Thursday, October 29, 2009

Last post for a while - keeping it real.

I won't be posting for a while so I thought I'd give my thoughts in this post.

The House episode on mirror therapy was great in that it helped spread awareness of a non drug way of dealing with pain. However it's important to keep things in perspective. Mirror therapy is not a quick cure or the perfect treatment. It offers, in my opinion, a tool to add to others things that work for you. There is ongoing research which shows that some people can get a great result. It really helped me. In my opinion it has a better chance of working if you get it right. I would have much preferred to have been guided by a physiotherapist but there was none here at the time I began who knew about guided imagery and mirror visual imagery. In Australia now there are many therapists who have been trained in this area. NoiGroup has exceptional training for professionals in Australia and throughout the world. Their website has excellent resources for patients and professionals. David Butler and Dr Lorimer Moseley explain about this new treatment and the new understanding of the part the brain has to play in pain in free video on the NoiGroup site.. Dr Moseley and his team have a new website Body in mind which I recommend you visit and keep visiting. I recommend that you read the article Guided motor imagery is effective for longstand complex regional pain syndrome.

There is great cause for optimism with so much research current. It pays not to put all your chickens in one basket and not count on one thing, one drug one therapy as a fix. Looking out for ourselves, making a list of what helps, eating well, being mindful, remembering to breathe and keeping it real seems to me to be a good way to go. Stay safe and remember to take care of you.

Wednesday, October 28, 2009

Mirror therapy - the importance of getting it right. - my observations.

I did mirror therapy this morning again for my ankle and discovered something.
I sat as you saw in the video with the mirror between my two feet. I moved my foot as I had done before but had this strange sensation, similar if not the same, as the sensation when I moved my painful foot and not my good foot whilst looking at the mirror image of my good foot.

I realized that I did not have the mirror positioned exactly centrally to my body. I also noticed that it was at an acute angle (smaller) instead of at right angles to my body. When I realigned the mirror all went well and no "strange sensation". It appears to me that the positioning/angle of the mirror such that the hidden foot is in the same position as the mirror image of the good foot is important in using this therapy and that having the position contry to the image could be causing a mismatch somehow.
I speculate whether the distance from the mirror might also be important.

If someone thinks videoing this might help others to understand please post a comment and I'll video what I did.

Body in mind - Dr Lorimer Moseley interviewed on ABC Science.

Dr Lorimer Moseley was interviewed yesterday by Annabel McGilvray on ABC Science radio broadcast. The importance of his new research is evident by the item listed in "just in" on the ABC News website.
Phantom limbs make impossible moves.

Check out Dr Moseley and crew's new website Body in Mind  

There is an excellent post about CRPS on Body in mind here.

Saturday, October 24, 2009

Mirror therapy improves motor function as well as reduces pain.

In the previous posts here and here you saw me using mirror therapy for severe foot pain and loss of function. You will have noticed that I mentioned that before doing the mirror trick I could not move my toes, nor could I raise and lower my foot. After continuing the movement trying to move both feet (good foot while looking at the mirror image of it and the painful, injured foot hidden behind the mirror) eventually I was actually able to move my toes and to raise and lower my foot. This remarkable improvement in motor function was after only a short time of doing this treatment.

I injured my ankle on Wednesday. Today, Saturday, I can walk normally although with some discomfort. There is still some swelling and bruising but much improved. My treatment has been mirror therapy a few times a day, laser acupuncture on Wednesday and Friday in the area of injury and Yamamoto New Scalp Acupuncture. The YNSA specifically is to address autonomic dysfunction. 

Body in mind has posted a comment by Dr Lorimar Moseley on a recently published letter in the New England Medical Journal. In the post he says, "it would be nice to see if pain reduction and motor improvement are related". 

Well in my my case with this injury, function definitely improved with mirror therapy. I went from couldn't move toes or foot to being able to move them. I  suspect that my inability to move my toes was because of pain. Mirror therapy eased the pain but also gave me visual input which created the illusion that my injured foot was moving. I don't pretend to understand this. I just know it works for me and for that I am very grateful. Before having this tool with which to help myself this would have been a different, much worse outcome for me involving ongoing extreme pain and loss of function for a long time.

Thursday, October 22, 2009

Mirror therapy for foot.

In this video I use mirror therapy to ease pain and improve movement in my painful right foot.

Another accident - mirror therapy helps again

Yesterday I turned my ankle on a tree root on my way along my favourite beach track. I landed hard hearing a crack as I went. The pain was extreme and immediately my blood pressure dropped as nausea etc set in. Fortunately the crack was no more than a twig I stood on in an effort not to fall. The sound was the same as the crack last time when I tore my knee tendons and broke cartilage so the memory made me afraid I'd done some serious damage. However the incident caused sufficient pain and shock to immediately bring about a return to autonomic dysfunction. As soon as I got home I took vitamin C in the hope of preventing a return to other Complex Regional Pain Syndrome. In the few hours between the fall and seeing my doctor the pain escalated to the extent I had great difficulty putting my foot to the floor. My doctor used laser acupuncture on the area and Yamamoto New Scalp Acupuncture to help calm the autonomic symptoms.

