Sensorimotor training for people with persistent pain

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Sensorimotor training for people with persistent
pain

• Leonie van den Bergh, MNZSP, MNZCP, ADP(OMT),
  Cred MDT, PGCert OccHealth,
• Contact blenheimphysio_at_actrix.co.nz
• 22-01-2011

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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 -Periphera
  l neurogenic
• Central neuropathic -Central neurogenic -Autonom
  ic -Affective
• Psychosocial Factors
• CNS Coordination
• Receive and process sensorimotor information
• Process cognitive information
• Resolve sensorimotor cognitive conflicts
• Compensate for neurological, sensimotor,
  cognitive deficits

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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

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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

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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
• gt50 suggested

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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

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Cognitive Learning DeficitsImplication 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

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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

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Tests - examples

• Eyes
• Smooth eye control
• Tracking
• Convergence
• Postural stability
• Balance

• Midline crossing
• cross-crawl
• Tactility
• Propriocepsis
• Primitive Reflexes