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Left/right discrimination

The ability to identify left or right images of their painful body part(s)

This ability appears to be important for normal recovery from pain. The good news is that the brain is plastic and changeable, if given the right training for long enough.

Here's a small example of Laterality (Left/Right) Training: (Please read before participating in the Laterality Training below)
Imagine you have had pain in your right foot for several years.  The last thing you want to do is focus on is your right  foot.   If someone shows you a picture of either a left or right foot and  you're asked to determine which 'foot' it is,  you will likely guess the picture is of the left foot, as you are trying to avoid consideration of your painful right foot.   However, if you recently injured your right foot, your focus will be on your right foot; therefore, if the very same picture is shown to you, you will likely  initially believe you are looking at a right foot.  Laterality training involves the use of very basic images which gradually becomes very complex and even artsy, in an endeavor to train the brain to recapture the ability to quickly judge right from left body parts.  This plays a role in the normal recovery from pain.  Over time more images will be added. 



If you put your left hand behind a mirror and right hand in front, you can trick your brain into believing that the reflection of your right hand in the mirror is your left hand. Your brain is made to think movement has occurred and has occurred without pain. You are now exercising your left hand in the brain, particularly if you start to move your right hand.  

Background (The following is quoted from Physiopedia  - physio-pedia.com/Mirror_Therapy )

Mirror therapy was invented by Vilayanur S. Ramachandran to help alleviate the Phantom limb pain, in which patients feel they still have a pain in the limb even after having it amputated.

Ramachandran and Rogers-Ramachandran first devised the technique in an attempt to help those with phantom limb pain resolve what they termed a ‘learned paralysis’ of the painful phantom limb. The visual feedback, from viewing the reflection of the intact limb in place of the phantom limb, made it possible for the patient to perceive movement in the phantom limb. Their hypothesis was that every time the patient attempted to move the paralyzed limb, they received sensory feedback (through vision and Proprioception) that the limb did not move. This feedback stamped itself into the brain circuitry through a process of Hebbian learning, so that, even when the limb was no longer present, the brain had learned that the limb (and subsequent phantom) was paralyzed. To retrain the brain, and thereby eliminate the learned paralysis, Ramachandran and Rogers-Ramachandran created the mirror box.

Technique

The patient places the 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. Through the use of this artificial visual feedback it becomes possible for the patient to "move" the phan tom limb, and to unclench it from potentially painful positions.

Principle of Mirror Therapy

This approach exploits the brain’s preference to prioritise visual feedback over somatosensory/proprioceptive feedback concerning limb position. In conditions such as phantom limb pain (PLP), stroke, or Chronic Regional Pain Syndrome Type 1 (CRPS1) where neuropathic processes cause issues with pain, related or unrelated to movement, this approach is thought to offer potential relief 

MT has been shown to increase cortical and spinal motor excitability, possibly through the effect on the mirror neuron system. Mirror Neurons accounts for about 20% of all the neurons present in a human brain. These mirror neurons are responsible for laterality reconstruction i.e., ability to differentiate between the left and the right side. When using the Mirror box, these mirror neurons gets activated and helps in the recovery of affected parts.This system is thought to use the observation of movement to stimulate the motor processes which would be involved in that movement. Similarities have been drawn with motor imagery where by the individual will mentally imagine movements rather than observing the reflection of a movement in a mirror. It is thought that the brains natural inclination to prioritise visual feedback over all others would make MT a more powerful tool, however research evidence is currently lacking in support of this hypothesis [1] [4].  It is to be noted that the major difference in the neuronal reorganisation while using a mirror box is that the ipsilateral hemisphere's neurons gives connection to the same side affected limbs rather than the conventional therapies which targets the neuronal reorganization of the contra-lateral hemisphere.

Evidence on effectiveness  See physio-pedia.com/Mirror_Therapy

There is an abundance of research providing evidence for the effectiveness of these techniques.  The neurotag spoke of previously can be ‘calmed down’ the perceived tissue areas of involvement can improve their tolerance to stress and your brain can gradually release it’s protective reactions and allow you to improve your ability to function with less or even no pain.  


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Is it LEFT or RIGHT? LATERALITY TRAINING IF YOU HAVE
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HIP PAIN
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CHRONIC PAIN It’s a Brain Thing! 

Pain is produced in the brain 100% of the time, all types of pain and no matter how long you’ve had pain.  Depending upon the nature of the pain, you may require physical therapy which will ultimately help you back to your normal functional daily routine and help you to return to work.  Acute pain can last from weeks to months; "When the injury heals and you continue having pain beyond the time of expected recovery, that's chronic pain.  Chronic pain lasts for weeks, months, even years. Generally, it's diagnosed after 3 to 6 months of pain. Chronic pain affects an estimated 116 million American adults; more than the total affected by heart disease, cancer and diabetes combined.  In some cases, the pain comes and goes. With chronic pain, the nervous system can become overly sensitive; stress of any kind, thoughts, emotions, diet and lifestyle can all effect pain. Chronic pain tissue damage is typically not the main issue.   

In Chronic pain, tissue damage isn’t typically the main issue.  The brain continues to produce pain even after tissues are restored and out of danger.  While many medical and/or healthcare providers advertise a plethora of treatments for pain, often none of their methods alone, or even in combination, may sufficiently address the overly sensitized brain.   The pain experiences forms what is called a pain ‘neurotag’.  All of the brain cells in that neurotag become activated.  When pain persists long enough other brain cells become involved and symptoms can spread and the pain can become chronic.   Medication can  only help to a limited extent. Active approaches are necessary to retrain the brain.  There are ways to reduce stress and allow your nervous system to wind down. 

Reflecting upon all the things that were happening when the pain began can alert you and help you determine links between a worrisome period in your life and a worsening pain picture.  Realizing deeper emotions can be part of the healing process.  Getting yourself moving at comfortable levels without fear and where the brain doesn’t over-protect by causing pain helps retrain the brain. Graded motor Imagery is a rehabilitation process used to treat pain and movement problems related to altered nervous systems by exercising the brain in measured and monitored steps which increase in difficulty as progress is made. 

The three different treatment techniques include left/right discrimination training, motor imagery exercises and mirror therapy.  Research shows people in pain often lose the ability to identify left or right images of their painful body part(s) (i.e. when viewing pictures of body parts they are slower and/or less accurate than somebody without pain at determining whether the image is a Left or Right).This ability appears to be important for normal recovery from pain.  Explicit motor imagery involves thinking about moving without actually moving. Imagined movements can actually be hard work if you are in pain.  


The Best Physical Therapy Center In Cape May County! 

TheProtectometer( ref. Butler, Moseley) can help reduce or even eliminate your pain when you allow your 'SIMs' (Safety In Me) to outweigh your 'DIMs' (Danger In Me).   You will learn to take plenty of SIMs with you on your journey back toward Health & Wellness!  Also, as a patient you will learn about the power of 'Bioplasticity' which will help you regain your function!

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