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
Why train the brain?
CRPS as an extreme protective response.
www.bodyinmind.com.au Copyright GL Moseley 2009
Why train the brain?
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.
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Our approach to treating CRPS
Why train the brain?
Neglect and ownership
www.bodyinmind.com.au Copyright GL Moseley 2009
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
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Could this ‘disownership’ contribute to symptoms?
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The rubber hand illusion
Mo
sele
y e
t a
l 200
8 PN
AS
105(
35),
131
69-7
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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
3www.bodyinmind.com.au
Copyright GL Moseley 2009
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
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Copyright GL Moseley 2009
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
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www.bodyinmind.com.au Copyright GL Moseley 2009
10
29.5
30.5
Pre Post
Time0 52
RHISynchronous tapping eyes
closed
Mo
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t a
l 200
8 PN
AS
105(
35),
131
69-7
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Copyright GL Moseley 2009
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
3www.bodyinmind.com.au
Copyright GL Moseley 2009
Yes.
Could this ‘disownership’ contribute to symptoms?
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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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Stimulator
Left
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Stimulator
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Stimulator
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Stimulator
Right
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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)
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 timeMoseley et al 2009 Brain (published on-line 150909)
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.
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.
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Why train the brain?
Recent developments
Disrupted bodily awareness
Disruption of high-order cognitive
representations.
www.bodyinmind.com.au Copyright GL Moseley 2009
Go to the next set of slides on Recent Developments