Training The Brain 5 Recent Developments Bodily Awareness

Complex Regional Pain www.bodyinmind.com.au Copyright GL Moseley 2009 Syndrome CRPS Rehabilitation (or training the brain) Lorimer Moseley NHMRC Senior Research Fellow Prince of Wales Medical Research Institute & Faculty of Medicine, University of NSW, Sydney, Australia

www.bodyinmind.com.au Copyright GL Moseley 2009 Why train the brain? CRPS as an extreme protective response.

www.bodyinmind.com.au Copyright GL Moseley 2009 Why train the brain? Our approach to treating CRPS Recent developments Cognitive Behavioural Brain Neglect and Disrupted bodily Understanding Function & changes ownership awareness the problem movement S1 reorganisation hierarchy Disruption of Other threatening ‘training the brain Reorganisation high-order elsewhere? cues are part 1’ cognitive relevant ‘training the brain representations. Educate & part 2’ explain

www.bodyinmind.com.au Copyright GL Moseley 2009 Why train the brain? Recent developments Disrupted bodily awareness Disruption of high-order cognitive representations.

www.bodyinmind.com.au Copyright GL Moseley 2009 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 32 CRPS patients 18 non-CRPS chronic hand pain patients Digital photo affected

www.bodyinmind.com.au Copyright GL Moseley 2009 32 CRPS patients 18 non-CRPS chronic hand pain patients Expanded or condensed affected

www.bodyinmind.com.au Copyright GL Moseley 2009 32 CRPS patients 18 non-CRPS chronic hand pain patients Expanded to 115% affected

www.bodyinmind.com.au Copyright GL Moseley 2009 32 CRPS patients 18 non-CRPS chronic hand pain patients Condensed to 85% affected

www.bodyinmind.com.au Copyright GL Moseley 2009 “Which of these is a true picture?”

www.bodyinmind.com.au Copyright GL Moseley 2009 “Which of these are chicken feet?”

www.bodyinmind.com.au Copyright GL Moseley 2009 Normal controls 50% Proportion of sample 0% 85% 90% 95% 100% 105% 110% 115% Size of affected limb as a proportion of true size Moseley 2004 Neurology 65, 773

www.bodyinmind.com.au Copyright GL Moseley 2009 Normal controls Patients with non-CRPS1 pain 50% Proportion of sample 0% 85% 90% 95% 100% 105% 110% 115% Size of affected limb as a proportion of true size Moseley 2004 Neurology 65, 773

www.bodyinmind.com.au Copyright GL Moseley 2009 Normal controls Patients with non-CRPS1 pain 50% Patients with CRPS1 Proportion of sample 0% 85% 90% 95% 100% 105% 110% 115% Size of affected limb as a proportion of true size Moseley 2004 Neurology 65, 773

www.bodyinmind.com.au Copyright GL Moseley 2009 Why might that be? This also happens after anaesthetic

www.bodyinmind.com.au Copyright GL Moseley 2009

www.bodyinmind.com.au Copyright GL Moseley 2009 Could distorted body image be contributing to symptoms?

www.bodyinmind.com.au Design Copyright GL Moseley 2009 10 patients with CRPS of one hand Random allocation Control Clear Magnified Minified

www.bodyinmind.com.au Copyright GL Moseley 2009 Moseley, Parsons & Spence 2008 Current Biology 18, 1047-8

www.bodyinmind.com.au Copyright GL Moseley 2009 Control 40 Change in pain (100 mm VAS) M R 0 0 10 20 Trial time (minutes)

www.bodyinmind.com.au Copyright GL Moseley 2009 Control Clear 40 Change in pain (100 mm VAS) M R 0 0 10 20 Trial time (minutes)

www.bodyinmind.com.au Copyright GL Moseley 2009 Control Clear Magnified 40 Change in pain (100 mm VAS) M R 0 0 10 20 Trial time (minutes)

Awww.bodyinmind.com.au Copyright GL Moseley 2009 100 *** 1.2 B * Peak pain Post- Mag. (100 mm task * VAS) swelling * Clear (aff/unaff) Ctrl 0 Ctrl Clear Mag. 0.8 0 20 Recovery time (minutes) Control Clear Magnified Moseley, Parsons & Spence 2008 Current Biology 18, 1047-8

www.bodyinmind.com.au Copyright GL Moseley 2009 Why train the brain? Our approach to treating CRPS Recent developments Cognitive Behavioural Brain Neglect and Disrupted bodily Understanding Function & changes ownership awareness the problem movement S1 reorganisation hierarchy Disruption of Other threatening ‘training the brain Reorganisation high-order elsewhere? cues are part 1’ cognitive relevant ‘training the brain representations. Educate & part 2’ explain

resources DAVID BUTLER | LORIMER MOSELEY | ART SUNYATA www.noigroup.com www.physiouk.co.uk www.OPTP.com www.noigroup.com www.OPTP.com www.physiouk.co.uk www.amazon.com

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Training The Brain 5 Recent Developments Bodily Awareness

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