Graded Motor Imagery Program

Research question1

Introduction1

Background1

Literature Review4

Methods9

Pain questionnaire (Quantitative)9

Focus group10

Comparison of Study Design to Answer the Research Question11

Critique12

Ethical Issues Related to the Study Design13

Conclusion13

References15

Appendix A18

Appendix B - Characteristics Table20

Appendix C-Survey form22

Graded Motor Imagery Program

Research question

Degree of variability seen amongst hand therapist in their GMI protocols

Introduction

This paper is intends to explore the degree of variability among hand therapists in regards to their Graded Motor Imagery GMI protocols. Also, it will consider the therapists' opinion of the reasons of any variability or difficulties they are facing when they decide to apply GMI in their clinical practice. Graded Motor Imagery (GMI) is an independently used therapy, which is effectively used in complex and persisting pain conditions.

Background

Graded motor imagery GMI is particularly used by hand therapists. It is used as a supporting therapy in the treatment of severe pain conditions such as complex regional pain syndrome and phantom limb pain. "Pain is considered one of the most challenging impairments to remediate due to the complex physiologic mechanisms involved in the normal response to pain as well as maladaptive pain states that frequently occur in persistent or chronic pain conditions. A comprehensive assessment of pain will enhance the development of an appropriate plan of care including the judicious use of modalities and other rehabilitation techniques. (Fedorczyk, 2005,p.1). Pain can be defined as a condition associated by an unpleasant and radiating sensory response. It is associated with emotional experience or tissue damage and considered as a warning signal. Graded motor imagery program GMI is mostly used by hand therapists. It offers a 3 stage synaptic exercise process for relieving severe pain conditions. It is used as a supporting therapy in the treatment of severe pain conditions such as complex regional painsyndrome and phantom limb pain. Complex regional pain syndrome type one (CRPS-1) is a disturbing and painful condition which is also known as RSD (reflex sympathetic dystrophy). Central and peripheral changes are seen in CRPS-1. The peripheral changes observed include elevated sympathetic activity, increase in the pain sensation and alteration in the activities of sympathetic neurons. The central changes observed include the motor cortex dis-inhibition, sensory cortical disruption and body scheme disturbance.The major clinical manifestation observed in the complex regional pain syndrome type one is the contraction in the cortex of limb (Juotten et.al, 2002, p.315) and disturbed schema of body. These conditions are observed in patients with CRPS-type one, stroke and in patients with PLP/ phantom limb pain (Gruser et.al, 2000,p.263). Graded motor imagery (GMI) helps in the cortical reorganization and helps in the efficient management of pain. This treatment was developed because of significant manifestations seen in patients with PLP (phantom limb pain), which explained that the pain was due to the primary cortex contra-lateral reorganization. This may be due to amputated hand or limb (Flor et.al, 1995,p.224).

The main function of graded motor imagery (GMI) is to return the flexibility back to the brain by graded exposures. It is an effective treatment procedure which could be used by therapists in regional and complex pain condition ...