Supporting garments for therapy purposes and pain management

Pressure garments have been used for decades for treating neurological disorders and improving stability. However, knowledge based on scientific research and clinical proof of treatment effects is still limited. Pressure garments (along with other pressure appliances) are usually applied for enhancing sensory perception, aiming at effective and functioning sensory integration.

The function of the pressure garment is based on enhancing proprioseptics of the body, body awareness and deep pressure input.  In different disorders of sensory integrations the feeling of pressure in large areas can help to manage the pressure inputs and overcome the feeling of irritation and malaise. This has a favorable effect on the ability to concentrate and generalized feeling of ease.

Targets of rehabilitation

When pressure garments are used as a part of rehabilitation, the target is usually to improve the use of client’s own sensory system. This starts by defining client’s starting level and certain physiological deficits. This helps to define the functions that should be built or learned, or the feelings, that should be eliminated. This targets to well-functioning somatosensory system and body awareness.

Sensory information intensifies body awareness. In certain conditions (e.g. hypotonia, neglect, dystonia or spasticity) it may be challenging to process this external information, which makes it hard to translate this information into movement.  Pressure garments, vibration devices and other pressure appliances intensify this information and help building more integrated moby awareness through proprioceptics. Pressure garments can be used for developing and improving motor skills. Enhanced motor skills may e.g. alleviate the pain, improve body control and help building stability of movement.

In some situations, the treatment may target towards a balance between sympathetic and parasympathetic nervous system. By acchieving this balance, the customer may also experience other benefits such as calming effect and relieved anxiety. Pressure garments are often used as a tool for improving emotional control. Garments may help coping with emotions caused by external stimuli, thereby leading to positive long-term effects in everyday life. In regular use, pressure clothes may serve as a tool for situational learning, which enables the body to adopt new ways of functioning.

Elastic pressure garments have been developed alongside with traditional orthoses and appliances from 1980’s. However, these are not directly comparable considering their materials and qualities. They can be used in conjunction, and in some cases flexible pressure garments can even replace tradional rigid orthoses. Compared with traditional orthoses, flexible pressure garment allows full range of movement and is breathable in use.

Results obtained by using pressure garments:

• Body control and support
• Awakening of deep pressure input
• Increasing functionality
• Soothing effect
• Body awareness
• Managing pain

Treating pain with pressure

Pressure garment can be used for treating pain. Neuropathic pain is is pain caused by disease or damage affecting the somatosensory nervous system.

Components of neuropathic pain vary between patients and each experienced pain. Pressure garments act as a stimulation treatment in pain management.  This means that even very gentle pressure may relieve experienced pain. Pain is often related to sleeping disorders, fatigue, mood swings, anxiety and secondary muscular symptoms. Most patients experience these when pain turns into chronic pain (CRPS) and causes sensory overload. Many patients have experienced that the use of pressure garments have releived these symptoms.

Pressure garments may serve many different purposes in pain management and control: patients with CRPS and EDS may use pressure garments to release muscular tension and thereby ease the functioning of the painful body part.

Research & studies

In this study field the proof of concept is there, but the hard data is lacking. Class 1 studies have not been made yet. A Class 1 study is a randomized, controlled clinical trial of the intervention of interest with masked or objective outcome assessment, in a representative population. Relevant baseline characteristics are presented and substantially equivalent among treatment groups or there is appropriate statistical adjustment for differences. The lack of class 1 studies does not mean that the aids are not effective – often necessary funds to finance class 1 studies are not available. Class 1 study in neurological pressure garments would be hard to organize because each individual responses differently to pressure treatment.

Many pressure garment trials begin, and are based on therapists’ own experiences and if pressure garments are seen fit for the situation, family, client or environment. It is important that the care personnel follows what happens during the treatment to build experience-based knowledge.

Experience-based knowledge on pressure garments is widely available. The absence of relevant studies means that recommendations are mostly based on the individual needs of the customer and rarely on specific diagnostic situations. Example: many cases, with different diagnosis, have the same manifestation of hypotonia or spacticity. Thus pressure garments are chosen to treat that, not necessarily the underlying diagnosis.

Theories on why pressure garments work

Changes achieved with pressure garments in movement and body control are neurophysiological and biomechanical in nature. (Hylton & Allen, 1997). Exact mechanisms are yet unknown. Central nervous system is a complex organization of nerve cells in which all activity is generated from external stimuli (Kottke, 1980). Nervous system gets feedback from our motor cortex and turns the sensory and proprioseptic feedback into movement. (Ellaway, 1995).Proprioception, deep pressure, viobration and light touch are all somatosensory inputs that enhance learning within the central nervous system: this is how we interpret the world itself.

It is proposed that pressure from skin contact and increased internal soft tissue pressure leads to enhanced proprioceptive feedback to improve positional limb and body awareness, improving muscle activation and movement control. It is also suggested that pressure garments have a dampening effect on external force vectors acting accross joints, containing overshooting of the limbs beyond the intended target point and increasing predictability of movement that may possibly enhance mechanical stability (Hylton & Allen, 1997).

Gracies et al (2000) suggest that the prolonged stretch and cutaneous stimulation from the tight skin contact resulted in reduction of the degree of spasticity in the affected limb, even though only a glove was in use. They also reported improved passive range of motion in the more proximal shoulder joint not covered by the garment. They speculated that a regional gate control effect may be produced at a spinal level by the cutaneous input from the pressure applied by the garment to the skin, which may affect the shoulder joint.

The theoretical basis of pain treatment is the gate control theory (1965, Ronald Melzack & Patrick Wall), which states that pain signals are not free to reach the brain as soon as they are generated at the injured tissues or sites. They need to encounter certain ‘neurological gates’ at the spinal cord level and these gates determine whether the pain signals should reach the brain or not. In other words, pain is perceived when the gate gives way to the pain signals and it is less intense or not at all perceived when the gate closes for the signals to pass through. This theory gives the explanation for why someone finds relief by rubbing, stroking or blowing air into the injured or painful area.

Lymed product groups

Lymed Sense somatic support garments are mostly custom-made used in occupational and neurological physiotherapy e.g. in cerebral palsy (CP), autism, hypotonia problems, palsy patients, Erb’s palsy and other neurological conditions for children and adults. Somatic Lymed Sense garments are applied for posture control and tone management, improving the functional skills and body awareness. Lymed Sense custom-made garments are also used in pain management. Products are made with either even or progressive pressure (or by combining the two), depending on the situation and need.

Lymed Interim & Light standard sized garments can be used as an easy tool in pain management, alongside with Sense custom-made products. Interim & Light pressure garment acts as a stimulation treatment in pain management.