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Video: "Allodynic Territory Assessment & Rehabilitation" on YouTube
Dear Colleagues
Following you will find the link for the Video published at the EFSHT Online Week 2020: 
This Video can only be accessed with this link.
All the best
Ulla
Comments
I must admit that the production of this video must have taken you a lot of time and energy, congratulations for this idea (especially in English!) and thanks for sharing it with us.
Nonetheless, I am sorry but it seems to me that I have seen some errors in the video, related to the method protocole
Let me propose to the moodle members the game of "search for the errors", so that we can confront ourselves to the careful observation of the whole video and our knowledge of the method
Please understand that this should be a constructive communication, let have a Fair play! We all learn each day new things
I give you a first clue : the pain scale...
Can't wait to have your feedbacks!!
Have a nice day, and thanks again Ulla for your work!!
Evangélia
Dear Evangélina
Thanks for your comment. As you said, everyone is welcome to point out mistakes or make suggestions for improvement.
I agree with you that the execution of the assessment is not precise enough for experts in SSR.
This video is made for laypersons and in no way claims to replace a training in the field of SSR. The goal is to make the SSR methods accessible to a broad audience. We did not have more than 15 minutes for the presentation at the online congress of EFSHT 2020 and therefore had to do without certain details in the execution e.g. pain scale.
Please specify your suggestions for improvement for us as experts.
All the best
Ulla
Dear Ulla,
First of all I would like to congratulate you for the editing of this video. A great idea!
Here is a comment about allodynography:
Using the RED color for mapping the allodynography can be misleading. Indeed, the aesthesiometer to map the allodynic territory is the 15 g corresponding to the color VIOLET on the rainbow pain scale. The color RED (corresponding to the 0,03 g aesthersiometer ) should be only used for mapping the rainbow pain scale RED.
Stay safe
Sandrine
It is a great personal quality that you have to accept our feedbacks, thank you for helping the SRN progress by sharing each other's knowledge ?
About the pain scale :
First of all, we ask the patient to IMAGINE the worst physical pain possible, this means the example they give us has to be external to their own pain experience (most common ex patients say : "a person burned from head to toes" ).
Secondly, we ask the patient several personal pain experiences he actually lived himself (usually about 3-4 are enough), from the smaller pain to the higher pain, and each time he has to put it on the scale, where he considers it should be placed regarding the 2 extremes of the 10cm scale :"NO PAIN" and "MAX IMAGINABLE PAIN = SKIN BURNED PERSON". Now we have our basis to start working on our allodynography.
Finally, we ask the patient : "right now, at this moment, without touching nor moving, where do you consider putting the pain you feel right now on this scale we just did together, between "NO PAIN" and "MAX IMAGINABLE PAIN = SKIN BURNED PERSON"? "
If patient put his pain at rest under 3cm, then we put the words" it starts(if rest pain is at 0cm) or it gets higher" at exactly 2,5cm and the word" STOP" at 3cm.
But if the patient's pain at rest is over 3cm, then the words "it gets higher" is put at +0,5cm of the rest pain, and the word "STOP" at +1cm of rest pain (ex : rest pain at 4cm. "it gets higher" is put at 4,5cm, and "STOP" at 5cm
I am not sure if there is in English à better way to write "it gets higher" to explain when pain gets higher when we apply the monofilament.
I hope it was clear enough, if not please don't hesitate to tell me. We are all here to help each other learn and progress in our practice. This is the purpose of our network and this moodle
Thank you again Ulla for initiating this video!
I wish you a very nice day and hope to read more comments a'd topics from our Somatosensory community.
Evangélia
Dear Sandrine & Evangélia
Thank you for your comments and your detailed explanation Evangélia.
Sandrine, what color do you use ,if you reassess the rainbow scale area with the same value the following weeks?
Evangélina, how do you handle the situations when patients are not able to imagine the
their highest imaginable pain or a pain of one cm? That is, what happens in my sessions very often.
Stay healthy
Ulla
Dear Ulla,
Sorry for the late response to your video. I watched it last week, but then I have been caught in my ADL.
First of all, I wanted to congratulate you on the quality of your video. Creating videos myself, I can imagine all the effort and time you put into that project to have that beautiful result.
