Does technology such as virtual reality have
a role in the treatment of pain?
The literature aro... more Does technology such as virtual reality have a role in the treatment of pain?
The literature around VR and pain is growing daily. However, much of it is limited to small sample sizes, lack of control groups, poor outcome measurement and lack of appropriate follow up. Opportunities abound to harness this multisensory world, in critically thought out trials, to address the various neurophysiological changes found in persistent and complex pain conditions. Exploring the technology first will allow clinicians to truly see the diverse array of possibilities rather then apply it solely to achieve an upscale version of an old treatment. It is likely that the greatest success will be found in program+ms that allow adjustments in VR programs to individuals’ neurophysiological contexts rather than a one size fits all model. However, this will bring large challenges in proving efficacy in trials.
Purpose: The Pain Science Division (PSD) is a special interest group of the Canadian Physiotherap... more Purpose: The Pain Science Division (PSD) is a special interest group of the Canadian Physiotherapy Association that serves physiotherapists who have an interest in better understanding and managing patients’ pain. The PSD developed evidence-based resources for its members with the goal of improving patient care by supporting professional development. However, online metrics tracking access to these resources indicated that access was low. The purpose of this study was to identify the barriers PSD members encountered to the use of PSD resources and to recommend interventions to address these barriers guided by the Theory and Techniques Tool (TTT). Method: We distributed an online survey to PSD members across Canada. We used the TTT, a knowledge translation tool, to guide the design of the questionnaire and identify actionable findings. Results: Response rates from 621 non-student members and 1,470 student members were 26.9% and 1.4%, respectively. Based on the frequency of practicing...
2017 International Conference on Virtual Rehabilitation (ICVR), 2017
Three patient case studies, will illustrate novel techniques for using virtual reality technology... more Three patient case studies, will illustrate novel techniques for using virtual reality technology to treat patients with complex rehabilitation needs. The patients were respectively diagnosed with Complex Regional Pain Syndrome (CRPS), persistent pain with post-concussion syndrome and persistent pain with Post-Traumatic Stress Disorder (PTSD). The common treatment goal for these patients is to use VR to promote top down regulation of the autonomic nervous system (ANS) by using VR to challenge the patients in small exposures. The exposure and subsequent required control by the patients will promote creation of new adaptive neural plastic networks. The patient treatment sessions were complete on a Computer Assisted Rehabilitation Environment (CAREN) Extended system (MotekForce link, The Netherlands) located at The Ottawa Hospital Rehabilitation Centre (TOHRC). The outcome measures to evaluate the treatment effectiveness will demonstrate changes in The World Health Organization categories of tissue dysfunction, patient activities and participation.
Study Design: Narrative review. Introduction: There are a variety of treatments with demonstrated... more Study Design: Narrative review. Introduction: There are a variety of treatments with demonstrated effectiveness for the management of complex regional pain syndrome (CRPS). However given the variability in symptom presentation in this population, therapists may be unsure what treatments would be most effective for individual clients. Purpose of the Study: To present a brief synthesis of the literature and propose a rehabilitation version of a mechanism-specific management algorithm to guide personalized treatment of CRPS. Methods: A systematic search of the literature was conducted to identify all randomized controlled trials, systematic reviews, and clinical practice guidelines addressing rehabilitation of CRPS. Results were reviewed independently by 2 reviewers and final selection of articles was reached by consensus, Data was extracted using standardized forms, and a single rater gave quality ratings. Both reviewers then used the extracted data to present a synthesis of the evidence categorized by the proposed mechanisms of effect. Results: A total of 111 articles were retrieved and reviewed for inclusion; 49 were selected for data extraction. A synthesis of the key recommendations was compiled into a rehabilitation-specific version of the mechanism-based management algorithm proposed by Gierthmühlen et al (2014). Conclusions: Consideration of mechanism-appropriate rehabilitation interventions may assist therapists to select the most appropriate and effective treatments from the body of evidence supporting rehabilitation of CRPS.
