Hi Orli: Just a few thoughts and questions:
How long ago did the client suffer the stroke? Do you think your client demonstrates shoulder-hand syndrome/ RSD type symptoms? Is your client on any antidepressant? I have been told that Cymbalta (Duloxetine, an antidepressant) has been helpful in clients with neurogenic pain and in clients with chemical depression such as commonly noticed in clients post CVA. Lot of the pain issues may actually be related to the post CVA syndrome. You may want to discuss this with the nurse/ neurologist. In my opinion, you may want to try sensory desensitization. Also, I feel training the hand "like a prosthesis" must be done in a manner that reinforces body awareness/ reduces neglect (that is, drawing more attention to the extremity versus alienating it as a foreign object and, although the movement or sensation is not felt as with a prosthesis, the client must rely on visual feedback on the quality of the movement/ activity performed). Activities requiring FMC is probably decreased due to paresthesia/ anesthesia, impaired stereognosis, and movements may be "animated" to begin with but should improve with regulation of sensation/ sensori-perceptual functions. I have found that contrast bath (as with RA cases) helps as well in preparation for tasks requiring FMC, probably with the increased circulation and again probably due to the increased sensory stimulus to the extremity. Joseph K. Wells, OTD, OTR/L www.americare-health.com Confidential Notice: The information contained in this electronic mail is only intended for the use of the individual or entity named above. If you are not the intended recipient, you are hereby notified that any distribution or copying of this communication in any format is strictly prohibited. If you received this message in error, please notify us immediately. HIPAA Disclosure, if Pertaining to Medical Records: This information has been disclosed to you from records whose confidentiality is protected by state and federal law. You are prohibited from making any further disclosures of it without specific and informed release of the individual to whom it pertains, their authorized representative, or as otherwise permitted by law. A general authorization for release of information is not sufficient for this purpose. -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Orli Weisser-Pike Sent: Monday, January 22, 2007 5:20 PM To: [email protected] Subject: [OTlist] Central post-stroke pain Hullo, I have a lady who is 44 y.o. s/p CVA affecting the left, non-dominant side, with hemianesthesia. Her motor strength is fine, her FMC is poor due to decreased proprioception, etc. She is increasingly suffering from pain in her left arm, side of her face, ear, sometimes down to her toes. Her neurologist has put her on Neurontin which seemed to help at the start, but her symptoms are increasing. Does anyone have any knowledge about this, and what may help facilitate functional use of her left arm? One therapist told me to teach her to regard her arm as a prosthesis and learn how to use it again--this makes sense to me. Any other advice will be helpful! Thanks again, Orli Orli Weisser-Pike, OTR/L, CLVT, SCLV Low Vision Rehabilitation Baptist Rehabilitation Germantown * 2100 Exeter Road * Germantown, TN 38138 http://www.baptistonline.org/facilities/germantown/services/lowvision.asp *(901)757-3458 ext. 308 *(901)757-3497 MailTo:[EMAIL PROTECTED] This message and any files transmitted with it may contain legally privileged, confidential, or proprietary information. If you are not the intended recipient of this message, you are not permitted to use, copy, or forward it, in whole or in part without the express consent of the sender. 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