Development of a Clinical Framework for Mirror Therapy in Patients with Phantom Limb Pain: An Evidence-based Practice Approach

Pain Practice ◽  
2015 ◽  
Vol 16 (4) ◽  
pp. 422-434 ◽  
Author(s):  
Andreas Rothgangel ◽  
Susy Braun ◽  
Luc de Witte ◽  
Anna Beurskens ◽  
Rob Smeets
Keyword(s):  
Evidence Based Practice ◽  
Phantom Limb Pain ◽  
Phantom Limb ◽  
Evidence Based ◽  
Mirror Therapy ◽  
Limb Pain ◽  
Practice Approach

A Virtual Reality Intervention for the Treatment of Phantom Limb Pain: Development and Feasibility Results

Pain Medicine ◽  
2019 ◽  
Vol 20 (10) ◽  
pp. 2051-2059 ◽  
Author(s):  
Thomas Rutledge ◽  
Deborah Velez ◽  
Colin Depp ◽  
John R McQuaid ◽  
Garland Wong ◽  
...  
Keyword(s):  
Virtual Reality ◽  
Phantom Limb Pain ◽  
Phantom Limb ◽  
Mirror Therapy ◽  
Limb Pain ◽  
Baseline Visit ◽  
Adverse Experiences ◽  
Treatment Measures ◽  
User Ratings ◽  
Very High

Abstract Objective To describe the development of a virtual reality (VR) treatment for phantom limb pain (PLP) and phantom sensations and provide feasibility data from testing the treatment in a population of veterans. Design & Subjects Fourteen participants completed a baseline visit evaluating their amputation, PLP, and phantom sensations. Subsequently, participants completed a VR treatment modeled after mirror therapy for PLP, navigating in a VR environment with a bicycle pedaler and motion sensor to pair their cadence to a VR avatar. The VR avatar enabled visualization of the participant’s intact phantom limb in motion, a hypothesized mechanism of mirror therapy. Setting Laboratory. Methods Participants completed pre- and post-treatment measures to evaluate changes in PLP, phantom sensations, and rate helpfulness, realism, immersion, adverse experiences, and treatment satisfaction. Results Eight of 14 participants (57.1%) reported PLP pre–VR treatment, and 93% (13/14) reported one or more unpleasant phantom sensations. After treatment, 28.6% (4/14) continued to report PLP symptoms (t[13] = 2.7, P = 0.02, d = 0.53) and 28.6% (4/14) reported phantom sensations (t[13] = 4.4, P = 0.001, d = 1.7). Ratings of helpfulness, realism, immersion, and satisfaction were uniformly high to very high. There were no adverse experiences. Four participants completed multiple VR treatments, showing stable improvements in PLP intensity and phantom sensations and high user ratings. Conclusions This feasibility study of a novel VR intervention for PLP was practical and was associated with significant reductions in PLP intensity and phantom sensations. Our findings support continued research in VR-based treatments in PLP, with a need for direct comparisons between VR and more established PLP treatments.

Preamputation Mirror Therapy May Prevent Development of Phantom Limb Pain: A Case Series

2010 ◽  
Vol 110 (2) ◽  
pp. 611-614 ◽  
Author(s):  
Steven R. Hanling ◽  
Scott C. Wallace ◽  
Kerry J. Hollenbeck ◽  
Brian D. Belnap ◽  
Matthew R. Tulis
Keyword(s):  
Case Series ◽  
Phantom Limb Pain ◽  
Phantom Limb ◽  
Mirror Therapy ◽  
Limb Pain

Effectiveness of mirror therapy, motor imagery, and virtual feedback on phantom limb pain following amputation: A systematic review

2017 ◽  
Vol 42 (3) ◽  
pp. 288-298 ◽  
Author(s):  
Laura Herrador Colmenero ◽  
Jose Manuel Perez Marmol ◽  
Celia Martí-García ◽  
María de los Ángeles Querol Zaldivar ◽  
Rosa María Tapia Haro ◽  
...  
Keyword(s):  
Systematic Review ◽  
Motor Imagery ◽  
Visual Feedback ◽  
Methodological Quality ◽  
Internal Validity ◽  
Phantom Limb Pain ◽  
Research Quality ◽  
Phantom Limb ◽  
Mirror Therapy ◽  
Limb Pain

Background: Phantom limb pain is reported in 50%–85% of people with amputation. Clinical interventions in treating central pain, such as mirror therapy, motor imagery, or virtual visual feedback, could redound in benefits to amputee patients with phantom limb pain. Objectives: To provide an overview of the effectiveness of different techniques for treating phantom limb pain in amputee patients. Study design: Systematic review. Methods: A computerized literature search up to April 2017 was performed using the following databases: PubMed, Scopus, CINAHL, MEDLINE, ProQuest, PEDro, EBSCOhost, and Cochrane Plus. Methodological quality and internal validity score of each study were assessed using PEDro scale. For data synthesis, qualitative methods from the Cochrane Back Review Group were applied. Results: In all, 12 studies met our inclusion criteria, where 9 were rated as low methodological quality and 3 rated moderate quality. All studies showed a significant reduction in pain, but there was heterogeneity among subjects and methodologies and any high-quality clinical trial (PEDro score ≤8; internal validity score ≤5) was not found. Conclusion: Mirror therapy, motor imaginary, and virtual visual feedback reduce phantom limb pain; however, there is limited scientific evidence supporting their effectiveness. Future studies should include designs with more solid research methods, exploring short- and long-term benefits of these therapies. Clinical relevance This systematic review investigates the effectiveness of mirror therapy, motor imagery, and virtual visual feedback on phantom limb pain, summarizing the currently published trials and evaluating the research quality. Although these interventions have positive benefits in phantom limb pain, there is still a lack of evidence for supporting their effectiveness.

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