-
Medicina (Kaunas, Lithuania) Sep 2023After major upper-limb amputation, people face challenges due to losing tactile information and gripping function in their hands. While vision can confirm the success...
After major upper-limb amputation, people face challenges due to losing tactile information and gripping function in their hands. While vision can confirm the success of an action, relying on it diverts attention from other sensations and tasks. This case report presents a 30-year-old man with traumatic, complete vision loss and transradial left forearm amputation. It emphasizes the importance of restoring tactile abilities when visual compensation is impossible. A prototype tactile feedback add-on system was developed, consisting of a sensor glove and upper arm cuff with related vibration actuators. We found a 66% improvement in the Box and Blocks test and an overall functional score increase from 30% to 43% in the Southampton Hand Assessment Procedure with feedback. Qualitative improvements in bimanual activities, ergonomics, and reduced reliance on the unaffected hand were observed. Incorporating the tactile feedback system improved the precision of grasping and the utility of the myoelectric hand prosthesis, freeing the unaffected hand for other tasks. This case demonstrated improvements in prosthetic hand utility achieved by restoring peripheral sensitivity while excluding the possibility of visual compensation. Restoring tactile information from the hand and fingers could benefit individuals with impaired vision and somatosensation, improving acceptance, embodiment, social integration, and pain management.
Topics: Male; Humans; Adult; Feedback; Feedback, Sensory; Artificial Limbs; Amputation, Surgical; Touch
PubMed: 37893428
DOI: 10.3390/medicina59101710 -
Pain Reports Dec 2023Limb trauma remains the most prevalent survivable major combat injury. In the First World War, more than 700,000 British soldiers received limb wounds and more than... (Review)
Review
Limb trauma remains the most prevalent survivable major combat injury. In the First World War, more than 700,000 British soldiers received limb wounds and more than 41,000 underwent an amputation, creating one of the largest amputee cohorts in history. Postamputation pain affects up to 85% of military amputees, suggesting that up to 33,000 British First World War veterans potentially reported postamputation pain. This qualitative systematic review explores the professional medical conversation around clinical management of chronic postamputation pain in this patient cohort, its development over the 20th century, and how this information was disseminated among medical professionals. We searched and archives (1914-1985) for reports referring to postamputation pain, its prevalence, mechanisms, descriptors, or clinical management. Participants were First World War veterans with a limb amputation, excluding civilians and veterans of all other conflicts. The search identified 9809 potentially relevant texts, of which 101 met the inclusion criteria. Reports emerged as early as 1914 and the discussion continued over the next 4 decades. Unexpected findings included early advocacy of multidisciplinary pain management, concerns over addiction, and the effect of chronic pain on mental health emerging decades earlier than previously thought. Chronic postamputation pain is still a significant issue for military rehabilitation. Similarities between injury patterns in the First World War and recent Iraq and Afghanistan conflicts mean that these historical aspects remain relevant to today's military personnel, clinicians, researchers, and policymakers.
PubMed: 37860786
DOI: 10.1097/PR9.0000000000001094 -
Clinical Rehabilitation Mar 2024Three-phase graded motor imagery (limb laterality, explicit motor imagery, and mirror therapy) has been successful in chronic pain populations. However, when applied to...
OBJECTIVE
Three-phase graded motor imagery (limb laterality, explicit motor imagery, and mirror therapy) has been successful in chronic pain populations. However, when applied to phantom limb pain, an amputation-related pain, investigations often use mirror therapy alone. We aimed to explore evidence for graded motor imagery and its phases to treat phantom limb pain.
DATA SOURCES
A scoping review was conducted following the JBI Manual of Synthesis and Preferred Reporting Items for Systematic Review and Meta-Analyses extension for Scoping Reviews. Thirteen databases, registers, and websites were searched.
