General patient information on therapy to help sensations to the skin feel more normal

General patient information on therapy to help sensations to the skin feel more normal

Introduction

Following an injury or operation, nerves within the skin can become overly sensitive. Stimulation to the skin such as touch or pressure can feel unpleasant or even painful. This leaflet provides you with information on how to improve these altered sensations.

GENERAL INSTRUCTIONS

Many of these activities involve touch and are suitable for the upper limb (arms and hands) and lower limbs (legs and feet) although some are specific to one limb as indicated. These activities can be done on a daily basis and incorporated into your normal routine. Where possible, feel the sensation on a part of your body not sensitive first and remember how that normal sensation felt when applying to the affected area.

REGULAR PRACTICE: LITTLE AND OFTEN

Regular practice of these activities will increase the benefit. A short period of desensitisation (even 1-2 minutes) as many times as possible throughout the day is recommended. It might be helpful to set aside particular times during the day to perform them. A quiet, relaxed environment with few distractions will help you to concentrate on the task. As you progress you may find other activities within your daily routine in which to incorporate these principles.

Remember: It may take several sessions before you notice improvements.It is important to be consistent with this treatment. The more consistent you are the faster your symptoms will be relieved.

DISCOMFORT

It is usual for these activities to be uncomfortable whilst doing them and shortly afterwards. You may find that there are certain activities that you are unable to tolerate. Choose one that you feel comfortable with and gradually progress to others as you are able. If you experience significant pain and discomfort then stop that activity and find one that is more tolerable.

CONCENTRATION IS IMPORTANT

To help normalise the system, it is important that you concentrate on the quality of the sensation. This can be done by first undertaking the activity on an unaffected limb. Concentrate on how this sensation feels, remember it and then undertake the activity on the affected area whilst looking at it and thinking about it.

SUGGESTED ACTIVITIES

1. Activities of daily living

Desensitisation therapy can be incorporated into activities of daily living as part of your normal routine.

Whilst in Bed

Feel the bed sheet against your unaffected limb. Close your eyes and concentrate on the quality of that sensation. Now feel the bed sheet against your affected area and recall how that normal sensation felt whilst thinking about the area you are touching.

Whilst dressing

Concentrate on your affected limb by looking at it and thinking about it as you get dressed. Feel the texture of the garment against your skin both on the unaffected area and the affected area.

Whilst having a bath or shower

Select a water temperature that you can tolerate. Feel the water on your unaffected body and now on your affected limb whilst looking at it and thinking about it. Recall how that normal sensation of the water felt against your skin. Gently rub either a soft flannel, sponge or scrunchy on the unaffected areas of your body. Use various movement such as circular actions, rubbing, patting and stroking. Concentrate on how these normal sensations felt whilst applying the movements to the affected areas of your body.

Activities for the upper limb only.

Whilst washing up feel the temperature of the water on both the affected and unaffected areas of your hands. Think about how the normal sensation of the water feels whilst concentrating on your affected hand. Focus on the action of your affected hand in the water. Where tolerated use different water temperatures such as tepid, hot and cold. Immerse your unaffected hand first then your affected hand for short periods. These periods can be lengthened over time.

Whilst cooking

When you are making pastry or bread, mix it with both hands. Concentrate on the texture of the mixture and action as you are doing so.

2. Use of different textures

Applying different textures to the skin is another way to re-educate the sensory system. Gather together a variety of rough and smooth textures that you can tolerate. Here are some suggestions:

Smooth: Felt, satin, silk, velvet, make up or soft paint brushes

Rough: Towelling, netting, scourers, flannel, wool, hook velcro.

Begin with one texture which causes the LEAST discomfort.

Place them on your unaffected limb and apply movements such as light stroking, firm stroking, tapping and circular actions. Note the various normal sensations that you feel. Now on the affected limb, apply the texture in similar movement working from an area that you can tolerate towards the more uncomfortable skin areas for example from the top of the arm towards the hand. Concentrate on the area by looking at it and thinking about it. Recall the normal sensations that you felt on the unaffected limb.

When the area is no longer sensitive to that textureyou can progress to the next texture which you identified caused you slightly more discomfort, and repeat as above.

3. Massage

Massaging the affected limb can also be beneficial. This can be done by either yourself or someone else. Moisturisers or massage oils can be used. Be sure not to use anything which may irritate the skin. Use different pressures such as soft touch and firm massage where tolerated. Apply various movements such as patting, stroking and circular actions. Concentrate on the area being touched by looking at and thinking about it. Massage from your fingers and toes towards the centre of your body.

