Date Presented 4/20/2018
Understanding neurological processing differences of children who have complex regional pain syndrome could help occupational therapy practitioners better understand their sensory modulation difficulties. Identifying common features could lead to improved intervention strategies and patient outcomes.
Primary Author and Speaker: Christopher Alterio
PURPOSE: The purpose of this study was to explore complex regional pain syndrome (CRPS) using models of sensory modulation difficulty (SMD) and narrative interview. Sensory processing theory, as grounded in sensory integration theory (Ayres, 1979, p. 5) and later modified by Dunn (1997), provided the background model for this study. The Sensory Profile 2 (Dunn, 2014) was used to provide an assessment of this relationship as reported by the parent. This type of test that measures behavioral responses was used in this study to inform a narrative inquiry to understand the impact of these disorders on occupation. This study explored assessment tools that could be helpful in identifying key areas of similarity between CRPS and SMD. Although any implied linkages between these conditions are theoretical at this time, identifying common features of the disorders could contribute to a deeper understanding of both.
METHOD: This study used a qualitative design in a case study format. All participants had a current diagnosis of CRPS secondary to orthopedic injuries. The principal investigator (PI) provided eligibility criteria to a therapist at a private occupational therapy facility. Purposive sampling was used with selection criteria as follows: current or historical clinical signs of CRPS, age <18 yr at time of initial injury, and patient at a private occupational therapy practice. None of the participants were patients of the PI. Maximum variation sampling was used regarding gender, underlying orthopedic condition, and educational attainment.
Participants were invited to participate in the study, and for those who expressed interest in participating, all personal and confidential information was deidentified and presented to the PI. After informed consent was obtained, participants completed the Sensory Profile 2 (Dunn, 2014), a standardized assessment used by occupational therapists to measure sensory processing abilities and to profile the effect of sensory processing on functional performance in daily life. The PI then interviewed the intervening therapist and the children and families regarding children’s occupational functioning. After reflecting on the parent and child interviews, play histories, and other narrative data, the PI analyzed the information obtained to report occupational performance difficulties.
RESULTS: This sample of children being treated for CRPS did not have atypical scores on the Sensory Profile 2. However, their parents reported severe concerns with hyperarousal and pain vigilance associated with CRPS. The parents also reported severe disruptions in their child’s normal occupational functioning. The case study method was useful for exploring these relationships for the children who participated in this study.
CONCLUSION: Researching similarities between CRPS and SMD could provide useful clinical information that leads to better understanding and improved intervention strategies and patient outcomes. This study provides a beginning model for further research in this area.
References
Ayres, A. J. (1979). Sensory integration and the child. Los Angeles: Western Psychological Services.
Dunn, W. (1997). The impact of sensory processing abilities on the daily lives of young children and their families: A conceptual model. Infants and Young Children, 9, 23–35. https://doi.org/10.1097/00001163-199704000-00005
Dunn, W. (2014). Sensory Profile 2 user’s manual. San Antonio, TX: Psychological Corporation.
Yin, R. K. (2009). Case study research: Design and methods (4th ed.). London: Sage.
