Become a Creator today!Start creating today - Share your story with the world!
Start for free
00:00:00
00:00:01
CRPS Case Conversation
203 Plays3 days ago
Delaney sits down with Miranda on the Hand Therapy Academy podcast to talk through her experience with a one-of-a-kind patient living with CRPS. Their discussion is packed with real-world takeaways that therapists can bring into their own sessions.
Recommended
Transcript
Introduction to Hand Therapy Academy
00:00:05
Miranda Materi
Hello, i'm Miranda. All
00:00:06
Delaney Wright
And I'm Delaney and we are Hand Therapy Academy.
00:00:09
Miranda Materi
right, Delaney, welcome back.
Case Introduction: CRPS Diagnosis
00:00:11
Miranda Materi
Today we're going to be sharing a case about a particular patient. and We're going to talk a little bit more about this patient and her diagnosis of the CRPS and what interventions were successful and what worked and then what has worked for some of your other patients.
00:00:11
Delaney Wright
Thank you.
00:00:27
Delaney Wright
Yes, so I had a super interesting case about a year
Patient's Condition and Initial Challenges
00:00:32
Delaney Wright
ago. She came to me, or maybe it was actually two years ago. She came to me with um CRPS affecting bilateral hands, arms, basically from the elbow down.
00:00:43
Delaney Wright
um, she was only able to move her index finger and her thumb on one hand, and she was, um, clenched on in her other digits and then her, um, index finger on the other hand.
00:00:54
Delaney Wright
Um, she tried like lots of different treatments, courses of therapy, therapists, uh, interventions, and nothing was really working
Pain Management Strategies
00:01:05
Delaney Wright
for her. Um,
00:01:06
Miranda Materi
Could you passively move her fingers out or would could you not touch them?
00:01:09
Delaney Wright
She was in so much pain that I couldn't even touch her hands.
00:01:13
Miranda Materi
Interesting.
00:01:13
Delaney Wright
i I did try initially to start like opening her fingers that were closed um and she was just in like an unbearable level of pain. ah But yeah, so we kind of avoided that after a little while. But so I treated her for a while and we did focused a lot on like desensitization, mirror therapy, um like kind of like the typical CRPS interventions. We did a lot of like, um, more like fun things. Cause she was a kid. She was about 12 or 13. And, ah so we did like fun stuff where she could like, we did tic-tac-toe cause she loved that. And like, she would draw on the wall, draw pictures.
00:01:54
Delaney Wright
Um, and those were, were all fun and she had less pain during those, but, um she never really got a whole lot better than just being able to use her index finger and her thumb.
00:02:06
Delaney Wright
Um,
00:02:06
Miranda Materi
A little bit more. Did, um was she able to do like her schoolwork and stuff?
Impact on School and Daily Life
00:02:11
Delaney Wright
um She was, she did have accommodations in terms of like time and stuff, um but the paper, like having her like hand resting on like the table, that bothered her like on her side of her hand and arm. um Yeah, she she did have accommodations, but to be able to do her schoolwork, but it was definitely more challenging for her.
00:02:30
Miranda Materi
Oh, that's so interesting.
00:02:31
Delaney Wright
Yeah.
00:02:31
Miranda Materi
oh Did she have any like trauma or anything or anything happen or?
00:02:36
Delaney Wright
You know, and there was, she, i believe she broke her distal radius like years ago, like many years ago. And um I don't know, I tried to like, kind of like while she was there after building like a relationship with her, ask about like her life outside of therapy, obviously.
00:02:52
Delaney Wright
And nothing like came up as any red flags. I've definitely had other patients who I've been like, oh, well, maybe that is why this is happening. But her, there was nothing that came up to me at all. And She was actually being treated by the PT clinic that we share space with for lower extremity CRPS as well.
Intensive Treatment and Recovery
00:03:08
Delaney Wright
One, her right ankle.
00:03:08
Miranda Materi
Oh, that's interesting.
00:03:09
Delaney Wright
Yeah. At the same time. So it was, um, she ended up actually going, she applied to Boston children's, um, and got in there and did six weeks of treatment there. Um, very intensive treatment, and ended up leaving with her hands open. So.
00:03:26
Miranda Materi
Oh, that's incredible. So for the treatment, was she there? Like, did she have to stay the night there and everything?
00:03:31
Delaney Wright
Yeah. So she was there all the time, stayed the night there. Um, and she, she told me, i actually got to see her and talk to her mom afterwards. And they told me that it was a lot of like, actually like exposing her to the pain and like, they would really induce more pain.
