Neurological

Graded motor imagery protocol for CRPS

In 2004, Lorimer Moseley published a RCT which assessed the use of a graded motor imagery protocol for the treatment of CRPS.  I find this protocol to be quite helpful in my treatment of CRPS-1 (when occuring in a patients hand or foot, unilaterally).   Each step is performed for 2 weeks.

1. Recognition of laterality in the hand or foot: Moseley states that “recognizing a pictured hand to be a left or right hand activates brain areas involved in higher-order aspects of motor output, the so-called pre-motor cortices, whereas explicitly imagined movements also activate the primary motor cortex.”  Perform this step by making flash-cards of pictures of hands or feet in different positions.  The patient is then asked to identify these as left or right as quickly as possible and as the examiner, you calculate the % identified correctly.  This is to be performed as quickly as possible.  Software has also been developed to perform this exercise/test and is found here.

2.  Imagined movements: Use the flash-cards of the hands and feet in exercise.  The patient will imagine moving the affected limb to the position demonstrated on the card.  They will then imagine returning to neutral and repeat this 3+ times.

3. Mirror-box therapy: Create a box to place the affected limb into with a mirror on the side.  Place the affected limb inside of the box and using the unaffected limb, assume positions as illustrated on the flash-cards used in the first 2 exercises.  While moving the unaffected limb, look into the mirror so that the patient has the illusion that the affected limb is performing the activity.  Eventually progress this so that the affected limb is moving inside the box with the unaffected limb, but still paying attention to the mirror.

Update: For a limited time, the NoiGroup has offered the Recognise Application for iphones for free.

Moseley GL. Graded motor imagery is effective for long-standing complex regional pain syndrome: a randomized controlled trial. Pain 2004: 108; 192-198.

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