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Complex Regional Pain
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                                              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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           Experiment: Do patients with
                CRPS actually t...
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     32 CRPS patients            18 non-CRPS chronic
                 ...
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     32 CRPS patients                  18 non-CRPS chronic
           ...
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Copyright GL Moseley 2009




     32 CRPS patients                18 non-CRPS chronic
             ...
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Copyright GL Moseley 2009




     32 CRPS patients                18 non-CRPS chronic
             ...
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Copyright GL Moseley 2009




  “Which of these is a true
  picture?”
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  “Which of these are chicken
  feet?”
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                                                      Normal controls



 ...
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                                                      Normal controls
    ...
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Copyright GL Moseley 2009
                                                     Normal controls
     ...
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Copyright GL Moseley 2009
                                                     Normal controls
     ...
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Copyright GL Moseley 2009



    Why might that be?

    This also happens after anaesthetic
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Copyright GL Moseley 2009
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Copyright GL Moseley 2009


                             Could distorted body
                      ...
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         10 patients with C...
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                            Moseley, Parsons & Spence 2008 Current Bio...
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                 Control
      40

Change in
     pain
 (100 mm
    VA...
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                 Control           Clear
      40

Change in
     pain...
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                 Control           Clear   Magnified
      40

Change ...
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     100                    ***            1.2
                          ...
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                                                             Why train the...
resources




                                    DAVID BUTLER
                                    |
                     ...
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Training The Brain 5 Recent Developments Bodily Awareness

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

Published in: Health & Medicine, Business

Training The Brain 5 Recent Developments Bodily Awareness

  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 Disrupted bodily awareness Disruption of high-order cognitive representations.
  5. 5. 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
  6. 6. www.bodyinmind.com.au Copyright GL Moseley 2009 32 CRPS patients 18 non-CRPS chronic hand pain patients Digital photo affected
  7. 7. www.bodyinmind.com.au Copyright GL Moseley 2009 32 CRPS patients 18 non-CRPS chronic hand pain patients Expanded or condensed affected
  8. 8. www.bodyinmind.com.au Copyright GL Moseley 2009 32 CRPS patients 18 non-CRPS chronic hand pain patients Expanded to 115% affected
  9. 9. www.bodyinmind.com.au Copyright GL Moseley 2009 32 CRPS patients 18 non-CRPS chronic hand pain patients Condensed to 85% affected
  10. 10. www.bodyinmind.com.au Copyright GL Moseley 2009 “Which of these is a true picture?”
  11. 11. www.bodyinmind.com.au Copyright GL Moseley 2009 “Which of these are chicken feet?”
  12. 12. 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
  13. 13. 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
  14. 14. 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
  15. 15. 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
  16. 16. www.bodyinmind.com.au Copyright GL Moseley 2009 Why might that be? This also happens after anaesthetic
  17. 17. www.bodyinmind.com.au Copyright GL Moseley 2009
  18. 18. www.bodyinmind.com.au Copyright GL Moseley 2009
  19. 19. www.bodyinmind.com.au Copyright GL Moseley 2009 Could distorted body image be contributing to symptoms?
  20. 20. www.bodyinmind.com.au Design Copyright GL Moseley 2009 10 patients with CRPS of one hand Random allocation Control Clear Magnified Minified
  21. 21. www.bodyinmind.com.au Copyright GL Moseley 2009 Moseley, Parsons & Spence 2008 Current Biology 18, 1047-8
  22. 22. 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)
  23. 23. 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)
  24. 24. 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)
  25. 25. 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
  26. 26. 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
  27. 27. 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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