I was in extreme pain again and really struggled on the trip home. I was very nauseous from the pain and at a loss what to do as I lay on the bed with my leg raised. I struggled to bear the pillow under my foot. I could no longer bear to move my toes or move my foot up and down. I was told this was because of swelling but I had my doubts.

Still convinced this was not CRPS but just my injury I remembered that I'd eased acute mouth pain using my version of mirror therapy. I had nothing to lose so sat on the side of my bed and positioned myself so that I could only see the mirror image of my good foot. This time I used the recommended method of moving both feet in the same way. I knew I could not wriggle my toes on the injured foot so that is what I watched myself doing in the merror. I tried to move the injured foot's toes in the same way. To my amazement I was able to curl them a little. I continued do this for about 30 seconds and then tried to move my foot up and down while I watched my other food doing this. Again amazingly I was able to move my painful foot, not as much but I moved it. I continued for about 30 seconds. Then I put my foot on the ground while watching the mirror image of my good foot doing the same. I did this only for a few seconds.
When I lay on the bed the pain was less intolerable and I could more comfortably rest my foot on the pilows.

I repeated this a few hours later and again this helped reduce the pain.

Today I did the mirror trick again. It helped again and I can now place my foot on the floor and walk with the aid of a crutch.

The pain went from extreme to bearable with mirror therapy.  Whether this pain has been wholly from the injury or from CRPS  from the injury I don't know. What I do know is that mirror therapy helped. I'll make a video shortly to show you what I did and will continue to do.

I will have Yamamoto New Scalp Acupuncture again tomorrow and next Monday and Wednesday. I'm really hoping that this will again correct the dyautonomia that has returned.

My husband and I are going to Vietnam in 9 days. I was getting fit, walking heaps and planning a short trek in the Highlands above Sapa near the Chinese border. This is a bit of a setback but I am confident I can recover by then using mirror therapy and with my GP's laser acupuncture and remarkable YNSA.

Monday, October 19, 2009

Happiness Institute - overcoming the tyranny of when & shape your future now.

This is today's Monday morning email from the Happiness Institute.
I subscribe.

In short - "you are not your past and you can shape your future".

Here you will find not just ideas but strategies to put them into place with relevant links. 
Dr Sharp's last sentence says it all.
"So there it is; the past is history, tomorrow's a mystery, today is a gift...that's why they call it the present."

Ramachandran - On your mind

This TED talk is one of my favoutites.

Sunday, October 18, 2009

Taking bio-feedback for pain relief to the next level.

Body in Mind tweeted about this video from TED talks.
Neuroscientist Christopher deCharms is helping to develop a new kind of MRI that allows doctor and patient to look inside the brain in real time -- to see visual representations of brain processes as they happen in order to help treat chronic pain with a kind of biofeedback. Being able to visualize pain can help patients control it.

Body in mind - Lorimer Moseley and team's new website

Lorimer Moseley and team focussing on clinical neuroscience and the role of the brain in health and disease in their web site Body in the Mind

Look to the left for a link to great information about CRPS..

In my garden today.
I'm sharing some photos I took today with my new camera a Panasonic Lumix DMC TZ7. It's small, light weight and has a great 12x zoom.

Far out on the horizen you'll see a whale watching boat.
In the next photo I've zoomed in.

Click on the image for a better look.

Friday, October 16, 2009

More people talking about mirror therapy

Diane Jacobs twittered about this. Diane has some very interesting tweets. Neuroplasticity is the ability of the brain to re organize itself. The brain creates new neural pathways which allow  it to compensate for injury etc. Recently the TV series House demonstrated this by using mirror therapy to stop phantom limb pain. 

There has been so much interest shown since this episode that CNN did a feature called

Brain mirror therapy CNN interviews Dr Sanjay Jupta.
This follows on from an earlier report For amputees an unlikely painkiller: mirrors. 
At the Walter Reed Center for Veterans mirror therapy is now offered routinely. Dr. Jack Tsao, a Navy neurologist with the Uniform Services University says"this treatment has the potential to benefit amputees worldwide, and the best part is, no special training is required to do it. He gives interested parties instructions over the phone or by e-mail."

Thursday, October 15, 2009

More evidence of the effectiveness of mirror therapy.

Anesthesia Dolorosa is one of the most dreaded complications of neurosurgery and is considered to be non-reversible.  It occurs when the trigeminal nerve is damaged by surgery or physical trauma in such a way that the feeling sensation in part of the face is reduced or eliminated entirely while the sense of pain remains.  

