Abstract
Phantom motor execution (PME), facilitated by myoelectric pattern recognition (MPR) and virtual reality (VR), is positioned to be a viable option to treat phantom limb pain (PLP). A recent clinical trial using PME on upper-limb amputees with chronic intractable PLP yielded promising results. However, further work in the area of signal acquisition is needed if such technology is to be used on subjects with lower-limb amputation. We propose two alternative electrode configurations to conventional, bipolar, targeted recordings for acquiring surface electromyography. We evaluated their performance in a real-time MPR task for non-weight-bearing, lower-limb movements. We found that monopolar recordings using a circumferential electrode of conductive fabric, performed similarly to classical bipolar recordings, but were easier to use in a clinical setting. In addition, we present the first case study of a lower-limb amputee with chronic, intractable PLP treated with PME. The patient’s Pain Rating Index dropped by 22 points (from 32 to 10, 68%) after 23 PME sessions. These results represent a methodological advancement and a positive proof-of-concept of PME in lower limbs. Further work remains to be conducted for a high-evidence level clinical validation of PME as a treatment of PLP in lower-limb amputees.
Highlights
IntroductionIt is common for the patient to perceive the missing limb as if it is still part of the body
Following an amputation, it is common for the patient to perceive the missing limb as if it is still part of the body
Statistical Analysis We investigated the real-time performance of two alternative electrode configurations (TMC and untargeted monopolar configuration (UMC)) to the conventional, targeted bipolar configuration (TBC)
Summary
It is common for the patient to perceive the missing limb as if it is still part of the body. The phenomenon, known as phantom limb, is accompanied by a wide range of sensory perceptions that can vary among patients but are collectively referred to as phantom sensations (such as warmth, cold, or kinesthesia) [1]. Amputees can often experience painful sensations in their phantom limb, giving rise to a condition commonly known as phantom limb pain (PLP). The pathogenesis of PLP is still controversial, and there is currently no treatment regarded as generally effective. PLP remains a major clinical challenge [2, 3].
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