Abstract
Phantom limb pain (PLP) develops in most patients with lower limb amputation. Changes in the peripheral and central nervous system (CNS) are hypothesized to contribute to PLP. Based on ideas to modify neural reorganization within the CNS, the aim of the study was to test, whether prostheses with somatosensory feedback might help to reduce PLP, and increase the functionality of movement with a prosthesis. We therefore equipped the prostheses of 14 lower leg amputees with a simple to use feedback system that provides electrocutaneous feedback to patients’ thigh whenever the foot and toes of the prosthesis touch the ground. Two weeks of training with such a feedback prosthesis reduced PLP, increased the functional use of the prosthesis, and increased patients’ satisfaction with prosthesis use. We found a significant overall reduction of PLP during the course of the training period. Most patients reported lower PLP intensities at the end of the day while before training they have usually experienced maximal PLP intensities. Furthermore, patients also reported larger walking distances and more stable walking and better posture control while walking on and across a bumpy or soft ground. After training, the majority of participants (9/14) preferred such a feedback system over no feedback. This study extends former observations of a similar training procedure with arm amputees who used a similar feedback training to improve the functionality of an arm prosthesis in manipulating and grasping objects.
Highlights
Major amputations of the lower limb are more prevalent than amputations of the upper limb [1]
Treatment was considered effective according to the consistency principle [48,49,50] which implies that no adjustment for multiple endpoints will be necessary, if statistical significance is demonstrated at a prespecified nominal level for the majority of primary endpoints. As this is a preclinical study, we report the qualitative data that were gathered on functionality of the prosthesis in the interview after the training, and we report adverse events that were spontaneously reported during the training period
The study shows in unilateral transtibial amputees that training with an somatosensory activity feedback (SAF) system providing electrocutaneous feedback to the thigh during walking reduces phantom limb pain (PLP) and improves functionality of movements with the prosthesis considerably for some patients
Summary
Major amputations of the lower limb are more prevalent than amputations of the upper limb [1]. 84% of people affected by amputation wear a lower limb prosthesis [2] for walking and other purposes of daily living. Common lower limb prostheses support walking, bending the knee joint, and absorb shocks and stabilize stance. They lack somatosensory feedback about the surface properties of the ground. This lack of somatosensory information might be one reason why users of transtibial prosthesis commonly have problems with walking, especially when walking outdoors, ambulating stairs, hills, or on uneven grounds [3,4,5,6].
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