Spatially-defined motor deficits in people with unilateral complex regional pain syndrome

Abstract

Unilateral CRPS is associated with a spatially-defined disruption of motor performance. Participants perform worse when the task is performed on the affected side of the body midline, regardless of whether they use their affected or healthy hand.

Disputing space-based biases in unilateral complex regional pain syndrome

“…However, several arguments suggest that changes in spatial cognition should not become less apparent over time: (a) there are clinical indications of greater contribution of central mechanisms to the manifestation of CRPS in its more chronic stages (Birklein & Schlereth, 2015;Bruehl & Chung, 2015;Veldman et al, 1993); (b) we found that longer CRPS duration predicted bilateral slowing of movement initiation, consistent with central changes in motor circuits; (c) there is evidence of positive correlations between CRPS duration and the extent of body perception distortion, body-related visuospatial bias, and spatially-defined motor bias (Lewis & Schweinhardt, 2012;Moseley, 2004;Reid et al, 2018Reid et al, , 2016; and (d) other studies (Bultitude et al, 2017;Filbrich et al, 2017;Frettlöh et al, 2006;Michal et al, 2016;Reid et al, 2016;Reinersmann et al, 2012) found no relationship between CRPS chronicity and any biases in spatial cognition, including our own findings from spatial tasks (Pearson's rs = 0.06 to 0.27; see Supplementary Figure 2). Another factor that could limit the extent to which our findings are comparable to previous experimental studies on spatial cognition in CRPS is that pain intensity reported by our participants was on average greater (except when compared to Bultitude et al, 2017, andSumitani et al, 2014;5.8/10 vs. 4.3-4.8/10, Filbrich et al, 2017;Moseley et al, 2012Moseley et al, , 2009Reid et al, 2018). However, previous research reported either positive relationships between pain intensity and severity of "neglect-like" symptoms (Frettlöh et al, 2006;Reid et al, 2016;Wittayer et al, 2018), or found no relationships between these factors (Bultitude et al, 2017;Filbrich et al, 2017;Michal et al, 2016;Moseley et al, 2009;Reid et al, 2016), including our own results (Pea...…”

“…The third limitation to the extent to which our results can be compared to those of previous studies that reported changes in spatial cognition in CRPS is that the duration of CRPS in our sample was on average longer (except when compared to Bultitude et al, 2017; 4 years vs. <1-3 years, Filbrich et al, 2017;Moseley et al, 2012Moseley et al, , 2009Reid et al, 2018Reid et al, , 2016Sumitani et al, 2014). However, several arguments suggest that changes in spatial cognition should not become less apparent over time: (a) there are clinical indications of greater contribution of central mechanisms to the manifestation of CRPS in its more chronic stages (Birklein & Schlereth, 2015;Bruehl & Chung, 2015;Veldman et al, 1993); (b) we found that longer CRPS duration predicted bilateral slowing of movement initiation, consistent with central changes in motor circuits; (c) there is evidence of positive correlations between CRPS duration and the extent of body perception distortion, body-related visuospatial bias, and spatially-defined motor bias (Lewis & Schweinhardt, 2012;Moseley, 2004;Reid et al, 2018Reid et al, , 2016; and (d) other studies (Bultitude et al, 2017;Filbrich et al, 2017;Frettlöh et al, 2006;Michal et al, 2016;Reid et al, 2016;Reinersmann et al, 2012) found no relationship between CRPS chronicity and any biases in spatial cognition, including our own findings from spatial tasks (Pearson's rs = 0.06 to 0.27; see Supplementary Figure 2). Another factor that could limit the extent to which our findings are comparable to previous experimental studies on spatial cognition in CRPS is that pain intensity reported by our participants was on average greater (except when compared to Bultitude et al, 2017, andSumitani et al, 2014;5.8/10 vs. 4.3-4.8/10, Filbrich et al, 2017;Moseley et al, 2012Moseley et al, , 2009Reid et al, 2018).…”

“…Systematic measurement of motor performance of people with CRPS revealed slower and more variable movements when they used their affected hand, but also when movements were performed in the affected side of space regardless of which hand they used (Reid et al, 2018). Thus, there is evidence that people with CRPS can show space-based neuropsychological changes that resemble perceptual, representational, and motor neglect.…”

“…For example, the severity of self-reported "neglect-like" symptoms (Frettlöh, Hüppe, & Maier, 2006) was associated with greater pain intensity, worse longterm pain outcomes, sensory loss, and motor impairment in the affected limb (Frettlöh et al, 2006;Kolb, Lang, Seifert, & Maihöfner, 2012;Wittayer, Dimova, Birklein, & Schlereth, 2018). Also, the magnitude of perceptual and motor spatial biases on experimental tasks correlated with greater pain intensity and longer CRPS duration (Reid et al, 2018(Reid et al, , 2016. Furthermore, larger temperature asymmetry between the affected and unaffected arms was related to greater magnitude of tactile spatial attention bias (Moseley et al, 2012(Moseley et al, , 2009).…”

“…Previously discussed literature shows that changes in spatial cognition correlate with clinical features of CRPS such as pain intensity, sensory and motor impairment, and temperature asymmetry (Frettlöh et al, 2006;Kolb et al, 2012;Moseley et al, 2013Moseley et al, , 2012Moseley et al, , 2009Reid et al, 2018Reid et al, , 2016Wittayer et al, 2018). There is also evidence to suggest that they are associated with other cognitive abnormalities (e.g.…”