Background: The increasing incidence of injuries sustained by clients during pulmonary rehabilita... more Background: The increasing incidence of injuries sustained by clients during pulmonary rehabilitation, created a need to develop a prevention strategy. A pre-pulmonary rehabilitation stability exercise class was created based on best practice principles from the orthopaedic literature. It has been discussed in the literature that patients who have COPD have poor stability strategies based on the dominance of the need to drive the respiratory system. If successful, it was felt that this program would decrease the incidence of injury, decrease length stay and help to optimize outcomes. Methods: Six months of data recording the incidence and severity of injuries from participants in the pulmonary rehabilitation program was collected in order to obtain comparative statistics and demonstrate the need for this program. A literature review was performed to determine the risk of injury in this population. In a 6 month period, 17% of COPD clients admitted to the Rehabilitation Centre for pul...
Complex Regional Pain Syndrome (CRPS) is a persistent pain condition that remains incompletely un... more Complex Regional Pain Syndrome (CRPS) is a persistent pain condition that remains incompletely understood and challenging to treat. Historically, a wide range of different outcome measures have been used to capture the multidimensional nature of CRPS. This has been a significant limiting factor in the advancement of our understanding of the mechanisms and management of CRPS.In 2013, an international consortium of patients, clinicians, researchers and industry representatives was established, to develop and agree on a minimum core set of standardised outcome measures for use in future CRPS clinical research, including but not limited to clinical trials within adult populationsThe development of a core measurement set was informed through workshops and supplementary work, using an iterative consensus process. 'What is the clinical presentation and course of CRPS, and what factors influence it?' was agreed as the most pertinent research question that our standardised set of pat...
Does technology such as virtual reality have
a role in the treatment of pain?
The literature aro... more Does technology such as virtual reality have a role in the treatment of pain?
The literature around VR and pain is growing daily. However, much of it is limited to small sample sizes, lack of control groups, poor outcome measurement and lack of appropriate follow up. Opportunities abound to harness this multisensory world, in critically thought out trials, to address the various neurophysiological changes found in persistent and complex pain conditions. Exploring the technology first will allow clinicians to truly see the diverse array of possibilities rather then apply it solely to achieve an upscale version of an old treatment. It is likely that the greatest success will be found in program+ms that allow adjustments in VR programs to individuals’ neurophysiological contexts rather than a one size fits all model. However, this will bring large challenges in proving efficacy in trials.
Purpose: The Pain Science Division (PSD) is a special interest group of the Canadian Physiotherap... more Purpose: The Pain Science Division (PSD) is a special interest group of the Canadian Physiotherapy Association that serves physiotherapists who have an interest in better understanding and managing patients’ pain. The PSD developed evidence-based resources for its members with the goal of improving patient care by supporting professional development. However, online metrics tracking access to these resources indicated that access was low. The purpose of this study was to identify the barriers PSD members encountered to the use of PSD resources and to recommend interventions to address these barriers guided by the Theory and Techniques Tool (TTT). Method: We distributed an online survey to PSD members across Canada. We used the TTT, a knowledge translation tool, to guide the design of the questionnaire and identify actionable findings. Results: Response rates from 621 non-student members and 1,470 student members were 26.9% and 1.4%, respectively. Based on the frequency of practicing...
2017 International Conference on Virtual Rehabilitation (ICVR), 2017
Three patient case studies, will illustrate novel techniques for using virtual reality technology... more Three patient case studies, will illustrate novel techniques for using virtual reality technology to treat patients with complex rehabilitation needs. The patients were respectively diagnosed with Complex Regional Pain Syndrome (CRPS), persistent pain with post-concussion syndrome and persistent pain with Post-Traumatic Stress Disorder (PTSD). The common treatment goal for these patients is to use VR to promote top down regulation of the autonomic nervous system (ANS) by using VR to challenge the patients in small exposures. The exposure and subsequent required control by the patients will promote creation of new adaptive neural plastic networks. The patient treatment sessions were complete on a Computer Assisted Rehabilitation Environment (CAREN) Extended system (MotekForce link, The Netherlands) located at The Ottawa Hospital Rehabilitation Centre (TOHRC). The outcome measures to evaluate the treatment effectiveness will demonstrate changes in The World Health Organization categories of tissue dysfunction, patient activities and participation.
