OBJECTIVES: To study the effectiveness of mirror therapy along with a Stroke rehabilitation program on oedema, pain intensity and functional activities in patients with shoulder‐hand syndrome (SHS) after stroke. DESIGN: Randomized controlled trial. Settings: Out‐patient rehabilitation center. METHODS: Thirty‐eight SHS patients after stroke, were randomly allocated into two groups; both the groups received a 4‐week stroke rehabilitation program, 30 min a day for 5 days a week. Control group patients performed all the exercises of stroke rehabilitation program, while directly visualizing their both limbs. Experimental group patients performed same exercises of stroke rehabilitation program in front of the mirror. Outcome Measures: Oedema (figure‐of‐eight measurement method), pain intensity (0–10 Numeric Pain Rating Scale [0–10 NPRS]), functional activities (Functional Independence Measure [FIM]). RESULTS: After intervention, both groups showed statistically significant (p < 0.05) improvement for all measures (oedema measurement, 0–10 NPRS and FIM). Improvements were more significant (p < 0.05) in the experimental group with mirror therapy for all three measures compared to the control group. Mean differences between groups were 1.40 cm for oedema measurement, 0.87 for NPRS score and 12.20 for FIM score. At 2‐week follow‐up, the improvements were sustained. CONCLUSION: The current study may indicate mirror therapy as an effective central neuromodulatory rehabilitative program to reduce pain, improves functional activities. More distinctively, this preliminary study suggests a decrease in oedema by mirror therapy for SHS after stroke. Improvement of upper limb in SHS after stroke will be more perceptible with the decrease in oedema, being the characteristic sign, following mirror therapy. Clinically, patients during their daily functional activities, shall be more confident to use their upper limb following mirror therapy after reduction in oedema along with pain.
Complex regional pain syndrome (CRPS) is a neuropathic pain condition that is difficult to treat. For behavioral interventions, graded motor imagery (GMI) showed relevant effects, but underlying neural substrates in patient groups have not been investigated yet. A previous study investigating differences in the representation of a left/right hand judgment task demonstrated less recruitment of subcortical structures, such as the putamen, in CRPS patients than in healthy controls. In healthy volunteers, the putamen activity increased after a hand judgment task training. In order to test for longitudinal effects of GMI training, we investigated 20 CRPS patients in a wait-list crossover design with 3 evaluation time points. Patients underwent a 6 week GMI treatment and a 6 week waiting period in a randomized group assignment and treatment groups were evaluated by a blinded rater. When compared to healthy matched controls at baseline, CRPS patients showed less functional activation in areas processing visual input, left sensorimotor cortex, and right putamen. Only GMI treatment, but not the waiting period showed an effect on movement pain and hand judgment task performance. Regression analyses revealed positive associations of movement pain with left anterior insula activation at baseline. Right intraparietal sulcus activation change during GMI was associated with a gain in performance of the hand judgment task. The design used here is reliable for investigating the functional representation of the hand judgment task in an intervention study. PERSPECTIVE: Twenty chronic CRPS patients underwent a 6 week GMI intervention in a randomized wait-list crossover design. functional MRI was tested pre and post for the hand lateralization task which improved over GMI but not over WAITING. Performance gain was positively related to right parietal functional MRI activation. (PsycInfo Database Record (c) 2023 APA, all rights reserved)
BACKGROUND: Effective treatment of longstanding Complex Regional Pain Syndrome (CRPS) is a challenge, as causal mechanisms remain elusive. People with CRPS frequently report distorted subjective perceptions of their affected limb. Evidence of pain reduction when the affected limb is visually altered in size suggests that visual illusions used to target central processing could restore coherence of this disrupted limb representation. We hypothesized that using virtual reality that alters hand image to match the patient's desired hand appearance would improve body perception disturbance and pain. Also, repeated exposure would maintain any therapeutic effect. METHODS: A blinded randomized controlled trial of 45 participants with refractory upper-limb CRPS and body perception disturbance (BPD) viewed a digital image of their affected hand for 1 min. The image was digitally altered according to the patient's description of how they desired their hand to look in the experimental group and unaltered in the control group. BPD and pain were measured pre-and post-intervention. A subgroup was followed up 2 weeks after a course of repeated interventions. RESULTS: BPD (mean-6, ± <i>SD</i> 7.9, <i>p</i> = 0.036, effect size [ES] = 0.6) and pain intensity (mean-0.43, ±<i> SD</i> 1.3, <i>p</i> = 0.047, ES = 0.5) reduced in 23 participants after single exposure compared to controls (<i>n</i> = 22). At follow-up, the subgroup (experimental <i>n</i> = 21; control <i>n</i> = 18) showed sustained pain reduction only (<i>p</i> = 0.037, ±SD 1.9, ES = 0.7), with an overall 1.2 decrease on an 11-point scale. CONCLUSIONS: Visually changing the CRPS hand to a desired appearance modulates BPD and pain suggesting therapeutic potential for those with refractory CRPS. Further research to optimize this therapeutic effect is required. Significance: Visual bodily illusions that change the shape and appearance of the painful CRPS hand to that desired by the patient result in a rapid amelioration of pain and body perception disturbance in people with longstanding CRPS. These findings highlight the future potential of this drug-free approach in the treatment of refractory CRPS. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