00:03:47
Delaney Wright
Like even though stretching her hands open really hurt, like ah severely hurt her, they, they did it. And, um, it was more like accepting that her level of pain was going to be
00:03:54
Miranda Materi
Oh, wow
00:03:58
Delaney Wright
always there and like abnormal compared to like what other people consider like normal pain. So it was definitely interesting.
00:04:07
Miranda Materi
That's interesting because it's just the opposite of what we do, right? We try to not elicit with CRPS and all of like the books. And even if you read Rehab with a Hand, it's all about like calming the nervous system and not causing it to like be overstimulated. So it's interesting that that sounds like it's actually what they were doing.
00:04:27
Delaney Wright
Yeah, it was actually really interesting when she came back and told me that. I was like, well, that is everything that I've never done with any of my patients who have also like presented with CRPS-like symptoms.
00:04:39
Delaney Wright
So it was...
00:04:40
Miranda Materi
Yeah. that Did your leg get better too?
00:04:43
Delaney Wright
Yep. Everything got better. and She's like a fully functioning, like teenage kid. She actually came.
00:04:47
Miranda Materi
Oh, that's awesome.
00:04:48
Delaney Wright
Yeah. She came to me for some, um, handwriting practice just like a year ago and she was great.
00:04:49
Miranda Materi
expert
00:04:55
Delaney Wright
She, no, I mean, I would occasionally ask her about her pain. She's like, she was like, I'm always going to have pain. You're not supposed to like, ask me about it. And I'm like, Oh, okay. I didn't know that, but okay, great.
00:05:06
Miranda Materi
Yes, that is very interesting. I know. And then have you had other patients with CRPS?
CRPS: Central vs. Peripheral Pain
00:05:11
Miranda Materi
Probably.
00:05:11
Delaney Wright
I've had, i haven't had somebody that's like diagnosed with it, but I've definitely had a lot of my patients come in presenting with like those early like inflammatory signs that indicate CRPS, like the swelling and the changes in the skin color.
00:05:25
Delaney Wright
And I've done like the normal like interventions, um the laterality guards, the mirror box, and those have helped tremendously. It was just...
00:05:35
Miranda Materi
Yeah. Well, it's interesting too, because I think when we see it, we're seeing the orthopedic conditions, it's after an event has happened, right? Like there's been some trauma to the hand or, or they've had surgery or so or something like that, where you're like, okay, well, you had something that elicited this response versus, you know, maybe with the, the child that you were seeing, there was no, like I guess you couldn't determine the event or why it occurred.
00:05:43
Delaney Wright
yeah Yeah, definitely.
00:06:00
Miranda Materi
So maybe two, that's different in itself, right? Like,
00:06:03
Delaney Wright
I feel like the mechanism probably is different, especially like at the like central systems, like interpretation of pain,
00:06:09
Miranda Materi
Right. It almost seems like, you know, like some of the ones that with are like the orthopedic are more peripheral based versus like where you're saying um this person definitely had a centralized pain response.
00:06:19
Delaney Wright
For sure, yeah.
00:06:20
Miranda Materi
And then with our peripheral nerve responses, it's making sure those don't convert into a centralized pain response.
00:06:27
Delaney Wright
Yeah. And that probably was the big difference there. And that's kind of why the interventions that I was giving her weren't really working. They were kind of helping manage the pain, but no big, no functional changes were happening, unfortunately.
00:06:40
Miranda Materi
Yeah, that's really interesting.
Resources for CRPS Treatment
00:06:42
Delaney Wright
Yeah.
00:06:42
Miranda Materi
But good to know that there's those resources out there and those, um especially for kids well and for adults too, right? there's We often refer to pain clinics, but there's actually some programs that are in place for people.
00:06:54
Delaney Wright
Exactly. Yeah.
00:06:55
Miranda Materi
Yeah.
00:06:55
Delaney Wright
I never would have known.
00:06:57
Miranda Materi
Yeah, me neither. you know i know like Mayo has a pain management program, but that's definitely not for kids. So
00:07:03
Delaney Wright
Yeah. Yeah. The Boston Children's one is specifically for like kids with CRPS. So a great resource for sure.
00:07:07
Miranda Materi
yeah, that's incredible.
Closing Remarks and Contact Information
00:07:10
Miranda Materi
right, Delaney, well, thank you for sharing your case.
00:07:13
Delaney Wright
Of course. Thank you so much for having me.
00:07:15
Miranda Materi
So for more information, you can reach out to us at our email at info at hamtherapyacademy, or you can reach out to us through Instagram at hamtherapyacademy.