Study Design: Narrative review. Introduction: There are a variety of treatments with demonstrated... more Study Design: Narrative review. Introduction: There are a variety of treatments with demonstrated effectiveness for the management of complex regional pain syndrome (CRPS). However given the variability in symptom presentation in this population, therapists may be unsure what treatments would be most effective for individual clients. Purpose of the Study: To present a brief synthesis of the literature and propose a rehabilitation version of a mechanism-specific management algorithm to guide personalized treatment of CRPS. Methods: A systematic search of the literature was conducted to identify all randomized controlled trials, systematic reviews, and clinical practice guidelines addressing rehabilitation of CRPS. Results were reviewed independently by 2 reviewers and final selection of articles was reached by consensus, Data was extracted using standardized forms, and a single rater gave quality ratings. Both reviewers then used the extracted data to present a synthesis of the evidence categorized by the proposed mechanisms of effect. Results: A total of 111 articles were retrieved and reviewed for inclusion; 49 were selected for data extraction. A synthesis of the key recommendations was compiled into a rehabilitation-specific version of the mechanism-based management algorithm proposed by Gierthmühlen et al (2014). Conclusions: Consideration of mechanism-appropriate rehabilitation interventions may assist therapists to select the most appropriate and effective treatments from the body of evidence supporting rehabilitation of CRPS.
Background: The increasing incidence of injuries sustained by clients during pulmonary rehabilita... more Background: The increasing incidence of injuries sustained by clients during pulmonary rehabilitation, created a need to develop a prevention strategy. A pre-pulmonary rehabilitation stability exercise class was created based on best practice principles from the orthopaedic literature. It has been discussed in the literature that patients who have COPD have poor stability strategies based on the dominance of the need to drive the respiratory system. If successful, it was felt that this program would decrease the incidence of injury, decrease length stay and help to optimize outcomes. Methods: Six months of data recording the incidence and severity of injuries from participants in the pulmonary rehabilitation program was collected in order to obtain comparative statistics and demonstrate the need for this program. A literature review was performed to determine the risk of injury in this population. In a 6 month period, 17% of COPD clients admitted to the Rehabilitation Centre for pul...
Complex Regional Pain Syndrome (CRPS) is a persistent pain condition that remains incompletely un... more Complex Regional Pain Syndrome (CRPS) is a persistent pain condition that remains incompletely understood and challenging to treat. Historically, a wide range of different outcome measures have been used to capture the multidimensional nature of CRPS. This has been a significant limiting factor in the advancement of our understanding of the mechanisms and management of CRPS.In 2013, an international consortium of patients, clinicians, researchers and industry representatives was established, to develop and agree on a minimum core set of standardised outcome measures for use in future CRPS clinical research, including but not limited to clinical trials within adult populationsThe development of a core measurement set was informed through workshops and supplementary work, using an iterative consensus process. 'What is the clinical presentation and course of CRPS, and what factors influence it?' was agreed as the most pertinent research question that our standardised set of pat...
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a role in the treatment of pain?
The literature around VR and pain is growing daily. However, much of it is limited to small
sample sizes, lack of control groups, poor outcome measurement and lack of appropriate follow
up. Opportunities abound to harness this multisensory world, in critically thought out trials, to
address the various neurophysiological changes found in persistent and complex pain
conditions. Exploring the technology first will allow clinicians to truly see the diverse array of
possibilities rather then apply it solely to achieve an upscale version of an old treatment. It is
likely that the greatest success will be found in program+ms that allow adjustments in VR
programs to individuals’ neurophysiological contexts rather than a one size fits all model.
However, this will bring large challenges in proving efficacy in trials.
a role in the treatment of pain?
The literature around VR and pain is growing daily. However, much of it is limited to small
sample sizes, lack of control groups, poor outcome measurement and lack of appropriate follow
up. Opportunities abound to harness this multisensory world, in critically thought out trials, to
address the various neurophysiological changes found in persistent and complex pain
conditions. Exploring the technology first will allow clinicians to truly see the diverse array of
possibilities rather then apply it solely to achieve an upscale version of an old treatment. It is
likely that the greatest success will be found in program+ms that allow adjustments in VR
programs to individuals’ neurophysiological contexts rather than a one size fits all model.
However, this will bring large challenges in proving efficacy in trials.