Reflex neurovascular dystrophy (RND) is a painful neurovascular disease that constricts the blood

Blood

Blood is a specialized bodily fluid in animals that delivers necessary substances such as nutrients and oxygen to the cells and transports metabolic waste products away from those same cells....

 vein

Vein

In the circulatory system, veins are blood vessels that carry blood towards the heart. Most veins carry deoxygenated blood from the tissues back to the heart; exceptions are the pulmonary and umbilical veins, both of which carry oxygenated blood to the heart...

s and reduces the supply of oxygen

Oxygen

Oxygen is the element with atomic number 8 and represented by the symbol O. Its name derives from the Greek roots ὀξύς and -γενής , because at the time of naming, it was mistakenly thought that all acids required oxygen in their composition...

 to the skin

Human skin

The human skin is the outer covering of the body. In humans, it is the largest organ of the integumentary system. The skin has multiple layers of ectodermal tissue and guards the underlying muscles, bones, ligaments and internal organs. Human skin is similar to that of most other mammals,...

, muscle

Muscle

Muscle is a contractile tissue of animals and is derived from the mesodermal layer of embryonic germ cells. Muscle cells contain contractile filaments that move past each other and change the size of the cell. They are classified as skeletal, cardiac, or smooth muscles. Their function is to...

s and bone

Bone

Bones are rigid organs that constitute part of the endoskeleton of vertebrates. They support, and protect the various organs of the body, produce red and white blood cells and store minerals. Bone tissue is a type of dense connective tissue...

s. 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

Nausea

Nausea , is a sensation of unease and discomfort in the upper stomach with an involuntary urge to vomit. It often, but not always, precedes vomiting...

, causing the child to vomit

Vomiting

Vomiting is the forceful expulsion of the contents of one's stomach through the mouth and sometimes the nose...

 on a daily basis.

RND can be caused by musculoskeletal inflammatory diseases such as arthritis

Arthritis

Arthritis is a form of joint disorder that involves inflammation of one or more joints....

. 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

Depression (mood)

Depression is a state of low mood and aversion to activity that can affect a person's thoughts, behaviour, feelings and physical well-being. Depressed people may feel sad, anxious, empty, hopeless, helpless, worthless, guilty, irritable, or restless...

, a lack of acceptance by society, or is injured.

The best known treatment of RND is extreme physical therapy. There are several such programs, including Children’s Hospital in Seattle

Seattle, Washington

Seattle is the county seat of King County, Washington. With 608,660 residents as of the 2010 Census, Seattle is the largest city in the Northwestern United States. The Seattle metropolitan area of about 3.4 million inhabitants is the 15th largest metropolitan area in the country...

, Mary Free Bed Rehabilitation in Grand Rapids, Michigan

Grand Rapids, Michigan

Grand Rapids is a city in the U.S. state of Michigan. The city is located on the Grand River about 40 miles east of Lake Michigan. As of the 2010 census, the city population was 188,040. In 2010, the Grand Rapids metropolitan area had a population of 774,160 and a combined statistical area, Grand...

, The Children's Institute of Pittsburgh in Pittsburgh, Pennsylvania, The Pediatric Rehab Unit at The Children's Hospital at Legacy Emanuel in Portland, Oregon, and the Children's Hospital of Philadelphia

Children's Hospital of Philadelphia

The Children's Hospital of Philadelphia is one of the largest and oldest children's hospitals in the world. CHOP has been ranked as the best children's hospital in the United States by U.S. News & World Report and Parents Magazine in recent years. As of 2008, it was ranked #1 in the nation for...

 (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.

External links

• Informational handout
• Program at the Children's Institute of Pittsburgh
  Pittsburgh, Pennsylvania
  Pittsburgh is the second-largest city in the US Commonwealth of Pennsylvania and the county seat of Allegheny County. Regionally, it anchors the largest urban area of Appalachia and the Ohio River Valley, and nationally, it is the 22nd-largest urban area in the United States...