Flashcards in Graded Motor Imagery for Chronic Pain Syndromes (PLP, CRPS) Deck (18)
What are the three stages of Graded Motor Imagery?
1. Recognition of laterally in the hand or foot (judging a pictured limb as belonging to the left or right, or moving towards one side of the body or the other)
2. Imagined Movements (mental imagery)
3. Mirror-box therapy
How do you build Recognition of laterally in the hand or foot?
Flashcards of hands and feet in different positions
-measure for time and % correct
What happens after amputation?
REORGANIZATION OF THE AMPUTATION ZONE IN THE SOMATOSENSORY CORTEX
SELECTIVE C FIBER LOSS, INPUT FROM STUMP NEURONS, ABNORMAL CHANGES IN DORSAL ROOT, GANGLION AND DORSAL HORN, SYMPATHETIC ACTIVATION
What are the Frontal-Parietal networks?
CLOSE NETWORKS- INTRA CORTICAL SENSORY TAKEOVER AND SYNESTHESIA OBSERVATIONS
DISTANT NETWORKS- HOMOLOGOUS CONTRALATERAL REPRESENTATION CONTRIBUTES TO LIMB CONFUSION
What happens with cortical reorganization?
Cortical reorganization occurs with persistent/chronic pain (changes in the sensory homonculus)
Sensitization- ↑ excitability of member neurons
Disinhibition- ↓ inhibition of non -member neurons
What happens with Laterality Recognition (R/L)?
People with chronic pain have a delay in response time (RT) to R/L judgments and/or decreased accuracy (when viewing pictures of the painful side)
Practicing R/L judgment improves response time and accuracy which corresponds with a decrease in pain
Mechanism of effect is still not entirely clear :
What do you do in Stage 2 of flashcard use?
Imagine your own limb doing the action - They will then imagine returning to neutral and repeat this 3+ times.
What are mirror neurons?
Mirror Neuron: “ a neuron that fires both when an individual acts and when the individual observes the same action performed by another”
Mirror neurons are found in the premotor, supplementary motor cortex, primary somatosensory cortex and inferior parietal cortex
Imp for understanding actions of others, learning new skills through imitation, language and empathy.
What is the importance of mirror neurons in motor imagery?
The concept of mirror neurons implies that brain cells can be activated when we watch someone else do something that we are not able or willing to do because of pain.
In other words, by watching a task being performed, we can still access functionally specific brain cells that are involved with performing that task.
What is the difference between R/L discrimination and imagined movements?
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 (less likely to illicit pain)
whereas explicitly imagined movements also activate the primary motor cortex (can exacerbate pain and swelling if done before R/L Judgment)
What are the three parts of R/L judgment?
1. Immediate or unconscious judgment
2. Mental movement (mentally maneuvering picture)
3. Checking if the first two agree
*This mental movement or motor imagery is initially
Explicit Motor Imagery– remember what happens?
Implicit motor imagery comes with practice
What is Explicit motor imagery?
We are aware of movement. Primary motor cells, more likely to activate pain
What is implicit motor imagery?
You do not know you are mentally moving (no longer aware of it), pre motor cells activated, primary motor cells only modified. Less likely to activate pain
How many reps does it take for explicit to become implicit?
Aggravated symptoms should ease (initial worsening of symptoms may occur but should resolve with practice)
How to progress mirror therapy?
While moving the unaffected limb, look into the mirror so that there is the illusion that the affected limb is performing the activity.
**Eventually progress this so that the affected limb is moving with the unaffected limb, but still paying attention to the mirrored image.
What are the benefits of mirror therapy?
Benefits of MT alone appear to be limited to patients who suffer from cramping and muscular-type phantom pain
For CVA there is a moderate quality of evidence that MT as an additional intervention improves recovery of arm function, and a low quality of evidence regarding lower limb function and pain after stroke
What benefits from GMI?
Strong evidence for helping those with CPRS and PLP - can possibly be expanded to other pain syndromes