Using Imaging to Restore Function
Talking to Elizabeth McBride Nielsen
By Debra Nelson-Hogan

Elizabeth McBride Nielsen, an artist profiled in the Winter 2005 issue of the RSDSA Review, has found another way for her Art to help her manage her CRPS—this time in the form of flash cards that she uses in the same way that others use graded motor imagery and mirror therapy. Her objective is to retrain her brain to witness normalcy of movement and to diminish pain.

Nielsen’s neurologist suggested using a flash card process to facilitate the left/right identification associated with graded motor imagery and to help activate the motor cortex of the brain. The process of graded motor imagery starts with the person assessing images of the affected limb and unaffected limb in various positions for the degree of pain that was likely to be experienced. Then, the person “imagines” moving the affected limb in a pain-free manner, to the point where he or she can eventually mimic this visualized movement. Additionally, she tries to quickly identify whether the images on the flash cards are left or right hands. This activity is done several times a day.

Nielsen went through magazines, clothing catalogues, and other publications from which she could take pleasant images of upper extremities. Now she has more than 60 images glued onto colored paper; most of the images are headless, so that she can imagine that the images actually are her own arm. Her reaction to the images is important, and some she found to be actually noxious. She felt her body withdraw when she looked at them.

“When I made the cards, I separated them into 3 piles. The green pile has images to which I react favorably. They have the correct positioning of the hand and arm and show the hand working well, perhaps holding a cup of tea or doing something else that I enjoy. In the yellow pile are the images that I feel so-so about, and the red pile includes the ones that I don’t like at all. For example, in one photo the ways the fingers were displayed on the computer was not inviting, so I put it in the noxious image pile.”

She also uses stand up mirrors to actually reinforce positive imaging using the same concept as a mirror box. “I see a healthy image through the mirror. When I first developed CRPS, it was unclear to me that the brain was the culprit. It didn’t make sense since the injury was to my wrist.

“Fortunately, I had a team of healthcare providers who over time helped me understand. I think this is important for all of us, because it explains why it is so challenging to override the misfired messages, and why you want to get the brain-patterned responses corrected as fast as possible,” she says.

“I answered questions about CRPS as if I had had a stroke. I thought I might be able to re-wire my circuitry. I look at images of healthy arms and purposely avoid looking at atrophy and I honor the memory of the better arm. I am in a better place when I use the flash cards. I have images of a beautiful hand and of arms held high. This is the image I try to reinforce using every mirror in my house.”

In addition to water therapy, which has helped her improve, she has found a lot of success with an innovative type of movement therapy. “I went to see another acupuncturist and orthopedist because I was overcompensating my left side. Eventually, I met a nurse who knew about CRPS. She ran a healing arts center and taught a dance class that was about the joy of movement.”

Libby started doing “Nia” (neuromuscular integrative action), a form of aerobic exercise that combines elements of dance, martial arts, and healing arts. “Nia is designed as a total fitness program and combines both the mind and body. I was floored by the fact that people actually danced in their own space in front of a mirror, which eliminated my fear of being touched our accidentally hurt. I purposely situated myself behind the talented teacher. For two and a half years, I stayed in the same place. When I couldn’t do movement, I let my brain take the image from someone else to complete it. I started physically seeing movement and spontaneous engagement of my arm. All of a sudden, there was hope! I’m doing this three or four times a week, and it is critical to my maintenance program. The ultimate goal to retrain my precious brain more and more. I have a sense of community and I am making myself better.”

She likes the fact that the routines are different and that movement is designed for spiritual, emotional, and physical satisfaction. The objective is to feel good and explore the joy of movement without judgment. “It is fascinating to see how your brain wants to engage in a healthy pattern.” She says that having CRPS can give you a distorted body image. “In my first book, I noticed later that every drawing I did of myself had the wrong limb affected and I didn’t notice it.” The movement and the imagery are helping her feel better and be more optimistic than ever. She emphasizes the need to retrieve pain-free memories that can imprint relief and restoration. “Fuel the healthier images.” Let the brain be reminded of the better times.

“I’m not a quitter and CRPS can challenge you to your very core. We all need hope. I do believe mirror therapy, the flash cards, and being present with people moving healthy limbs can all contribute to overriding the destructive messages and patterns of assault that CRPS presents,” she concluded.

RSDSA Review. Summer 2008.