Type 1 Complex Regional Pain Syndrome in upper limb and mirror therapy in sub-acute phase of stroke: Comparison of two protocols by SCED method

Abstract

Mirror therapy is an effective analgesic treatment of the Type 1 Complex Regional Pain Syndrome (CRPS-1) of the upper limb, often diagnosed within a year after a stroke. However, few protocols have been redacted so far. Our study aims to answer the following question: should we favor distal or proximal mobilization of the upper limb in the treatment of CRPS-1 in sub-acute phase of stroke? We conducted a single-case experimental study (SCED), in multiple baselines across three patients. Each one realizes the two protocols, randomly distributed: distal mobilization and proximal mobilization of the upper limb. We daily assessed pain on an EVA. The function and motor function of the upper limb are weekly assessed by the Frenchay Arm Test (FAT), the Abilhand self-questionnaire, and the Fugl-Meyer Assessment-Upper Extremity (FMA-UE). Regardless of the protocol, we notice significant results for each of the three patients concerning pain, function and motor function of the upper limb. By comparing the two protocols with each other, we find an equivalent analgesic efficacy and an improvement in motor function. Concerning the functional gain, the FAT shows a slight superiority of the proximal mobilization, whereas the Abilhand self-questionnaire reveals a trend towards improvement in favor of a distal mobilization of the upper limb. Although we included only three patients, the methodology used, namely the SCED, brings significant results despite the heterogeneity of the characteristics presented by our patients. Nevertheless, we note that mirror therapy is a preferred treatment in patients with mild to moderate cognitive disorders, in order to promote adherence to treatment. Whatever the joint visualized by the patient, mirror therapy is an effective analgesic treatment of the upper limb of neurovascular origin of the CRPS-1, strengthening the importance of the collaboration between vascular neurology and MPR units.