REVIEW METHODS
Published works on any date prior to the search (August 2023) were included that involved one or more graded motor imagery phases for participants ages 18+ with amputation and phantom limb pain. Extracted data included study characteristics, participant demographics, treatment characteristics, and outcomes.
RESULTS
Sixty-one works were included representing 19 countries. Most were uncontrolled studies (31%). Many participants were male (75%) and had unilateral amputations (90%) of varying levels, causes, and duration. Most works examined one treatment phase (92%), most often mirror therapy (84%). Few works (3%) reported three-phase intervention. Dosing was inconsistent across studies. The most measured outcome was pain intensity (95%).
CONCLUSION
Despite the success of three-phase graded motor imagery in other pain populations, phantom limb pain research focuses on mirror therapy, largely ignoring other phases. Participant demographics varied, making comparisons difficult. Future work should evaluate graded motor imagery effects and indicators of patient success. The represented countries indicate that graded motor imagery phases are implemented internationally, so future work could have a widespread impact.
Topics: Female; Humans; Male; Amputation, Surgical; Amputees; Imagery, Psychotherapy; Pain Management; Phantom Limb
PubMed: 37849299
DOI: 10.1177/02692155231204185 -
ELife Oct 2023Impressive progress is being made in bionic limbs design and control. Yet, controlling the numerous joints of a prosthetic arm necessary to place the hand at a correct...
Impressive progress is being made in bionic limbs design and control. Yet, controlling the numerous joints of a prosthetic arm necessary to place the hand at a correct position and orientation to grasp objects remains challenging. Here, we designed an intuitive, movement-based prosthesis control that leverages natural arm coordination to predict distal joints missing in people with transhumeral limb loss based on proximal residual limb motion and knowledge of the movement goal. This control was validated on 29 participants, including seven with above-elbow limb loss, who picked and placed bottles in a wide range of locations in virtual reality, with median success rates over 99% and movement times identical to those of natural movements. This control also enabled 15 participants, including three with limb differences, to reach and grasp real objects with a robotic arm operated according to the same principle. Remarkably, this was achieved without any prior training, indicating that this control is intuitive and instantaneously usable. It could be used for phantom limb pain management in virtual reality, or to augment the reaching capabilities of invasive neural interfaces usually more focused on hand and grasp control.
Topics: Humans; Amputees; Artificial Limbs; Arm; Electromyography; Movement; Virtual Reality
PubMed: 37847150
DOI: 10.7554/eLife.87317 -
Frontiers in Human Neuroscience 2023Several studies have found changes in the organization of the primary somatosensory cortex (SI) after amputation. This SI reorganization was mainly investigated by...
INTRODUCTION
Several studies have found changes in the organization of the primary somatosensory cortex (SI) after amputation. This SI reorganization was mainly investigated by stimulating neighboring areas to amputation. Unexpectedly, the somatosensory representation of the deafferented limb has rarely been directly tested.
METHODS
We stimulated the truncated peroneal nerve in 24 unilateral transtibial amputees and 15 healthy controls. The stimulation intensity was adjusted to make the elicited percept comparable between both stimulation sides. Neural sources of the somatosensory-evoked magnetic fields (SEFs) to peroneal stimulation were localized in the contralateral foot/leg areas of SI in 19 patients and 14 healthy controls.
RESULTS
We demonstrated the activation of functionally preserved cortical representations of amputated lower limbs. None of the patients reported evoked phantom limb pain (PLP) during stimulation. Stimulation that evoked perceptions in the foot required stronger intensities on the amputated side than on the intact side. In addition to this, stronger stimulation intensities were required for amputees than for healthy controls. Exploratorily, PLP intensity was neither associated with stimulation intensity nor dipole strength nor with differences in Euclidean distances (between SEF sources of the healthy peroneus and mirrored SEF sources of the truncated peroneus).
DISCUSSION
Our results provide hope that the truncated nerve may be used to establish both motor control and somatosensory feedback via the nerve trunk when a permanently functional connection between the nerve trunk and the prosthesis becomes available.
