Thursday, August 13, 2009

In answer to David's question

Interesting point about the attention to the point of initial site of that flare up. Can you explain more and how this relates to the discoveries of V.S. Ramachandran?

I suggest reading
The use of visual feedback, in particular mirror visual feedback, in restoring brain function V.S. Ramachandran and Eric L. Altschuler

"This article reviews the potential use of visual feedback, focusing on mirror visual feedback, introduced over 15 years ago, for the treatment of many chronic neurological disorders that have long been regarded as intractable such as phantom pain, hemiparesis from stroke and complex regional pain syndrome."
It states, "Apart from its clinical importance, mirror visual feedback paves the way for a paradigm shift in the way we approach neurological disorders. "
I can only access the abstract. I suggest reading the whole article if you can.

This article in MSN Body & Fitness - Brain and Body by Maia Szalavitz on mirror therapy offers a few ideas from Professor Jack Tsao and Dr Lorimer Moseley about possible reasons for mirror therapy working for some and not others.

As far as Ramachandran goes wikipedia states
Ramachandran and Rogers-Ramachandran proposed the "learned paralysis" hypothesis of painful phantom limbs (Ramachandran & Blakeslee 1998).

It goes on to state
The patient places his or her good limb into one side, and the stump into the other. The patient then looks into the mirror on the side with good limb and makes "mirror symmetric" movements, as a symphony conductor might, or as we do when we clap our hands. Because the subject is seeing the reflected image of the good hand moving, it appears as if the phantom limb is also moving.

The important thing to note here, I believe, is that the patient is focusing on the mirror image of their whole limb in the area of the limb that is painful on the other limb (or phantom limb).
If the arm is missing from the elbow down, it is the mirror image of the limb from the elbow down of the good arm that the patient is watching in the mirror. It is not the upper arm, or the shoulder, or just the fingers. It is the actual painful missing limb that is the focus.

I came to the realization that you need to be mindful of the main focus of pain and concentrate on that part because I got it wrong. We learn from our mistakes. I was treating a left shoulder flare up which had quickly included the whole arm. I was raising and lowering etc my right arm and watching the mirror image of the right arm. I did it a little and often as I've learned is best for me. Nothing happened. No pain relief or change in sensation, or relaxation of muscles etc.
I thought I'd been kidding myself about mirror therapy. Maybe I was wrong.

Then it hit me. It was tendonitis in the shoulder that started this flare. I went back and tried this time looking at the mirror image of my shoulder while I moved my arm in a way that caused pain in my painful side. It worked! As on other occasions, there was no miracle cure but I noticed a relaxation of muscles, releasing of muscle spasm and a sense of calm. I repeated the mirror trick a little and often and eventually the pain went. Fixing the pain is just part of the answer. Weak muscles and loss of tone needed be addressed so physical therapy was important. There is no point in stopping the pain without doing something to fix the problem. Pain will just return.

Check out .If pain returns when you stop mirror therapy there could be an underlying pathology

It also seems important that the patient be mindful of what is happening in their own body, how it feels, what works, what feels unhelpful. It seems important that the patient trusts their own feelings and the therapist listens and is guided by what is actually happening.

I am really interested in discovering the link between miror neurons, the cortical representation of the body in the brain and the micro system of the body in the scalp in Yamamoto New Scalp acupuncture. At first they seem polls apart but I know from experience that they both work to resolve CRPS. They appear to have the same/similar means of respolve. They both involve body in the head/brain stuff. It feels the same when symptoms improve and symptoms improve along the same path eg extremities back to the initial source of pain. I wish I understood. I want to know more.

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