scholarly journals Efferent retargeting in above-knee amputees is positively related to phantom limb pain

2020 ◽  
Author(s):  
Amanda S. Therrien ◽  
Cortney Howard ◽  
Laurel J. Buxbaum
Keyword(s):  
Upper Limb ◽  
Lower Limb ◽  
Phantom Limb Pain ◽  
Cortical Reorganization ◽  
Phantom Limb ◽  
Thigh Muscle ◽  
Emg Activity ◽  
Phantom Pain ◽  
Limb Pain ◽  
Lower Limb Amputees

AbstractMany individuals who undergo limb amputation experience persistent phantom limb pain (PLP). The underlying mechanism of PLP is unknown, but the phenomenon has been associated with reorganization in sensorimotor cortex following amputation. The traditional view is that cortical reorganization degrades the missing limb’s representation. However, recent work suggests that an amputated limb’s cortical representation remains intact and that reorganization reflects a retargeting of efferent projections to residual muscles proximal to the amputation site. Evidence of retargeting has only been shown in individuals with upper limb amputations, and the relationship of retargeting to PLP is controversial. This study assessed retargeting and its relationship to PLP in 10 individuals with lower limb amputations. We recorded electromyographic (EMG) activity in a residual thigh muscle (vastus lateralis, VL) in patients with above-knee amputations during cyclical movements of the foot. VL activity on the amputated side was compared to that recorded on patients’ intact side while they moved their phantom and intact feet, respectively. VL activity in the patient group was also compared to VL activity from a sample of 9 control participants with no amputation. We show that phantom foot movement is associated with greater VL activity in the amputated leg than that seen in the intact leg as well as that exhibited by controls. The magnitude of residual VL activity was also positively related to ratings of PLP. These results provide the first support for retargeting in lower limb amputees and suggest that retargeting is related to the experience of phantom pain.New and NoteworthyPrevious work has only examined retargeting in upper limb amputees. This study provides evidence for retargeting in lower limb amputees and suggests that retargeting is related to phantom limb pain.

Phantom Limb: A Phenomenological Study

1982 ◽  
Vol 141 (1) ◽  
pp. 54-58 ◽  
Author(s):  
G. D. Shukla ◽  
S. C. Sahu ◽  
R. P. Tripathi ◽  
D. K. Gupta
Keyword(s):  
Upper Limb ◽  
Lower Limb ◽  
Phenomenological Study ◽  
Phantom Limb Pain ◽  
Phantom Limb ◽  
Limb Pain ◽  
Post Operative Period ◽  
The Right ◽  
Lower Limb Amputees

SummaryPhantom limb phenomena during the post-operative period were studied in 72 amputees. All were right handed. Phantom limb was present in 86.1 per cent of the cases, significantly more commonly following amputation of the right arm. Nearly half of the phantoms developed within the first 24 hours and another quarter in the next 24 hours, appearing earlier in lower limb amputees. Movements in the phantom were felt by three-quarters of the cases, an incidence unaffected by site or side of amputation. Telescopy was present in nearly two-thirds and phantom limb pain in over two-thirds, significantly more commonly in the upper limb amputees but uninfluenced by the side of amputation. Thirty-one of the patients dreamed that their limbs were intact.

scholarly journals Characterisation of Phantom Limb Pain in Traumatic Lower-Limb Amputees

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
André Tadeu Sugawara ◽  
Marcel Simis ◽  
Felipe Fregni ◽  
Linamara Rizzo Battistella
Keyword(s):  
Lower Limb ◽  
Phantom Limb Pain ◽  
Cross Sectional Study ◽  
Phantom Limb ◽  
Limb Amputation ◽  
Limb Pain ◽  
Cross Sectional ◽  
Proper Diagnosis ◽  
Pain Descriptors ◽  
Lower Limb Amputees

Introduction. There is no diagnosis for phantom limb pain (PLP), and its investigation is based on anamnesis, which is subject to several biases. Therefore, it is important to describe and standardize the diagnostic methodology for PLP. Objective. To characterise PLP and, secondarily, to determine predictors for its diagnosis. Methodology. This is a cross-sectional study involving patients with unilateral traumatic lower-limb amputation aged over 18 years. Those with clinical decompensation or evidence of disease, trauma, or surgery in the central or peripheral nervous system were excluded. Sociodemographic and rehabilitative data were collected; PLP was characterised using the visual analogue scale (VAS), pain descriptors, and weekly frequency. Results. A total of 55 eligible patients participated in the study; most were male, young, above-knee amputees in the preprosthetic phase of the rehabilitation. The median PLP VAS was 60 (50–79.3) mm characterised by 13 (6–20) different descriptors in the same patient, which coexist, alternate, and add up to a frequency of 3.94 (2.5–4.38) times per week. The most frequent descriptor was movement of the phantom limb (70.91%). Tingling, numbness, flushing, itchiness, spasm, tremor, and throbbing are statistically significant PLP descriptor numbers per patient predicted by above-knee amputation, prosthetic phase, higher education level, and greater PLP intensity by VAS ( p < 0.05 ). Conclusion. PLP is not a single symptom, but a set with different sensations and perceptions that need directed and guided anamnesis for proper diagnosis.

scholarly journals Phantom Limb Pain: Mechanisms and Treatment Approaches

2011 ◽  
Vol 2011 ◽  
pp. 1-8 ◽  
Author(s):  
Bishnu Subedi ◽  
George T. Grossberg
Keyword(s):  
Neuropathic Pain ◽  
Specific Treatment ◽  
Phantom Limb Pain ◽  
Cortical Reorganization ◽  
Phantom Limb ◽  
Phantom Pain ◽  
Limb Pain ◽  
Pain Mechanisms ◽  
Treatment Approaches ◽  
The Past