PubMed: 37746055
DOI: 10.3389/fnhum.2023.1240937 -
Scientific Reports Sep 2023We report the presence of a tingling sensation perceived during self-touch without physical stimulation. We used immersive virtual reality scenarios in which subjects...
We report the presence of a tingling sensation perceived during self-touch without physical stimulation. We used immersive virtual reality scenarios in which subjects touched their body using a virtual object. This touch resulted in a tingling sensation corresponding to the location touched on the virtual body. We called it "phantom touch illusion" (PTI). Interestingly, the illusion was also reported when subjects touched invisible (inferred) parts of their limb. We reason that this PTI results from tactile gating process during self-touch if there is no tactile input to supress. The reported PTI when touching invisible body parts indicates that tactile gating is not exclusively based on vision, but rather on multi-sensory, top-down input involving body schema. This supplementary finding shows that representations of one's own body are defined top-down, beyond the available sensory information.
Topics: Humans; Touch; Illusions; Touch Perception; Extremities; Phantoms, Imaging
PubMed: 37723256
DOI: 10.1038/s41598-023-42683-0 -
Journal of Pharmacy & Bioallied Sciences Jul 2023Transcutaneous electrical nerve stimulation (TENS) therapy has been accepted to treat a wide range of illnesses, including phantom limb pain, joint pain, low back pain,... (Review)
Review
Transcutaneous electrical nerve stimulation (TENS) therapy has been accepted to treat a wide range of illnesses, including phantom limb pain, joint pain, low back pain, and cervical discomfort. TENS is not frequently used in dentistry, despite its potential advantages. 3, 4 Therefore, the rationale of present review is to discuss its dental applications in order to spread awareness of them among the dental profession.
PubMed: 37693968
DOI: 10.4103/jpbs.jpbs_122_23 -
Scientific Reports Sep 2023Mirror therapy is applied to reduce phantom pain and as a rehabilitation technique in post-stroke patients. Using Virtual Reality and head-mounted displays this therapy...
Mirror therapy is applied to reduce phantom pain and as a rehabilitation technique in post-stroke patients. Using Virtual Reality and head-mounted displays this therapy can be performed in virtual scenarios. However, for its efficient use in clinical settings, some hardware limitations need to be solved. A new system to perform mirror therapy in virtual scenarios for post-stroke patients is proposed. The system requires the patient a standalone virtual reality headset with hand-tracking features and for the rehabilitator an external computer or tablet device. The system provides functionalities for the rehabilitator to prepare and follow-up rehabilitation sessions and a virtual scenario for the patient to perform rehabilitation. The system has been tested on a real scenario with the support of three experienced rehabilitators and considering ten post-stroke patients in individual sessions focused on upper limb motor rehabilitation. The development team observed all the sessions and took note of detected errors regarding technological aspects. Solutions to solve detected problems will be proposed and evaluated in terms of feasibility, performance cost, additional system cost, number of solved issues, new limitations, or advantages for the patient. Three types of errors were detected and solved. The first error is related to the position of the hands relative to the head-mounted display. To solve it the exercise area can be limited to avoid objectives that require turning the head too far. The second error is related to the interaction between the hands and the virtual objects. It can be solved making the main hand non-interactive. The last type of error is due to patient limitations and can be mitigated by having a virtual hand play out an example motion to bring the patient's attention back to the exercise. Other solutions have been evaluated positively and can be used in addition or instead of the selected ones. For mirror therapy based on virtual reality to be efficient in post-stroke rehabilitation the current head-mounted display-based solutions need to be complemented with specific strategies that avoid or mitigate the limitations of the technology and the patient. Solutions that help with the most common issues have been proposed.
Topics: Humans; Mirror Movement Therapy; Hand; Stroke; Upper Extremity; Virtual Reality
PubMed: 37679388
DOI: 10.1038/s41598-023-40546-2