Complex Regional Pain Syndrome Treatment Involves the HandTutor

English: SASEBO, Japan (May 3, 2007) – H...

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Complex regional pain syndrome (CRPS) is a chronic pain condition that is believed to be the result of dysfunction in the central or peripheral nervous systems. Features include  intense burning pain changes in skin sensitivity, sweating, and  swelling as well as changes in the color and temperature of the skin over the affected limb (e.g hand upper or lower extremity). Although more common in young woman, CRPS affects both men and women with no age prefence.

CRPS I is often triggered by tissue injury. CPRS includes all patients with the above symptoms but no underlying nerve injury.

CRPS II patients experience the same symptoms but there is a clear nerve injury.

CRPS is diagnosed through the symptom of continuous, intense pain that is not indicated by the severity of the injury CRPS often affects one of the extremities (limbs) (arms, legs, hands, or feet) and is often seen with a “burning” pain, increased skin sensitivity and changes in skin temperature. For instance the extremity will be warmer or cooler compared to the opposite extremity where no pain is felt.

Changes in skin color include: blotchy, purple,  red of pale, a change in skin texture: skin becomes thin and shiny and this may be accompanied with excess sweating/ a change in  hair and nail growth pattern, stiffness and swelling of the affected joints, motor disability including the inability to move the affected body part within the normmal performance. The pain may spread and include the entire arm or leg, even in the case where the primary injury was located only to a finger or toe. Pain may also travel to the opposite extremity. CPRS may also be accompanied by increased emotional stress.

The symptoms of CRPS are seen to vary in severity and length with some experts believing that there are three stages which mark progressive changes in the skin, muscles, joints, ligaments, and bones of the affected area

Stage 1 – 1 to 3 months, characterized by severe burning pain + muscle spasm + joint stiffness + rapid hair growth + alterations in the blood vessels + change in skin color and temperature.

Stage 2 -3 – 6 months characterized by increasing pain + swelling + decreased hair growth + cracked/ brittle/ grooved, or spotty nails + softened bones + stiff joints + weak muscle tone.

Stage 3: Syndrome progresses to point where change in the skin and bone are no longer reversible. Pain becomes unbearable and may may involve the entire limb. This may be accompanied by marked muscle loss (atrophy), a reduction in mobility + involuntary contractions of the muscles and tendons that flex or extend the joints. The limbs may also become distorted.

CRPS is diagnosed through observation of the signs and symptoms.  CPRS is a syndrome so Doctors are not sure of the exact mechanism the sympathetic nervous system may play a role in sustaining the pain.  A recent theory suggests that pain receptors in the affected part of the body become responsive to catecholamines released from sympathetic nerve and it is these that activate pain pathways after the initial tissue or nerve injury.

The immune is a candidate for post-injury CRPS (CRPS II)and this will account for the inflammatory symptoms of redness, warmth, and swelling in the affected area.

However, many conditions have similar symptoms to CRPS and this makes it difficult for the clinician to make a firm diagnosis . This is especially true early in the course of the disorder when the symptoms are few or mild. Therefor the clinician must firstly rule out other conditions.

The prognosis of CRPS is seen to vary from person to person with spontaneous remission of symptoms occurring in certain people. Other  patients may incur unremitting pain and crippling, irreversible changes in spite of treatment.

Because there is no cure for CRPS, treatment is aimed at relieving painful symptoms and preventing musculosckeletal changes due to the patients not using the painful limb. Therefore Physical therapy will allow for an exercise program that keeps the painful limb or body part moving. This will avoid contractures and keep the patients range of motion, movement ability and function. This is where the Tutor System plays an integral part. The newly developed HandTutor and its sister devices (ArmTutor, LegTutor, 3DTutor) have become a key system in neuromuscular rehabilitation and physical therapy. These innovative devices implement an impairment based program with augmented feedback and encourage motor learning and exercise practice through intensive active exercises. The ArmTutor, LegTutor, 3DTutor and HandTutor are used in patients CRPS and pain with the exercises challenging and motivating the patient to perform repetitive training tailored to the patient’s performance despite the pain. Occupational therapists together with their physical therapist colleagues are using the HandTutor, ArmTutor, LegTutor and 3DTutor in the US and many foreign rehabilitation hospitals. The Tutors are used in the inpatient, out-patient, and private clinic environment as well as by home care patients. For further details, please see


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