title: Prevention of neural hypersensitivity after acute upper limb burns: Development and pilot of a cortical training protocol.
abstract: BACKGROUND
  Acute burn patients suffer pain and secondary hyperalgesia. This alters movement patterns and impairs function. Non-pharmacological methods of treatment are limited and lack rigorous testing and evidence for use. The treatment in this case series was designed to direct conscious attention to, and normalise sensation of, the injured limb in pain free way. The aim of the study was to describe a cortical training programme (CTP) in acute upper limb burn patients and to investigate the efficacy, safety and feasibility of the protocol.
  
  
  METHODS
  The study is a descriptive case series (n=6). Study tasks engaged sensory and motor nerves to influence the perception of the injured area. Visual and tactile inputs to maintain and, or normalise the homuncular map were central to the intervention.
  
  
  RESULTS
  One patient, who commenced the study without resting pain, responded negatively. The remaining five patients had reduced pain and fear avoidance behaviours with associated improvement in arm function.
  
  
  CONCLUSIONS
  The CTP approach is safe and feasible for use with acute burn patients where pain is reported at rest. Comparative studies are required to determine the relative efficacy of the program to usual interventions and the patients who may benefit from the technique.
authors.affiliation: Burn Service of Western Australia, Royal Perth Hospital, Burn Injury Research Unit, University of Western Australia, McComb Foundation of WA, Australia. dale.edgar@health.wa.gov.au
authors.forename: Dale
authors.initials: D
authors.lastname: Edgar
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Zorzi
authors.forename: Ben M
authors.initials: BM
authors.lastname: Wand
authors.forename: Nathalie
authors.initials: N
authors.lastname: Brockman
authors.forename: Carolyn
authors.initials: C
authors.lastname: Griggs
authors.forename: Matthew
authors.initials: M
authors.lastname: Clifford
authors.forename: Fiona
authors.initials: F
authors.lastname: Wood
mesh_terms: D000328:Adult; D001134:Arm Injuries / Q000150:complications*; D002056:Burns / Q000150:complications* / Q000523:psychology; D004192:Discrimination, Psychological; D005240:Feasibility Studies; D005260:Female; D007839:Functional Laterality; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology / Q000517:prevention & control* / Q000523:psychology; D010468:Perceptual Disorders / Q000628:therapy*; D010865:Pilot Projects; D012677:Sensation; D012867:Skin / Q000503:physiopathology; D014110:Touch