Sensorimotor training for people with persistent pain

1. Sensorimotor training for people with persistent pain • Leonie van den Bergh, MNZSP, MNZCP, ADP(OMT), Cred MDT, PGCert OccHealth, • Contact: blenheimphysio@actrix.co.nz • 22-01-2011

2. Categories of Pain Diagnosis • Patho-Anatomical • Movement Dysfunction • Translation control: hypo- hyper mobility -Movement pattern • Motor fitness: aerobic,endurance, strength -Respiratory Control • Pain Mechanism • Nociceptive, -Peripheral neuropathic -Peripheral neurogenic • Central neuropathic -Central neurogenic -Autonomic -Affective • Psychosocial Factors • CNS Coordination • Receive and process sensorimotor information • Process cognitive information • Resolve sensorimotor & cognitive conflicts • Compensate for neurological, sensimotor, cognitive deficits

3. Pain and the Brain • People with ongoing or recurrent pain have similar problems to people with cognitive learning dysfunction • Pain is generated in the brain in response to stimuli: noxious, emotional, etc • In patients with mild brain dysfunction (CNS coordination) therapeutic exercise does not always help. They need “brain training” first

4. Primitive Reflexes and Sensimotor Function • In normal development primitive reflexes are facilitated by sensory function • However, the movement created by the reflexes facilitates further development of the sensory system • In normal development, both are required to achieve optimal function • In rehabilitation, BOTH are required

5. Primitive reflexes • Brainstem mediated • stereotypical movements • Survival reflexes during development • Not “lost” during development • Suppressed by higher brain function • 70 confirmed and agreed primitive reflexes • >50 suggested

6. CNS Coordination deficits are: • Cognitive learning difficulties • Primitive Reflexes • Sensorimotor defecits • Unable to learn coordination exercises • General exercise unlikely to help • Higher disability • Higher Psychosocial factors • Higher psychological reactions • Prone to central sensitization

7. Cognitive Learning Deficits:Implication for Pain and Education • Reduced ability to • Understand the education we give • Take advise and follow instructions • Understand exercise • Coping strategies • Problem solve • Time frame for education longer Implication for negative thinking, cognitive errors • anxiety, fear, catastrophizing Central sensitization (brain generated pain

8. There is evidence that sensory motor training can help pain • Phantom limb pain • Tactile discrimination training (Flor et al 2001,Lancet) • Chronic Regional Pain syndrome • Tactile discrimination training (Mosely et al 2007, Pain) • Neck Pain • Joint position sense, oculomotor, eye-head coordination (Revel et al 1994, Humphreys and Irgens 2002 • Balance and dizzyness • Oculomotor and vestibular training Hansson et al 2006, Storaci et al 2006

9. Tests - examples • Eyes • Smooth eye control • Tracking • Convergence • Postural stability • Balance • Midline crossing • cross-crawl • Tactility • Propriocepsis • Primitive Reflexes