Initial evidence suggested that people with complex regional pain syndrome (CRPS) have reduced attention to the affected side of their body and the surrounding space, which might be related to pain and other clinical symptoms. Three previous unblinded, uncontrolled studies showed pain relief after treatment with prism adaptation, an intervention that has been used to counter lateralised attention bias in brain-lesioned patients. To provide a robust test of its effectiveness for CRPS, we conducted a double-blind randomized controlled trial of prism adaptation for unilateral upper-limb CRPS-I. Forty-nine eligible adults with CRPS were randomized to undergo 2 weeks of twice-daily home-based prism adaptation treatment (n = 23) or sham treatment (n = 26). Outcomes were assessed in person 4 weeks before and immediately before treatment, and immediately after and 4 weeks after treatment. Long-term postal follow-ups were conducted 3 and 6 months after treatment. We examined the effects of prism adaptation vs sham treatment on current pain intensity and the CRPS symptom severity score (primary outcomes), as well as sensory, motor, and autonomic functions, self-reported psychological functioning, and experimentally tested neuropsychological functions (secondary outcomes). We found no evidence that primary or secondary outcomes differed between the prism adaptation and sham treatment groups when tested at either time point after treatment. Overall, CRPS severity significantly decreased over time for both groups, but we found no benefits of prism adaptation beyond sham treatment. Our findings do not support the efficacy of prism adaptation treatment for relieving upper-limb CRPS-I. (PsycInfo Database Record (c) 2022 APA, all rights reserved)
OBJECTIVE: The study aimed to evaluate the efficacy of Bio-Electro-Magnetic-Energy-Regulation (BEMER) magneto-therapy on pain and functional outcome in complex regional pain syndrome type I (CRPS-I). We hypothesized that BEMER therapy, based on its declared effects on microcirculation, could be beneficial in the treatment of this condition. METHODS: This was a randomized controlled double-blind pilot study that included 30 patients with CRPS-I. Patients were divided into two groups: a study group, in which the rehabilitation program was combined with BEMER therapy for 10 consecutive days, and a control group, in which the rehabilitation program was combined with a sham BEMER treatment. Outcome measures (Visual Analogic Scale pain; Hand Grip Strength; Disabilities of the Arm, Shoulder, and Hand ; Maryland Foot Score) were taken at the beginning and end of treatment, and at 1 month follow-up. RESULTS: The study demonstrated that the group treated with BEMER combined with rehabilitation yielded better results in the short term, in terms of pain reduction and functional improvement both at the upper and lower limbs. CONCLUSIONS: Data from the present pilot study suggest that BEMER therapy can be indicated, in combination with traditional rehabilitation programs, for the treatment of CRPS-I.
To study the effectiveness of mirror therapy along with a Stroke rehabilitation program on oedema, pain intensity and functional activities in patients with shoulder‐hand syndrome (SHS) after stroke.
Thirty‐eight SHS patients after stroke, were randomly allocated into two groups; both the groups received a 4‐week stroke rehabilitation program, 30 min a day for 5 days a week. Control group patients performed all the exercises of stroke rehabilitation program, while directly visualizing their both limbs. Experimental group patients performed same exercises of stroke rehabilitation program in front of the mirror. Outcome Measures: Oedema (figure‐of‐eight measurement method), pain intensity (0–10 Numeric Pain Rating Scale [0–10 NPRS]), functional activities (Functional Independence Measure [FIM]).
RESULTS:
After intervention, both groups showed statistically significant (p < 0.05) improvement for all measures (oedema measurement, 0–10 NPRS and FIM). Improvements were more significant (p < 0.05) in the experimental group with mirror therapy for all three measures compared to the control group. Mean differences between groups were 1.40 cm for oedema measurement, 0.87 for NPRS score and 12.20 for FIM score. At 2‐week follow‐up, the improvements were sustained.
CONCLUSION:
The current study may indicate mirror therapy as an effective central neuromodulatory rehabilitative program to reduce pain, improves functional activities. More distinctively, this preliminary study suggests a decrease in oedema by mirror therapy for SHS after stroke. Improvement of upper limb in SHS after stroke will be more perceptible with the decrease in oedema, being the characteristic sign, following mirror therapy. Clinically, patients during their daily functional activities, shall be more confident to use their upper limb following mirror therapy after reduction in oedema along with pain.