To answer Evangelina question, I have noted a few elements that could be changed if you ever wanted to produce another video. Beside what Evangelina et Sandrine already said, here are my recommendations :
1)When you do an allodynography and the person says
*green: move 1cm forward
*orange: move 1mm forward
*red: stop (don't go back)
2)When you do an allodynography or aesthesiography on the hand: test the monofilament on each finger included in the territory you are evaluating.
3)When you do cartography, the contour of the body part evaluated should be brown.
4)The first g. used in the rainbow pain scale is 0,03g (not 0,04g; you were right the first time you said it).
5)Each color in the RPS takes a different time frame to resolve (±16 days for purple, ±23 days for indigo, ±34 days for blue, ±50 days for green, etc.).
6)When you talked about counter stimulation, the main rule to follow is: the stimulus needs to be comfortable. You don't need to apply it ''far away'' from the injury. In fact, the stimulus can be in the same territory as the allodynia, as long as it's comfortable/the symptoms don't increase. If it's not comfortable, then you can try to stimulate, in proximal, a branch of the same family (when applicable). If it's still uncomfortable, then you can go further (as you did in the back).
7)When you do counter stimulation, always go towards the spine (without touching it), while following the sens of the nerve (horizontally or vertically).
I don't know if other CSTP can confirm what I wrote?
Otherwise, to answer your last questions:
1) The only color that matters when you do a RPS is the first one you use (that represents the intensity of the allodynia), you can use different colors every time after that + you write the date with the color you used the same day.
2)I don't know what Evangelina does with her patients, but we have been suggested to ask them about the pain they could have heard on the radio/ saw in the news/read in the journal, etc.
Hopefully, this topic can help different therapists.
Thanks again for sharing,
Sarah Bouchard, CSTP and president of the somatosensory rehabilitation of pain network
Dear Sarah
Thank you very much for your detailed feedback.
All the best
Ulla
Dear all,
Thank you Ulla for the work. It is helpful for spreading the knowledge of somatosensory rehabilitation in the case of mechanical allodynia.
To answer Evangelia, I use "it increases" sometimes for the "orange".
I want to come back on a few points Sarah commented :
Point 2: The precision one is going to look for while doing aesthesiography won't necessarly be possible when mapping allodynography because of the potential raise of pain. For this territory there would at most be one and a half finger. The option Ulla chose here is a good one.
Point 4: Yes it is the 0.03 g. We prefer talking about the marks RPS red is #2.44.
Point 5: Allthough studies show evidence of different time frames for each RPS colour, when talking to our patients, we usualy use the simplification of "about one colour per month" It's good enough ...
Point 6: I think the sentence "You don't need to apply it ''far away'' from the injury. In fact, the stimulus can be in the same territory as the allodynia, as long as it's comfortable/the symptoms don't increase." is a very dangerous one allthough the intention is certainly right. Yes DVCS can be done on the same territory of maximal origin of the affected nerve branch but it is NECESSARLY IN THE PROXIMAL part of this one. The choice in the video is a great illustration of DVCS I think it would have been too long to go over all the steps that led the therapist to thise choice.
Point 7: I have no knowledge of those rules for DVCS allthough the petting from distal to proximal helps avoiding getting too close to the allodynic territory. When on upper or lower segmentary level our patients are tought to go, either back and forth, down from the upper limit or up from the lower.
Lets not forget to make the difference between the moments where we need to be very precise in our teaching and the general presentations that need to stay somewhat simple.
Yes the colour used for allodynography should be VIOLET, yes the VAS maximum imaginable pain is an important item as well. Going back and forth for allodynography is no good idea because it can unnecessarely hurt the patient. Those are the most important things I noticed.
I hope to be able to show you a video of my own for the online teaching of the method in these next months...
All the best and continue the good work.
Rebekah DELLA CASA, CSTP, Somatosensory Rehabilitation Instructor
Dear Rebekah,
Thank you for your detailed statement and the clarifications.
I am very much looking forward to see your video.
All the best
Ulla
Dear Ulla,
Nice to see your video and sure appreciate the efforts that had gone behind in coming out with this. This is a good start and I hope you can come up with another one too sometime soon with the suggestions that has come out or on a different theme.
Good job and keep it up.
Again, a very clear explanation Rebekah. Looking forward to your video too.
Regards
Joshua Samuel R