Graded Motor Imagery for Women at Risk for Developing Type I CRPS Following Closed Treatment of Distal Radius Fractures

Distal radius fractures (DRF) account for nearly one-fifth of all fractures in older adults
with women sustaining them at a rate of 5 to 1 relative to their male counterparts. The
majority of DRF occur as a result of low impact injuries to the wrist with the hand being
outstretched and are most often managed via closed treatment and cast immobilization The
aftereffects of these injuries include pain, distal upper limb immobility, distal
sensorimotor changes, hand weakness, edema, and type I complex CRPS development. Women, those
sustaining low-force injuries, and those who undergo closed treatment and cast immobilization
of the DRF, are at increased risk for developing type I CRPS. Given that alterations in the
brain's somatosensory strip likely influence CRPS development, a newer intervention, graded
motor imagery, is being used to restore the affected limbs cortical representation to its
typical state. Beyond pain reduction, the implications of this type of approach also include
restoring sensorimotor function to the affected limb. Evidence supports that these
interventions can impact CRPS symptoms as well as motor function but only after they've
developed. To date, there is no literature exploring how these techniques, specifically
graded motor imagery, can be applied to prevent or mitigate the aforementioned aftereffects
of DRF in women.

To this end the investigators propose to pilot a 6-week randomized comparative effectiveness
trial, where the modified graded motor imagery program + standard of care group is compared
to a standard of care (SOC) control group. Immediately following cast immobilization, the
intervention group and control group will each participate in one 1-hr and three 30-minute
clinic-based sessions and 15 minute home programs three times daily. Blinded assessments will
occur at baseline, 3 weeks, cast removal, and one and 3 months after cast removal and will
include pain, sensorimotor, edema, and CRPS diagnostic outcomes.

The project's aims are to: 1) determine the feasibility of recruiting, enrolling, treating,
and following participants and 2) determine if those who participate in a GMI and SOC hand
therapy program have differing pain, function, and counts of CRPS diagnoses when compared to
those who receive only the SOC. The investigators hypothesize 1) that the project will be
feasible to carry out on a larger scale and 2) that an early GMI will improve the pain,
functional and upper limb sensorimotor outcomes of persons with closed treatment of DRF
relative to a standard of care intervention.

Inclusion Criteria:

- Women 55 years or older who have received closed treatment of distal radius fractures

Exclusion Criteria:

- Central nervous system disorders (e.g., Brain injury, Spinal Cord Injury, Parkinson's,
Multiple Sclerosis)

- Surgical fixation of fracture

- Non english speaking

- Concomitant ipsilateral injuries (i..e., BBFF)

- Other injuries to the affected limb interfering with baseline affected limb function

- Cognitive disorders which would preclude from following the testing commands and home
program participation

- Conditions of the contralateral upper limb which would result in painful and markedly
limited active hand, wrist and forearm motion as this may impact the brain's ability
to perceive safe and proficient movement during mirror therapy.

- Visual impairments resulting in the inability to participate in GMI components