The blog An Anesthesia Dolorosa Miracle tells the remarkable true story of how a husband and wife worked out a way using mirror therapy to relieve and finally stop the extreme pain of this debilitating condition. This is really worth reading especially the great explanations with attached photos. 

Wednesday, October 14, 2009

The Happiness Institute free webinar "Create the best job in the world - for yourself".

This might seem like an odd post for my blog however stress of job loss, having to change our lives and redefine who we are is very real to people with chronic pain especially CRPS/RSD. If in the workforce or planning a return this could suit you.If this webinar isn't for you it may help someone important to you. Remember happiness changes the brain in ways that are helpful.

The Happiness Institute in Sydney, Australia is now offering a series of free webinars. The last one was on "resilience", having the skills to cope with stressors in life. This one will be offered again so I'll post about it then.

This webinar Create the best job in the world - for yourself, is about maximizing the happiness and satisfaction the participants can gain from the time they are working

Presented by Professor Tim Sharp participants will learn how to:

- clarify your priorities, discover your purpose and paint a positive vision of the future
- approach whatever you do with enthusiasm and interact with whomever you need to work with positivity
- identify your inner strengths and attributes and utilise these effectively to enjoy what you do more and to be more  successful
- and finally, be resilient, bounce back from adversity and stay on track once you've planned out your path 

Wednesday, November 11 at 5.30 - 6.30 EST (that's Sydney, Australia time)
This world clock will help you find the time difference.

This is now over however this link will take you to a very good document Resilience - maintaining the happiness through the hard times
and for therapists this is a great resource Building resilience - using positive psychology to get through tough times. (slide show)

Monday, October 12, 2009

Interview on Charlie Rose with Dr V S Ramachandran

Charlie Rose presents an interview with V S Ramachandran in which he discusses among other things, mapping of the brain, treating phantom pain and stroke symptoms using a mirror, autism and the mirror neuron system.

By using a mirror image of a normal limb to convince the brain that everything is OK, V S Ramachandran, a United States Neurologist, in 1998, managed to relieve phantom limb pain.

Since then research has shown that Complex Regional Pain Syndrome and other chronic pains can be relieved by looking at the mirror image of the corresponding painful body part.

In Australia there is a great deal of interest, with mirror therapy becoming more widely accepted as treatment for chronic pain, in particular for the treatment of Complex Regional Pain Syndrome.

In 2004 thirteen chronic CRPS Type I patients were given two weeks each of a hand laterality recognition task, imagined hand movements and mirror therapy. The results upheld their hypothesis.

In 2006 at Oxford University in the UK, Dr Lorimer Moseley was involved in a much larger study . Their conclusion was that Motor Imagery using mirrors reduced pain and disability in patients with Complex Regional Pain Syndrome Type I or phantom limb pain, but the mechanism, or mechanisms, of the effect were not clear.

Dr Moseley and David Butler have written an excellent book which examines this novel approach to pain management, "Explain Pain". The Neuro-orthopeadic Institute of Australasia, NOI Group, was formed to support therapists here, in the USA and in Europe. If interested go to
the left of this blog and click on the link under crps/rsd related articles.

In the UK doctors, such as Dr Candy MacCabe of the University of Bath's School for Health, and Dr Ilan Lieberman, a Consultant Doctor specializing in Pain Medicine and Anesthesia at the University Hospital of South Manchester in England, have been able to alleviate the pain of Complex Regional Pain Syndrome using a simple mirror box.

In 2003 D MacCabe first described the use of this therapy for CRPS Type I. She showed that mirror visual feedback (MVF) relieved pain significantly, and normalized temperature changes in the affected limb. In 2006 in the Netherlands, a trial treatment of patients with Complex Regional Pain Syndrome Type I with mirror therapy was conducted with the aim to improve arm-hand function. The hypothesis of this study is that mirror therapy stimulates cortical representation of the upper extremity. The functionality of the upper extremity is expected to improve more than with only conservative therapy.

This "cortical" model of pain suggests that the brai's image of the body can become faulty, resulting in a mismatch between the brain's movement control systems and its sensory systems, causing a person to experience pain when they move a particular hand, foot or limb. 

Researchers believe that this kind of problem could be behind a host of pain-related disorders such as Complex Regional Pain Syndrome and repetitive strain injury. 

Look to the right of this blog for links to research under "mirror therapy links".

Making a Mirror Box for Treatment of Phantom Limb Pain

This video shows how easy it is to make your own box. and have collapsable boxes for sale.

Remember you can also use just a mirror so long as the problem body part is hidden behind the mirror and you can see the mirror image of the good part.

Thursday, October 08, 2009

Mirror therapy trial - currently recruiting

house s06e03 mirror box

The Utube video which was previously posted here has been removed as it breaches copyright in Australia.

It showed an episode of "House" in which in which Dr House successfully treats phantom limb pain using mirror box therapy.
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