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: 1.56). 02/2009; 88(1):78-81. DOI: 10.1097/PHM.0b013e318191105b
Source: PubMed

ABSTRACT 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.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: Mirror therapy is a relatively new therapeutic modality, where movement of the unaffected limb is used to facilitate performance of the affected limb. Literature review of clinical studies regarding the effectiveness of mirror therapy in different groups of patients was performed. The review focussed on randomised controlled trials and studies, which explore the underlying mechanisms of mirror therapy. Conclusions: The majority of randomised controlled trials were done in stroke patients. In these, mirror therapy improved the velocity and accuracy of the impaired upper limb movement and sensation. No significant effect was found on spasticity, gait and hand function. The effect of mirror therapy on active range of motion, hand grip, function of the upper limb and reduction of pain intensity was not fully conclusive. For complex regional pain syndrome type I, mirror therapy improved hand grip and function, and reduced pain intensity and hand oedema. There is also evidence that mirror therapy reduces pain in a phantom limb. Most of the reviewed studies included small sample size. Studies on the underlying mechanisms of mirror therapy suggested as more likely the effect of increased forced attention and mental training rather than increased activation of mirror neurons in healthy subjects. Probably, the underlying mechanisms of mirror therapy differ in patients with sensory-motor impairments compared to healthy subjects.
  • Source
    [Show abstract] [Hide abstract]
    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.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Many upper limb amputees experience an incessant, post-amputation "phantom limb pain" and report that their missing limbs feel paralyzed in an uncomfortable posture. One hypothesis is that efferent commands no longer generate expected afferent signals, such as proprioceptive feedback from changes in limb configuration, and that the mismatch of motor commands and visual feedback is interpreted as pain. Non-invasive therapeutic techniques for treating phantom limb pain, such as mirror visual feedback (MVF), rely on visualizations of postural changes. Advances in neural interfaces for artificial sensory feedback now make it possible to combine MVF with a high-tech "rubber hand" illusion, in which subjects develop a sense of embodiment with a fake hand when subjected to congruent visual and somatosensory feedback. We discuss clinical benefits that could arise from the confluence of known concepts such as MVF and the rubber hand illusion, and new technologies such as neural interfaces for sensory feedback and highly sensorized robot hand testbeds, such as the "BairClaw" presented here. Our multi-articulating, anthropomorphic robot testbed can be used to study proprioceptive and tactile sensory stimuli during physical finger-object interactions. Conceived for artificial grasp, manipulation, and haptic exploration, the BairClaw could also be used for future studies on the neurorehabilitation of somatosensory disorders due to upper limb impairment or loss. A remote actuation system enables the modular control of tendon-driven hands. The artificial proprioception system enables direct measurement of joint angles and tendon tensions while temperature, vibration, and skin deformation are provided by a multimodal tactile sensor. The provision of multimodal sensory feedback that is spatiotemporally consistent with commanded actions could lead to benefits such as reduced phantom limb pain, and increased prosthesis use due to improved functionality and reduced cognitive burden.
    Frontiers in Human Neuroscience 02/2015; 9:26. DOI:10.3389/fnhum.2015.00026 · 2.90 Impact Factor