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Hali K, Manzo MA, Koucheki R, Wunder JS, Jenkinson RJ, Mayo AL, Ferguson PC, Lex JR. Use of virtual reality for the management of phantom limb pain: a systematic review. Disabil Rehabil 2024; 46:629-636. [PMID: 36724203 DOI: 10.1080/09638288.2023.2172222] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 01/19/2023] [Indexed: 02/02/2023]
Abstract
PURPOSE To summarize the research on the effectiveness of virtual reality (VR) therapy for the management of phantom limb pain (PLP). METHODS Three databases (SCOPUS, Ovid Embase, and Ovid MEDLINE) were searched for studies investigating the use of VR therapy for the treatment of PLP. Original research articles fulfilling the following criteria were included: (i) patients 18 years and older; (ii) all etiologies of amputation; (iii) any level of amputation; (iv) use of immersive VR as a treatment modality for PLP; (v) self-reported objective measures of PLP before and after at least one VR session; (vi) written in English. RESULTS A total of 15 studies were included for analysis. Fourteen studies reported decreases in objective pain scores following a single VR session or a VR intervention consisting of multiple sessions. Moreover, combining VR with tactile stimulation had a larger beneficial effect on PLP compared with VR alone. CONCLUSIONS Based on the current literature, VR therapy has the potential to be an effective treatment modality for the management of PLP. However, the low quality of studies, heterogeneity in subject population and intervention type, and lack of data on long-term relief make it difficult to draw definitive conclusions.IMPLICATION FOR REHABILITATIONVirtual reality (VR) therapy has emerged as a new potential treatment option for phantom limb pain (PLP) that circumvents some limitations of mirror therapy.VR therapy was shown to decrease PLP following a single VR session as well as after an intervention consisting of multiple sessions.The addition of vibrotactile stimuli to VR therapy may lead to larger decreases in PLP scores compared with VR therapy alone.
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Affiliation(s)
- Kalter Hali
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Marc A Manzo
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Robert Koucheki
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Jay S Wunder
- Division of Orthopedic Surgery, Department of Surgery, University of Toronto, Toronto, Canada
- Mount Sinai Hospital, University Musculoskeletal Oncology Unit, Toronto, Canada
| | - Richard J Jenkinson
- Division of Orthopedic Surgery, Department of Surgery, University of Toronto, Toronto, Canada
- Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Amanda L Mayo
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Division of Physical Medicine & Rehabilitation, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Peter C Ferguson
- Division of Orthopedic Surgery, Department of Surgery, University of Toronto, Toronto, Canada
- Mount Sinai Hospital, University Musculoskeletal Oncology Unit, Toronto, Canada
| | - Johnathan R Lex
- Division of Orthopedic Surgery, Department of Surgery, University of Toronto, Toronto, Canada
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Kleeva D, Soghoyan G, Biktimirov A, Piliugin N, Matvienko Y, Sintsov M, Lebedev M. Modulations in high-density EEG during the suppression of phantom-limb pain with neurostimulation in upper limb amputees. Cereb Cortex 2024; 34:bhad504. [PMID: 38220575 DOI: 10.1093/cercor/bhad504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 11/12/2023] [Accepted: 11/13/2023] [Indexed: 01/16/2024] Open
Abstract
Phantom limb pain (PLP) is a distressing and persistent sensation that occurs after the amputation of a limb. While medication-based treatments have limitations and adverse effects, neurostimulation is a promising alternative approach whose mechanism of action needs research, including electroencephalographic (EEG) recordings for the assessment of cortical manifestation of PLP relieving effects. Here we collected and analyzed high-density EEG data in 3 patients (P01, P02, and P03). Peripheral nerve stimulation suppressed PLP in P01 but was ineffective in P02. In contrast, transcutaneous electrical nerve stimulation was effective in P02. In P03, spinal cord stimulation was used to suppress PLP. Changes in EEG oscillatory components were analyzed using spectral analysis and Petrosian fractal dimension. With these methods, changes in EEG spatio-spectral components were found in the theta, alpha, and beta bands in all patients, with these effects being specific to each individual. The changes in the EEG patterns were found for both the periods when PLP level was stationary and the periods when PLP was gradually changing after neurostimulation was turned on or off. Overall, our findings align with the proposed roles of brain rhythms in thalamocortical dysrhythmia or disruption of cortical excitation and inhibition which has been linked to neuropathic pain. The individual differences in the observed effects could be related to the specifics of each patient's treatment and the unique spectral characteristics in each of them. These findings pave the way to the closed-loop systems for PLP management where neurostimulation parameters are adjusted based on EEG-derived markers.
