Training The Brain 3 Brain Changes

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Part of training the brain series focused on Complex Regional Pain Syndrome (CRPS) but relevant to all types of pain.

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Training The Brain 3 Brain Changes

  1. 1. 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
  2. 2. www.bodyinmind.com.au Copyright GL Moseley 2009 Why train the brain? CRPS as an extreme protective response.
  3. 3. www.bodyinmind.com.au Copyright GL Moseley 2009 Why train the brain? Our approach to treating CRPS Cognitive Behavioural Brain changes Understanding the Function & S1 reorganisation problem movement hierarchy Reorganisation Other threatening elsewhere? cues are relevant ‘training the brain part 1’ ‘training the brain Educate & explain part 2’
  4. 4. www.bodyinmind.com.au Copyright GL Moseley 2009 Why train the brain? CRPS as an extreme protective response. Cognitive Behavioural Brain changes Understanding the Function & S1 reorganisation problem movement heirarchy Reorganisation Other threatening elsewhere? cues are relevant ‘training the brain part 1’ ‘training the brain Educate & explain part 2
  5. 5. www.bodyinmind.com.au Copyright GL Moseley 2009 Why train the brain? CRPS as an extreme protective response. Cognitive Behavioural Brain changes Understanding the Function & S1 reorganisation problem movement heirarchy Reorganisation Other threatening elsewhere? cues are relevant ‘training the brain part 1’ ‘training the brain Educate & explain part 2
  6. 6. 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
  7. 7. www.bodyinmind.com.au Copyright GL Moseley 2009 Unaffected side vs affected side Maihofner et al 2003 Neurology 61 1707-15
  8. 8. www.bodyinmind.com.au Copyright GL Moseley 2009 Using discrimination of tactile stimuli to restore S1 maps
  9. 9. www.bodyinmind.com.au Copyright GL Moseley 2009 Stimulation only - representation together Discriminating between stimuli - representation moves apart Braun et al, J Neurosci, 2000, 20(1):446-
  10. 10. www.bodyinmind.com.au Copyright2001 Lancet 357 1763-4 Flor et al GL Moseley 2009 RCT Discriminate location & intensity between stimuli
  11. 11. www.bodyinmind.com.au Copyright2001 Lancet 357 1763-4 Flor et al GL Moseley 2009 RCT Discriminate location & intensity between stimuli
  12. 12. www.bodyinmind.com.au Copyright2001 Lancet 357 1763-4 Flor et al GL Moseley 2009 RCT Discriminate location & intensity between stimuli
  13. 13. www.bodyinmind.com.au Copyright2001 Lancet 357 1763-4 Flor et al GL Moseley 2009 RCT Discriminate location & intensity between stimuli
  14. 14. www.bodyinmind.com.au Copyright2001 Lancet 357 1763-4 Flor et al GL Moseley 2009 RCT Discriminate location & intensity between stimuli
  15. 15. www.bodyinmind.com.au Copyright2001 Lancet 357 1763-4 Flor et al GL Moseley 2009 RCT Discriminate location & intensity between stimuli
  16. 16. www.bodyinmind.com.au Copyright2001 Lancet 357 1763-4 Flor et al GL Moseley 2009 RCT Discriminate location & intensity between stimuli
  17. 17. www.bodyinmind.com.au Copyright2001 Lancet 357 1763-4 Flor et al GL Moseley 2009 RCT Discriminate location & intensity between stimuli
  18. 18. www.bodyinmind.com.au Copyright2001 Lancet 357 1763-4 Flor et al GL Moseley 2009 RCT Discriminate location & intensity between stimuli
  19. 19. www.bodyinmind.com.au Copyright2001 Lancet 357 1763-4 Flor et al GL Moseley 2009 RCT Discriminate location & intensity between stimuli D
  20. 20. www.bodyinmind.com.au Copyright2001 Lancet 357 1763-4 Flor et al GL Moseley 2009 RCT 6 Discriminate location & intensity between stimuli Phantom limb pain Pre Post 0 40 0 D D
  21. 21. www.bodyinmind.com.au Copyright2001 Lancet 357 1763-4 Flor et al GL Moseley 2009 RCT 6 Discriminate location & intensity between stimuli Phantom limb pain Pre Post 0 40 0 D D
  22. 22. www.bodyinmind.com.au Flor et al 2001 Lancet 357 1763-4 RCT Copyright GL Moseley 2009 6 Discriminate location & intensity between stimuli Phantom limb pain Pre Post 0 40 0 D Change in acuity, pain & representation all related Spearman’s >0.73 p <0.05
  23. 23. www.bodyinmind.com.au Flor et al 2001 Lancet 357 1763-4 RCT Copyright GL Moseley 2009 6 Discriminate location & intensity between stimuli Phantom limb pain Pre Post 0 40 0 D Change in acuity, pain & representation all related Spearman’s >0.73 p <0.05
  24. 24. A. Stimulation www.bodyinmind.com.au Copyright GL Moseley 2009 NO ATTENTION Probes Screen 5 1 2 34 2 mm 11 mm Affected part ATTENTION Stimulation sites 5 1 2 4 3 5 5 5 1 2 34 1 2 34 Photograph of affected part, with stimulation2008 Pain 137(3) 600-8 Moseley et al sites marked.
  25. 25. www.bodyinmind.com.au Copyright 8 Moseley 2009 GL NO ATTENTIO Pain NRS 4 Screen 5 0 1 2 34 60 TPD mm ATTENTION 30 10 Task-specific NRS 5 5 5 5 1 2 34 1 2 34 0 Wait No Attention Review attention Moseley et al 2008 Pain 137(3) 600-8
  26. 26. www.bodyinmind.com.au Copyright GL Moseley 2009 Schaefer et al 2005 Neuroimage
  27. 27. www.bodyinmind.com.au Copyright GL Moseley 2009 Taylor-Clarke et al 2002 Curr Biol 12 233-236
  28. 28. www.bodyinmind.com.au Copyright GL Moseley 2009 Moseley & Wiech 2009 Pain 144(3) 314-9
  29. 29. www.bodyinmind.com.au Copyright GL Moseley 2009 Moseley & Wiech 2009 Pain 144(3) 314-9
  30. 30. www.bodyinmind.com.au Copyright GL Moseley 2009 Moseley & Wiech 2009 Pain 144(3) 314-9 Two sessions of this per day for two weeks, reduced pain, increased tactile acuity and function.
  31. 31. www.bodyinmind.com.au Copyright GL Moseley 2009 Moseley & Wiech 2009 Pain 144(3) 314-9
  32. 32. www.bodyinmind.com.au Copyright GL Moseley 2009 We hypothesise that one session of this will be better. Moseley & Wiech 2009 Pain 144(3) 314-9
  33. 33. www.bodyinmind.com.au Copyright GL Moseley 2009 Moseley & Wiech 2009 Pain 144(3) 314-9
  34. 34. www.bodyinmind.com.au Copyright GL Moseley 2009 Why train the brain? Our approach to treating CRPS Cognitive Behavioural Brain changes Understanding the Function & S1 reorganisation problem movement hierarchy Reorganisation Other threatening elsewhere? cues are relevant ‘training the brain part 1’ ‘training the brain Educate & explain part 2’
  35. 35. www.bodyinmind.com.au Copyright GL Moseley 2009 Why train the brain? Recent developments Go to the next Neglect and ownership Disrupted bodily awareness set of slides on Disruption of Recent high-order cognitive Developments representations.

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