RSD can be extremely difficult to treat. Prevention is truly the best option, but it sounds like you are just now getting the referral for something that already is an established problem. Its really important that the affected limb is maintained in proper alignment - in folks who have sustained a CVA, movement of the limb while it is out of alignment is one of the big causal factors in developing and exacerbating RSD(or CRPS). When you attempt to get the arm moving, make sure that the scapular-humeral rhythm is maintained - that the scapula is moving along with the humerus. Does the patient have any active movement in the arm? If so, some folks have had success with a scrub and carry technique. This involves having patient perform alternating exercises, "scrubbing" a table, and then carrying an object(like a briefcase) in the hand. I treated one woman who successfully treated her own RSD through swimming. Getting the patient to move the arm themselves, through active assisted movement or bilateral movement, with you facilitating the maintenance of good alignment, is less fear-producing and more effective for getting movement. If there is no active movement in the arm, sometimes you can get the patient into a light weight bearing position, and have him/her move over the arm while reaching to perform a meaningful task. As with any patient, the more meaningful the task is to the person, the greater the level of engagement, which may reduce the fear/focus on the affected limb. Some patients respond to first having a nerve block done, followed by as much movement as can be tolerated. Do you know what the MD has done to treat the condition? What stage is the patient in? If its stage 1 or 2, some of the above suggestions may help, but if its progressed to stage 3, its irreversible, and the prognosis for improvement is poor. Good luck with this challenge! Ann
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