow-up. CONCLUSION: Motor imagery reduced pain and disability in these patients with complex regional pain syndrome type I or phantom limb pain, but the mechanism, or mechanisms, of the effect are not clear.
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