Abstract
Background: Phantom limb pain (PLP) is commonly seen following upper extremity (UE) amputation. Use of both mirror therapy, which utilizes limb reflection in a mirror, and virtual reality therapy, which utilizes computer limb simulation, has been used to relieve PLP. We explored whether the Virtual Integration Environment (VIE), a virtual reality UE simulator, could be used as a therapy device to effectively treat PLP in individuals with UE amputation.Methods: Participants with UE amputation and PLP were recruited at Walter Reed National Military Medical Center (WRNMMC) and instructed to follow the limb movements of a virtual avatar within the VIE system across a series of study sessions. At the end of each session, participants drove virtual avatar limb movements during a period of “free-play” utilizing surface electromyography recordings collected from their residual limbs. PLP and phantom limb sensations were assessed at baseline and following each session using the Visual Analog Scale (VAS) and Short Form McGill Pain Questionnaire (SF-MPQ), respectively. In addition, both measures were used to assess residual limb pain (RLP) at baseline and at each study session. In total, 14 male, active duty military personnel were recruited for the study.Results: Of the 14 individuals recruited to the study, nine reported PLP at the time of screening. Eight of these individuals completed the study, while one withdrew after three sessions and thus is not included in the final analysis. Five of these eight individuals noted RLP at baseline. Participants completed an average of 18, 30-min sessions with the VIE leading to a significant reduction in PLP in seven of the eight (88%) affected limbs and a reduction in RLP in four of the five (80%) affected limbs. The same user reported an increase in PLP and RLP across sessions. All participants who denied RLP at baseline (n = 3) continued to deny RLP at each study session.Conclusions: Success with the VIE system confirms its application as a non-invasive and low-cost therapy option for PLP and phantom limb symptoms for individuals with upper limb loss.
Highlights
By the year 2050, it is estimated that almost 3.6 million persons will be living with amputations within the United States [1]
For the clinical trial “Virtual Integration Environment in Decreasing Phantom Limb Pain,” identifier number NCT01462461 (ClinicalTrials.gov), volunteers were recruited at Walter Reed National Military Medical Center (WRNMMC) in Bethesda, MD, within 18 months of sustaining an upper extremity (UE) amputation
Participant ID, amputation details, and residual limb pain (RLP) status are provided for the eight individuals who completed this study
Summary
By the year 2050, it is estimated that almost 3.6 million persons will be living with amputations within the United States [1]. Reports estimate that 85% of all persons with amputation experience painful sensations, or phantom limb pain (PLP), either immediately following amputation or within days to weeks post-operation [3]. Both phantom sensations and PLP are bothersome and even disabling, interfering with the ability to live independently and further emphasizing the need for successful treatment interventions. Phantom limb pain (PLP) is commonly seen following upper extremity (UE) amputation Use of both mirror therapy, which utilizes limb reflection in a mirror, and virtual reality therapy, which utilizes computer limb simulation, has been used to relieve PLP. We explored whether the Virtual Integration Environment (VIE), a virtual reality UE simulator, could be used as a therapy device to effectively treat PLP in individuals with UE amputation
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