Comparison of Body Positions in Virtual Reality Mirror Box Therapy for Treatment of Phantom Limb Pain in 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.

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Phantom Limb: A Phenomenological Study

The British Journal of Psychiatry ◽

10.1192/bjp.141.1.54 ◽

1982 ◽

Vol 141 (1) ◽

pp. 54-58 ◽

Cited By ~ 46

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.

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Virtual Reality Treatment Displaying the Missing Leg Improves Phantom Limb Pain: A Small Clinical Trial

Neurorehabilitation and Neural Repair ◽

10.1177/15459683211054164 ◽

2021 ◽

pp. 154596832110541

Author(s):

Elisabetta Ambron ◽

Laurel J. Buxbaum ◽

Alexander Miller ◽

Harrison Stoll ◽

Katherine J. Kuchenbecker ◽

...

Keyword(s):

Clinical Trial ◽

Virtual Reality ◽

Lower Limb ◽

Phantom Limb Pain ◽

Lower Limb Amputation ◽

Phantom Limb ◽

Limb Amputation ◽

Limb Pain ◽

Small Clinical Trial ◽

Leg Movements

Background Phantom limb pain (PLP) is a common and in some cases debilitating consequence of upper- or lower-limb amputation for which current treatments are inadequate. Objective This small clinical trial tested whether game-like interactions with immersive VR activities can reduce PLP in subjects with transtibial lower-limb amputation. Methods Seven participants attended 5–7 sessions in which they engaged in a visually immersive virtual reality experience that did not require leg movements (Cool! TM), followed by 10–12 sessions of targeted lower-limb VR treatment consisting of custom games requiring leg movement. In the latter condition, they controlled an avatar with 2 intact legs viewed in a head-mounted display (HTC Vive TM). A motion-tracking system mounted on the intact and residual limbs controlled the movements of both virtual extremities independently. Results All participants except one experienced a reduction of pain immediately after VR sessions, and their pre session pain levels also decreased over the course of the study. At a group level, PLP decreased by 28% after the treatment that did not include leg movements and 39.6% after the games requiring leg motions. Both treatments were successful in reducing PLP. Conclusions This VR intervention appears to be an efficacious treatment for PLP in subjects with lower-limb amputation.

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The effects of graded motor imagery and its components on phantom limb pain and disability in upper and lower limb amputees: a systematic review protocol

Systematic Reviews ◽

10.1186/s13643-016-0322-5 ◽

2016 ◽

Vol 5 (1) ◽

Cited By ~ 13

Author(s):

Katleho Limakatso ◽

Lieselotte Corten ◽

Romy Parker

Keyword(s):

Systematic Review ◽

Motor Imagery ◽

Lower Limb ◽

Phantom Limb Pain ◽

Phantom Limb ◽

Systematic Review Protocol ◽

Limb Pain ◽

Review Protocol ◽

Graded Motor Imagery ◽

Lower Limb Amputees

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

10.1101/2020.08.12.248518 ◽

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.

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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

BMJ Military Health ◽

10.1136/jramc-2018-001001 ◽

2018 ◽

Vol 166 (3) ◽

pp. 146-150 ◽

Cited By ~ 1

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.

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