Self-Delivered Home-Based Mirror Therapy for Lower Limb Phantom Pain

Department of Anesthesiology and Perioperative Medicine, Oregon Health and Science University, Portland, Oregon 97239, USA.
American journal of physical medicine & rehabilitation / Association of Academic Physiatrists (Impact Factor: 2.2). 02/2009; 88(1):78-81. DOI: 10.1097/PHM.0b013e318191105b
Source: PubMed


Home-based patient-delivered mirror therapy is a promising approach in the treatment of phantom limb pain. Previous studies and case reports of mirror therapy have used a therapist-guided, structured protocol of exercises. No case report has described treatment for either upper or lower limb phantom pain by using home-based patient-delivered mirror therapy. The success of this case demonstrates that home-based patient-delivered mirror therapy may be an efficacious, low-cost treatment option that would eliminate many traditional barriers to care.

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Available from: Beth Darnall, Apr 30, 2015
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    • "Number of treatments has been used in the past to reduce phantom limb pain namely mirror box therapy and virtual reality [50]. As it has been clinically proven that both mirror boxes [1] and the use of virtual reality [2] contribute to phantom limb pain relief, the control of the ambidextrous hand should contribute to pain relief if its movements are close enough to the ones of a human hand. Amputees or people suffering from neurological disorder have been provided assistance by connecting robot limbs to a brain-machine interface [3], [4] robotic hands have also been used as rehabilitation devices for recovering patients [5], [6]. "
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    ABSTRACT: This paper presents the mechanical design and development process of an ambidextrous robot hand driven by pneumatic muscles. The ambidextrous hand is capable of performing both right hand and left hand movements. In addition to ambidextrous movements, hand offers a range twice larger than common fingers. The mechanical design of an ambidextrous robot has been investigated in a way to reduce maximum possible number of actuators. Actuated by only 18 pneumatic muscles, the ambidextrous hand has a total of 13 degrees of freedom which permit to imitate equally a hand of each side. The ambidextrous hand is 3D printed after carefully analyzing the material, tendon routing, kinematic performance and overall design parameters. The main application areas of this project are in rehabilitation and physiotherapy after strokes and management of phantom pain for amputees by controlling the robotic prosthesis remotely via internet and social media interface. The ambidextrous feature of the robotic hand allows completing the tele-rehabilitation for both left and right hands using one robotic device.
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    • "This result implies a limitation of VAS as a reliable probe to determine the effect of MVF on phantom limb awareness. A traditional and conventional way to characterize phantom limb is describing the patient's feeling as a case report and case series [7], [10], [13]. Except for brain imaging study, almost all outcome measures employed in the behavioral and clinical studies regarding the extent of motion and pain of phantom limb were subjective or psychological scale, such as visual analog scale. "
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    ABSTRACT: To test whether the phantom limb awareness could be altered by observing mirror reflection-induced visual feedback (MVF) in unilateral forearm amputees. Ten unilateral forearm amputees were asked to perform bilateral (intact and phantom) synchronous wrist motions with and without MVF. During wrist motion, electromyographic activities in the extensor digitorum longus (EDL) and flexor carpi radialis muscles (FCR) were recorded with bipolar electrodes. Degree of wrist range of motion (ROM) was also recorded by electrogoniometry attached to the wrist joint of intact side. Subjects were asked to answer the degree of attainment of phantom limb motion using a visual analog scale (VAS: ranging from 0 (hard) to 10 (easy)). VAS and ROM were significantly increased by utilizing MVF, and the extent of an enhancement of the VAS and wrist ROM was positively correlated (r = 0.72, p<0.05). Although FCR EMG activity also showed significant enhancement by MVF, this was not correlated with the changes of VAS and ROM. Interestingly, while we found negative correlation between EDL EMG activity and wrist ROM, MVF generally affected to be increasing both EDL EMG and ROM. Although there was larger extent of variability in the effect of MVF on phantom limb awareness, MVF has a potential to enhance phantom limb awareness, in case those who has a difficulty for the phantom limb motion. The present result suggests that the motor command to the missing limb can be re-activated by an appropriate therapeutic strategy such as mirror therapy.
    PLoS ONE 07/2013; 8(7):e69324. DOI:10.1371/journal.pone.0069324 · 3.23 Impact Factor
    • "Although subsequent research has shown some promise (Darnall, 2009; MacLachlan, McDonald, & Waloch, 2004) there have also been reports of the procedure being distressing and painful for some. For instance, Chan, Witt, Charrow et al. (2007) reported that pain reduction was greater in their mirror therapy group, compared with a covered-mirror control group, or an imagery comparison group. "
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    ABSTRACT: Limb amputation is both a life-saving procedure and a life-changing event. The aims of rehabilitation following amputation are to restore acceptable levels of functioning that allow individuals to achieve their goals, facilitate personal health, and improve participation in society and quality of life, either with or without a prosthesis. Individual responses to limb loss are varied and complex; some individuals experience functional, psychological, and social dysfunction; many others adjust and function well. This chapter highlights critical psychological and social issues in amputation, summarizes current knowledge in these domains, and provides a brief overview of psychological interventions designed to address these issues.
    The Oxford Handbook of Rehabilitation Psychology, 1 edited by Paul Kennedy, 07/2012: chapter 20- Limb Amputation; Oxford University Press., ISBN: 9780199733989
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