Training The Brain 4 Recent Developments Neglect

Lorimer MoseleyNHMRC Senior Research FellowPrince of Wales Medical Research Institute & Faculty of Medicine, University of NSW, Sydney, Australia

CRPS Rehabilitation (or training the brain)

www.bodyinmind.com.au Copyright GL Moseley 2009 Complex Regional Pain

Syndrome

http://www.google.com/profiles/lorimer.moseley

http://www.google.com/profiles/lorimer.moseley

http://www.bodyinmind.com.au/training-the-brain-1-cognitive-understanding-the-problem/




http://www.bodyinmind.com.au


Why train the brain?

CRPS as an extreme protective response.

www.bodyinmind.com.au Copyright GL Moseley 2009




Cognitive

Understanding the problem

Other threatening cues are relevant

Educate & explain

Behavioural

Function & movement hierarchy

‘training the brain part 1’

Brain changes

S1 reorganisation

Reorganisation elsewhere?

‘training the brain part 2’

Recent developments

Neglect and ownership

Disrupted bodily awareness

Disruption of high-order cognitive

representations.


Our approach to treating CRPS









http://www.bodyinmind.com.au/training-the-brain-2-behavioural-function-and-movement-hierarchy/










http://www.bodyinmind.com.au/training-the-brain-3-brain-changes-s1-reorganisation/








http://www.bodyinmind.com.au/training-the-brain-4-recent-developments-neglect-and-ownership/




http://www.bodyinmind.com.au/training-the-brain-5-recent-developments-disrupted-bodily-awareness/







Neglect and ownership


Recent developments







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




Could this ‘disownership’ contribute to symptoms?




The rubber hand illusion

Mo

sele

y e

t a

l 200

8 PN

AS

105(

35),

131

69-7

3www.bodyinmind.com.au

Copyright GL Moseley 2009



10

0

-1º

-1º

0º

0º

Ctl CtlRHI

60 s

Vividness of RHI

Foot temperature

Hand temperature

The rubber hand illusion

Mo

sele

y e

t a

l 200

8 PN

AS

105(

35),

131

69-7





10

32.0

33.0

Control Rubber hand illusion

Mo

sele

y e

t a

l 200

8 PN

AS

105(

35),

131

69-7





10

32.0

33.0

Control Rubber hand illusion

Pre PostM

ose

ley

et

al 2

008

PNA

S 10

5(35

), 1

3169

-73

www.bodyinmind.com.au






10

29.5

30.5

Pre Post

Time0 52

RHISynchronous tapping eyes

closed

Mo

sele

y e

t a

l 200

8 PN

AS

105(

35),

131

69-7





10

-1º

0º

Vividness of the illusion0 105

R =0.50*

Skin temperature

Mo

sele

y e

t a

l 200

8 PN

AS

105(

35),

131

69-7





Yes.

Could this ‘disownership’ contribute to symptoms?




The neglect question...




Vibrator




Vibrator




Vibrator




Vibrator







Stimulator




Stimulator




Stimulator

Left




Stimulator




Stimulator




Stimulator

Right




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)




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 timeMoseley et al 2009 Brain (published on-line 150909)




This shows that the bigger the shift in

processing, the colder the limb is,

relative to the opposite one.

Moseley et al 2009 Brain (published on-line 150909)

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.





Recent developments

Disrupted bodily awareness

Disruption of high-order cognitive

representations.


Go to the next set of slides on Recent Developments









Business

Training The Brain 4 Recent Developments Neglect