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Crps ppt

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Crps ppt

  1. 1. Amanda Nowak OT/s
  2. 2.  Pain is a signal that the body has been damaged or something is wrong Reaction designed to protect you (makes you stop what you are doing what caused it Pain can either be acute or chronic
  3. 3. The Processof PainStimulus  Painreceptors  Spinalcord  Thalamus Cerebral cortex  “OUCH”
  4. 4.  Abnormality of the processing of pain by the neurologic system CRPS can be either type I (RSD) or type II (causalgia) Pain is disproportionate to the initial event An official diagnosis must first rule out any alternative diagnosis Frequently diagnosed associated with mild severe injuries/surgeries (commonly carpal tunnel release, Dupuytren’s release, and distal radial fracture) Can occur either before or after therapy referral
  5. 5.  Allodynia Hyperalgia Hyperpathia Swelling Stiffness Discoloration Abnormal hair/ nail growth Hyperhydrosis Motor Dysfunction Bone Degeneration
  6. 6. CRPS Pain rated a 42Most painful form of chronic pain
  7. 7.  Ask which areas are hypersensitive BEFORE touching the patient Pain assessment is important to determine client’s tolerance Postpone unnecessary tests to a time when they are not swollen, painful, and stiff Measuring edema: use warm water and as quickly as you can Phych eval
  8. 8.  Pain  Stress Loading  Modalities (moist heat,  “load and carry” fluidotherapy, contrast  Joint Protection baths)  Patient Education Edema  “To Improve, Move”  Elevation with AROM, manual edema mobilization, compression, massage Sensation  Desensitization Range of Motion  PROM, stretching, blocking, tendon gliding, PNF patterns Splinting  Resting position
  9. 9. No protocol works for all patients with CRPS. It is dependent on current pain level, symptoms, and tolerance (see handout)
  10. 10. OCCUPATIONAL THERAPY PHYSICAL THERAPYi) to reduce clinical symptoms, i) Increasing the degree ofand protect and support the control over the pain andaffected limb in the most improving the way the patientfunctional and comfortable copes with the syndromeposition by means of a splint. ii) Extinguishing the source ofii) to normalize sensitivity by pain and treating anycarrying out an extensive dysregulationdesensitization program iii) Improving skillsiii) to encourage the functionaluse of the limb within the painthreshold.iv) to encourage independence
  11. 11.  Communicate regarding progress/lack of progress Monitor symptoms and adjust treatment accordingly Communicate with therapist regarding goals Discuss maximal pain limits and which pain reduction techniques are most effective Record progress of home exercise program Provide adaptations and assistive devices for ADL’s and work related activities Modify/Adjust splints
  12. 12. Shows a trend that mirror therapy is effective with CRPS. Mirror therapy was shown to be effective in CRPS patients in Stage I and II but not effective in Stage III patients. It had an immediate analgesiceffect with a reduction in stiffness. In those patients which mirror therapy was not effective, all were lower extremity affected. 17 different outcome measures were used measuring symptoms,functional levels, and the treatment itself. It is noted that Mirror therapy in CRPS II patients is worth further exploration.Results of these studies were not statistically analyzed
  13. 13. May be safe and effective 186 PatientsAssumes that avoiding use of a limb Referred due to pain will result in loss of function“Graded exposure”Discussion of possible pain increaseTraction & translation of joints 106 Patients Included 80 Patients 4 Patients Stopped 2Passive Stretching Excluded Male 2FemaleFunctional use immediately after 2 arm/hand 2 leg/footDesensitizationMax of 5 45 min sessions over 3 months with evaluation of Arm/hand 39 Leg/foot 63 treatment 3 months after last patients patients treatment 18 full recovery 31 full recovery 19 partial recovery 27 partial recoveryFocuses on FUNCTIONAL 2 patients lost to 5 no change improvement only follow-up
  14. 14.  Completely individual The sooner treatment begins, the quicker improvements are noted The longer treatment is delayed, the more likely it is to require long-term treatment
  15. 15. No, there is a lack of evidence in all areas ofCRPS and more research needs to be done to find the most effective treatments for these patients.
  16. 16.  Cooper, C. (2007). Fundamentals of hand therapy. Mosby-Elsevier: St. Louis, MO. Ek, J., Gijn, J., Samwel, H., Egmond, J., Klomp, F., & Dongen, R. (2009). Pain exposure physical therapy may be a safe and effective treatment for longstanding complex regional pain syndrome type 1: a case series. Clinical Rehabilitation, 23, 1059–1066. doi: 10.1177/0269215509339875 Ezendam, D., Bongers, R. & Jannik, M. (2009). Systematic review of the effectiveness of mirror therapy in upper extremity function. Disability and Rehabilitation, 31(26), 2135– 2149. doi: 10.3109/09638280902887768 Geertzen, J. & Harden, R. (2006). Physical and Occupational Therapies in Complex Regional Pain Syndrome Type I. Joumal of Neuropathic Pain & Symptom Palliation, 2(3), 51-55. doi: doi:10.1300/J426v02n03_11 Kishner, S., Rothaermel, B., Munshi, S., Malalis, J. & Gunduz, O. (2011). Complex regional pain syndrome. Turkish Journal of Physical Medicine and Rehabilitation, 57, 156-164. doi: 10.4274/tftr.09327 Maihofer, C., Seifert, F., & Markovic, K. (2010). Complex regional pain syndromes: new pathophysiological concepts and therapies. European Journal of Neurology, 17, 649–660. doi: doi:10.1111/j.1468-1331.2010.02947.x Mos, M., Sturkenboom, M., & Huygen, F. (2009). Current understandings of complex regional pain syndrome. Pain Practice, 9(2), 86-99. doi: 10.1111/j.1533-2500.2009.00262.x Perez, R., Zollinger, P., Dijkstra, P., Thomassen-Hilgersom, I., Zuurmond, W., Rosenbrand, K. & Geertzen, J. (2010). REevseiadrche anrticclee based guidelines for complex regional pain syndrome type 1. BMC Neurology, 10(20), 1-14.

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