Abstract
BackgroundPhantom limb pain (PLP) is characterized by the anatomical shifting of neighbouring somatosensory and motor areas into a deafferented cortical area of the brain contralateral to the amputated limb. It has been shown that maladaptive neuroplasticity is positively correlated to the perception of PLP in amputees. Recent studies support the use of graded motor imagery (GMI) and its component to alleviate the severity of PLP and disability. However, there is insufficient collective empirical evidence exploring the effectiveness of these treatment modalities in amputees with PLP. This systematic review will therefore explore the effects of GMI and its individual components on PLP and disability in upper and lower limb amputees.MethodsWe will utilize a customized search strategy to search PubMed, Cochrane Central register of Controlled Trials, MEDLINE, Embase, PsycINFO, PEDro, Scopus, CINAHL, LILACS, DARE, Africa-Wide Information and Web of Science. We will also look at clinicaltrials.gov (http://www.clinicaltrials.gov/), Pactr.gov (http://www.pactr.org/) and EU Clinical trials register (https://www.clinicaltrialsregister.eu/) for ongoing research. Two independent reviewers will screen articles for methodological validity. Thereafter, data from included studies will be extracted by two independent reviewers through a customized pre-set data extraction sheet. Studies with a comparable intervention and outcome measure will be pooled for meta-analysis. Studies with high heterogeneity will be analysed through random effects model. A narrative data analysis will be considered where there is insufficient data to perform a meta-analysis.DiscussionSeveral studies investigating the effectiveness of GMI and its different components on PLP have drawn contrasting conclusions regarding the efficacy and applicability of GMI in clinical practice. This systematic review will therefore gather and critically appraise all relevant data, to generate a substantial conclusion and recommendations for clinical practice and research on this subject.Systematic review registrationPROSPERO CRD42016036471Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-016-0322-5) contains supplementary material, which is available to authorized users.
Highlights
Phantom limb pain (PLP) is characterized by the anatomical shifting of neighbouring somatosensory and motor areas into a deafferented cortical area of the brain contralateral to the amputated limb
Description of condition Amputation is the removal of a body extremity which is generally caused by severe trauma, circulatory disorders, neoplasm, deformities and infection of the limb
The purpose of this review is to explore the effects of graded motor imagery (GMI) and its individual components on PLP and disability in upper and lower limb amputees
Summary
Phantom limb pain (PLP) is characterized by the anatomical shifting of neighbouring somatosensory and motor areas into a deafferented cortical area of the brain contralateral to the amputated limb. Neuroimaging studies of patients with PLP revealed neuroplastic alterations of the somatotopic organization of the cortical and sub-cortical areas of the brain [9, 13] These changes are characterized by the anatomical shifting of neighbouring somatosensory [18] and motor [4] areas into a deafferented cortical area of the brain contralateral to the amputated limb. These neuroplastic changes are positively correlated to the severity of PLP [15, 17]. These neuroplastic alterations can be reverted, with a correlation between the reversal of neuroplastic changes and pain relief in amputees with PLP [1, 11, 20]
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