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Complex Regional Pain
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Copyright GL Moseley 2009


                                              Syn...
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                            Why train the brain?



      CRPS as an extre...
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                                                             Why train the...
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Copyright GL Moseley 2009
                            Why train the brain?




                     ...
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  Does it feel like it is mine?
                              Many patie...
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             Could this ‘disownership’ contribute to
                 ...
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                              The rubber hand
        Copyright GL Moseley 2009


                  ...
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                              The rubber hand
        Copyright GL Moseley 2009                     ...
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        Copyright GL Moseley 2009




                                                             1...
Pre
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   ...
Pre
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...
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        Copyright GL Moseley 2009




                                                          0º
 ...
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                                           Yes.
             Could thi...
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                    The neglect question...
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               Vibrator
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               Vibrator
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               Vibrator
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               Vibrator
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                            Stimulator
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                            Stimulator
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                   Left




                            Stimulator
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                            Stimulator
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                            Stimulator
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                                         Right




                   ...
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In chronic CRPS,
   you have to
  stimulate the
 affected hand
   about 2...
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Copyright GL Moseley 2009

    But when you
 cross your arms,
     the opposite
      occurs - you
 ...
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Copyright GL Moseley 2009
           This shows that the
            bigger the shift in
           ...
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Copyright GL Moseley 2009
                            Why train the brain?



                      ...
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Training The Brain 4 Recent Developments Neglect

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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 4 Recent Developments Neglect

  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 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
  4. 4. www.bodyinmind.com.au Copyright GL Moseley 2009 Why train the brain? Recent developments Neglect and ownership
  5. 5. www.bodyinmind.com.au Copyright GL Moseley 2009 Does it feel like it is mine? Many patients report feelings of foreigness & hostility towards the limb. “I feel like it is not mine, like it is an imposter” Lewis et al 2008 Pain
  6. 6. www.bodyinmind.com.au Copyright GL Moseley 2009 Could this ‘disownership’ contribute to symptoms?
  7. 7. www.bodyinmind.com.au The rubber hand Copyright GL Moseley 2009 illusion Moseley et al 2008 PNAS 105(35), 13169-73
  8. 8. www.bodyinmind.com.au The rubber hand Copyright GL Moseley 2009 Ctl RHI Ctl illusion 10 Vividness of RHI 0 0º Moseley et al 2008 PNAS 105(35), 13169-73 Foot temperature -1º 60 s 0º Hand temperature -1º
  9. 9. www.bodyinmind.com.au Copyright GL Moseley 2009 10 Moseley et al 2008 PNAS 105(35), 13169-73 33.0 32.0 Control Rubber hand illusion
  10. 10. Pre www.bodyinmind.com.au Copyright GL Moseley 2009 Post 10 Moseley et al 2008 PNAS 105(35), 13169-73 33.0 32.0 Control Rubber hand illusion www.bodyinmind.com.au
  11. 11. Pre www.bodyinmind.com.au Copyright GL Moseley 2009 Post 10 Moseley et al 2008 PNAS 105(35), 13169-73 30.5 Synchronous tapping eyes closed RHI 29.5 0 2 Time 5
  12. 12. www.bodyinmind.com.au Copyright GL Moseley 2009 0º Skin temperature Moseley et al 2008 PNAS 105(35), 13169-73 -1º R =0.50* 0 5 10 Vividness of the illusion 10
  13. 13. www.bodyinmind.com.au Copyright GL Moseley 2009 Yes. Could this ‘disownership’ contribute to symptoms?
  14. 14. www.bodyinmind.com.au Copyright GL Moseley 2009 The neglect question...
  15. 15. www.bodyinmind.com.au Copyright GL Moseley 2009 Vibrator
  16. 16. www.bodyinmind.com.au Copyright GL Moseley 2009 Vibrator
  17. 17. www.bodyinmind.com.au Copyright GL Moseley 2009 Vibrator
  18. 18. www.bodyinmind.com.au Copyright GL Moseley 2009 Vibrator
  19. 19. www.bodyinmind.com.au Copyright GL Moseley 2009
  20. 20. www.bodyinmind.com.au Copyright GL Moseley 2009 Stimulator
  21. 21. www.bodyinmind.com.au Copyright GL Moseley 2009 Stimulator
  22. 22. www.bodyinmind.com.au Copyright GL Moseley 2009 Left Stimulator
  23. 23. www.bodyinmind.com.au Copyright GL Moseley 2009 Stimulator
  24. 24. www.bodyinmind.com.au Copyright GL Moseley 2009 Stimulator
  25. 25. www.bodyinmind.com.au Copyright GL Moseley 2009 Right Stimulator
  26. 26. www.bodyinmind.com.au Copyright GL Moseley 2009 In chronic CRPS, you have to stimulate the affected hand about 25ms before the other to think the stimuli occurred at the same time Moseley et al 2009 Brain (published on-line 150909)
  27. 27. www.bodyinmind.com.au Copyright GL Moseley 2009 But when you cross your arms, the opposite occurs - you have to stimulate the UNaffected 20ms before the affected to think the stimuli occurred at the same time Moseley et al 2009 Brain (published on-line 150909)
  28. 28. www.bodyinmind.com.au Copyright GL Moseley 2009 This shows that the bigger the shift in processing, the colder the limb is, relative to the opposite one. The shift away from the affected limb is opposite to what we see with acute threatening stimuli Van Damme et al 2009 Brain Res. 2009;1253:100-106. Moseley et al 2009 Brain (published on-line 150909)
  29. 29. www.bodyinmind.com.au Copyright GL Moseley 2009 Why train the brain? Recent developments Go to the next Disrupted bodily awareness set of slides on Disruption of Recent high-order cognitive Developments representations.

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