The vast amount of research over the past decades has significantly added to our knowledge of phantom limb pain. Multiple factors including site of amputation or presence of preamputation pain have been found to have a positive correlation with the development of phantom limb pain. The paradigms of proposed mechanisms have shifted over the past years from the psychogenic theory to peripheral and central neural changes involving cortical reorganization. More recently, the role of mirror neurons in the brain has been proposed in the generation of phantom pain. A wide variety of treatment approaches have been employed, but mechanism-based specific treatment guidelines are yet to evolve. Phantom limb pain is considered a neuropathic pain, and most treatment recommendations are based on recommendations for neuropathic pain syndromes. Mirror therapy, a relatively recently proposed therapy for phantom limb pain, has mixed results in randomized controlled trials. Most successful treatment outcomes include multidisciplinary measures. This paper attempts to review and summarize recent research relative to the proposed mechanisms of and treatments for phantom limb pain.

scholarly journals Effect of one session of mirror therapy on phantom limb pain and recognition of limb laterality in military traumatic lower limb amputees: a pilot study

2018 ◽  
Vol 166 (3) ◽  
pp. 146-150 ◽  
Author(s):  
Andrew P Wareham ◽  
V Sparkes
Keyword(s):  
Reaction Time ◽  
Lower Limb ◽  
Phantom Limb Pain ◽  
Phantom Limb ◽  
Mirror Therapy ◽  
Limb Pain ◽  
Main Driver ◽  
Post Test ◽  
Lower Limb Amputees ◽  
Cortical Reorganisation

Up to 70 % of military amputees suffer phantom limb pain (PLP), which is difficult to treat. PLP has been attributed to cortical reorganisation and associated with impaired laterality. Repeated sessions of mirror therapy (MT) can benefit PLP; however, anecdotal evidence suggests one MT session could be effective. In a one-group pretest and post-test design, 16 UK military unilateral lower limb amputees (median age: 31.0, 95% CI 25.0 to 36.8 years) undertook one 10 min MT session. Visual analogue scale (VAS) pain and laterality (accuracy and reaction time) measurements were taken pre-MT and post-MT. Median VAS PLP did not differ significantly between pre-MT 15 mm (2–53 mm) and post-MT 12 mm (1–31) (p=0.875) scores. For the amputated limb, there were no significant differences between pre-MT and post-MT scores for laterality accuracy, 95.3%, 95% CI 90.5% to 97.6% and 96.7%, 95% CI 90.0% to 99.4%, respectively (p=0.778), or reaction time, 1.42 s, 95% CI 1.11 to 2.11 s and 1.42 s, 95% CI 1.08 to 2.02 s, respectively (p=0.629). Laterality was also not different between limbs for accuracy, p=0.484, or reaction time, p=0.716, and did not correlate with PLP severity. No confounding variables predicted individual responses to MT. Therefore, one 10 min MT session does not affect laterality and is not effective as standard treatment for PLP in military lower limb amputees. However, substantial PLP improvement for one individual and resolution of a stuck phantom limb for another infers that MT may benefit specific patients. No correlation found between PLP and laterality implies associated cortical reorganisation may not be the main driver for PLP. Further research, including neuroimaging, is needed to help clinicians effectively target PLP.

scholarly journals Clinical Feasibility and Preliminary Outcomes of a Novel Mixed Reality Based System to Manage Phantom Pain for Patients with Lower Limb Amputation.: A Pilot Study

2020 ◽  
Author(s):  
Thiru M Annaswamy ◽  
Kanchan Bahirat ◽  
Gargi Raval ◽  
Yu-Yen Chung ◽  
Balakrishnan Prabhakaran
Keyword(s):  
Lower Limb ◽  
Mixed Reality ◽  
Phantom Limb Pain ◽  
Phantom Limb ◽  
Limb Amputation ◽  
Phantom Pain ◽  
Mirror Therapy ◽  
Limb Pain ◽  
History Of ◽  
Game Performance

Objective: This report describes the details of Mr. MAPP, a virtual mirror therapy system and the results of a clinical feasibility and evaluation study of a pilot sample of patients with history of lower limb amputation and phantom limb pain. Materials and Methods: Mr. MAPP system uses a Kinect V2 RGB-D camera to capture the patient, generates a live interactive 3D model, and incorporates it into a virtual exergame. Mr. MAPP mirrors their preserved limb and allows participants to visualize their amputated limb virtually and perform their prescribed exercise program. Mr. MAPP creates a digital diary of their therapy sessions by recording game performance and errors. Ten consecutive patients with history of limb loss and phantom pain were targeted for this pilot study. They received a Mr. MAPP system and a laptop for home use for 1-month. Outcome measures including pain intensity and pain interference measured on Numerical Rating Scale (NRS) and McGill Pain Questionnaire (MPQ) as well as functional outcomes measured on Patient Specific Functional Scale (PSFS) were obtained at baseline, and after 1-month. Results: Seven participants were enrolled, out of which four completed the study. The study was temporarily suspended due to restrictions imposed during the COVID-19 public health emergency. In-game performance data showed a trend towards improvement in most participants. Compared to baseline, NRS and MPQ scores at 1-month showed no clear trends. PSFS scores improved for 1 participant and remained unchanged for others. Conclusion: Gamified home exercises performed via a novel, mixed-reality system, Mr. MAPP, using which virtual mirror therapy was delivered, is feasible and has potential to improve pain and pain related function in patients with lower limb amputations and phantom limb pain.

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