4. Immersion Massage

• Fill a number of bowls with different particles of varying textures (smooth to rough) e.g. lentils, rice pasta, sand etc.
• Establish an order as before – least comfortable to the most comfortable. Place your sensitive hand into the bowl which causes the LEAST discomfort, and move your hand around in stirring motions changing the speed and direction. Build up time up to 10 minutes.
• When the particles become tolerable you can progress to your next bowl of least discomfort
• You can also put small objects such as buttons, keys into the bowl to pick out when able.
• You can bounce your hand gently up and down in the particles.

PATIENT GUIDELINES FOR THE USE OF MIRROR VISUAL FEEDBACK

These guidelines should only be used following consultation with your clinician.

What is mirror visual feedback?

Mirrors have been found to be of use in the treatment of Amputee phantom limb pain and we too have found that some patients with areas of pain and altered sensation (often hypersensitive) also report a reduction in their pain. It is thought that the mirror works by ‘tricking’ the brain to believe that the painful limb is now ‘normal’, through looking at the reflection of the unaffected limb. This helps, over time, to correct the messages to the brain and thereby reducing pain which in turn may assist exercise.

What should I do?

Mirror visual feedback should become part of your planned exercise programme. Follow the instructions below 4-5 times a day (or as directed) but only use the mirror for brief periods (maximum 10 minutes) or until you feel you are no longer able to concentrate. It is best to use it ‘little and often’. Like any new technique, it will need practice and may need several trials before you are used to it.

• Find a quiet room where you will be able to concentrate and not be interrupted.
• Ensure that you are seated/lying comfortably with your back well supported.
• Position the mirror so that the reflective surface is facing your unaffected limb and your affected limb (the one with problems) is hidden behind the mirror (figures 1 & 2)

• Lean forward so that you are now able to see the mirror image of your unaffected limb in the mirror and simply look at this reflection WITHOUT MOVING either your affected or unaffected limb. Concentrate hard on the mirror reflection for the minimum of a couple of minutes.
• Once you are comfortable with this, very SLOWLY start to move BOTH limbs in EXACTLY the same way whilst still looking at the reflection in the mirror. You may want someone with you the first time you do this to ensure you are moving both limbs at the same time and in the same way. It does not matter what movements you choose to do as long as you do the same with both limbs. However, there may be specific exercises that your physiotherapist has prescribed for you that you could perform whilst using the mirror.
• If pain prevents movement of your affected limb, then try to IMAGINE that you are moving it in the same manner as the unaffected limb.
• If pain or stiffness becomes a problem whilst you are exercising then stop and go back to simply looking at the mirror image whilst both limbs are resting.

REMEMBER do not use the mirror for prolonged periods as your concentration levels will drop and always move your affected and unaffected limbs in the same way.

Are there any side effects with this treatment?

Occasionally, people feel unusual sensations in the limb that is hidden from their view, when using the mirror.

For example:

• Heavier or lighter
• Warmer or colder
• Reduced sensation or as if it is ‘floating’
• Or even that you have an additional limb

All of these sensations are much less common when both limbs are moving in the same manner and should last no more than a few seconds or minutes after you have stopped using the mirror. If at any time you find a sensation uncomfortable or disturbing, then simply stop the particular exercise and view both limbs without the mirror and the sensation should quickly pass.

If your symptoms or condition worsens, or if you are concerned about anything, please call your GP, 111, or 999.

Patient Experience

We know that being admitted to hospital can be a difficult and unsettling time for you and your loved ones. If you have any questions or concerns, please do speak with a member of staff on the ward or in the relevant department who will do their best to answer your questions and reassure you. 

Feedback

Feedback is really important and useful to us – it can tell us where we are working well and where improvements can be made. There are lots of ways you can share your experience with us including completing our Friends and Family Test – cards are available and can be posted on all wards, departments and clinics at our hospitals. We value your comments and feedback and thank you for taking the time to share this with us.

Patient Advice and Liaison Service (PALS)

If you have any concerns or questions about your care, we advise you to talk with the nurse in charge or the department manager in the first instance as they are best placed to answer any questions or resolve concerns quickly. If the relevant member of staff is unable to help resolve your concern, you can contact the PALS Team. We offer informal help, advice or support about any aspect of hospital services & experiences.

Our PALS team will liaise with the various departments in our hospitals on your behalf, if you feel unable to do so, to resolve your problems and where appropriate refer to outside help.

If you are still unhappy you can contact the Complaints Department, who can investigate your concerns. You can make a complaint orally, electronically or in writing and we can advise and guide you through the complaints procedure.

How to contact PALS:

Telephone Patient Services: 0300 123 1732 or via email at: [email protected]

Opening times:

The PALS telephone lines are open Monday to Friday from 8.30am to 4.00pm. Please be aware that you may need to leave a voicemail message, but we aim to return your call within one working day.

If you are unable to understand this leaflet, please communicate with a member of staff.

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