Reflex neurovascular dystrophy

Reflex neurovascular dystrophy (RND) is a painful neurovascular disease that reduces the supply of oxygen to the skin, muscles and bones. RND is the pediatric version of Reflex Sympathetic Dystrophy. This lack of oxygen can cause acid to build up, causing new pain that is then sent back through the cycle to cause the neurovascular nerves to constrict the blood flow again. If untreated, the pain caused by RND can become so severe that it interferes with the patient's ability to move the affected body part. For example, if a patient had RND in his leg, he would develop problems walking. In 90% of RND cases, only one or two areas of the patient's body are affected. In the other 10%, RND affects the patient's entire body. Many full-body cases start normally in one or two areas, but progress and spread over time. RND is more common among girls than boys (80% of children with RND are girls). A rare symptom of RND is nausea, causing the child to vomit on a daily basis.

Causes
RND can be caused by musculoskeletal inflammatory diseases such as arthritis. Reflex Neurovascular Dystrophy can not be brought on by stress; it can only be amplified by stress once RND is already present in the patient. Stress may continue to play a major role in RND even after the child has RND under control. It can relapse if the child feels depression, or is injured.

Treatment
The best known treatment of RND is extreme physical therapy. There are several such programs, including Children’s Hospital in Seattle, Mary Free Bed Rehabilitation in Grand Rapids, Michigan, The Children's Institute of Pittsburgh in Pittsburgh, Pennsylvania, The Pediatric Rehab Unit at The Children's Hospital at Legacy Emanuel in Portland, Oregon, Children's Specialized Hospital in New Brunswick, New Jersey and the Children's Hospital of Philadelphia (CHOP). In a typical course of therapy, the child is put through 5 to 7 hours of therapy including intensive physical, occupational and pool and/or yoga therapy. While often painful, such therapy helps to improve blood flow and break the RND cycle. The therapy usually lasts between 2–4 weeks before the child has the RND under control. Small relapses and flare ups may occur, usually only during 5 years of the treatment, which is the average time until the child is pain free, though RND can continue to occur and may never cease.

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