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Affiliation(s)
- Daria Kleeva
- Vladimir Zelman Center for Neurobiology and Brain Rehabilitation, Skolkovo Institute of Science and Technology, Bolshoy Boulevard, 30, p. 1, Moscow 121205, Russia
- MSU Institute for Artificial Intelligence, Lomonosov Moscow State University
| | - Gurgen Soghoyan
- Vladimir Zelman Center for Neurobiology and Brain Rehabilitation, Skolkovo Institute of Science and Technology, Bolshoy Boulevard, 30, p. 1, Moscow 121205, Russia
| | - Artur Biktimirov
- Laboratory of Experimental and Translational Medicine, School of Biomedicine, Far Eastern Federal University
| | - Nikita Piliugin
- Vladimir Zelman Center for Neurobiology and Brain Rehabilitation, Skolkovo Institute of Science and Technology, Bolshoy Boulevard, 30, p. 1, Moscow 121205, Russia
| | | | | | - Mikhail Lebedev
- MSU Institute for Artificial Intelligence, Lomonosov Moscow State University
- Faculty of Mechanics and Mathematics, Lomonosov Moscow State University
- Sechenov Institute of Evolutionary Physiology and Biochemistry of the Russian Academy of Sciences
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de Jongh Curry AL, Hunt ME, Pasquina PF, Waters RS, Tsao JW. Non-surgical Management of Phantom Limb Pain: Current and Emerging Clinical Approaches. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2023. [DOI: 10.1007/s40141-023-00377-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Tran Y, Austin P, Lo C, Craig A, Middleton JW, Wrigley PJ, Siddall P. An Exploratory EEG Analysis on the Effects of Virtual Reality in People with Neuropathic Pain Following Spinal Cord Injury. SENSORS 2022; 22:s22072629. [PMID: 35408245 PMCID: PMC9002545 DOI: 10.3390/s22072629] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 03/27/2022] [Accepted: 03/27/2022] [Indexed: 02/01/2023]
Abstract
Neuropathic pain in people with spinal cord injury is thought to be due to altered central neuronal activity. A novel therapeutic intervention using virtual reality (VR) head-mounted devices was investigated in this study for pain relief. Given the potential links to neuronal activity, the aim of the current study was to determine whether use of VR was associated with corresponding changes in electroencephalography (EEG) patterns linked to the presence of neuropathic pain. Using a within-subject, randomised cross-over pilot trial, we compared EEG activity for three conditions: no task eyes open state, 2D screen task and 3D VR task. We found an increase in delta activity in frontal regions for 3D VR with a decrease in theta activity. There was also a consistent decrease in relative alpha band (8–12 Hz) and an increase in low gamma (30–45 Hz) power during 2D screen and 3D VR corresponding, with reduced self-reported pain. Using the nonlinear and non-oscillatory method of extracting fractal dimensions, we found increases in brain complexity during 2D screen and 3D VR. We successfully classified the 3D VR condition from 2D screen and eyes opened no task conditions with an overall accuracy of 80.3%. The findings in this study have implications for using VR applications as a therapeutic intervention for neuropathic pain in people with spinal cord injury.
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Affiliation(s)
- Yvonne Tran
- Department of Linguistics, Macquarie University Hearing, Macquarie University, Sydney, NSW 2109, Australia
- Correspondence:
| | - Philip Austin
- Department of Pain Management, HammondCare, Greenwich Hospital Greenwich, Sydney, NSW 2065, Australia; (P.A.); (P.S.)
| | - Charles Lo
- Management Disciplinary Group, Wentworth Institute of Higher Education, Surrey Hills, NSW 2010, Australia;
| | - Ashley Craig
- Sydney Medical School-Northern, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (A.C.); (J.W.M.); (P.J.W.)
- John Walsh Centre for Rehabilitation Research, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW 2065, Australia
| | - James W. Middleton
- Sydney Medical School-Northern, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (A.C.); (J.W.M.); (P.J.W.)
- John Walsh Centre for Rehabilitation Research, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW 2065, Australia
| | - Paul J. Wrigley
- Sydney Medical School-Northern, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (A.C.); (J.W.M.); (P.J.W.)
- Pain Management Research Institute, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW 2065, Australia
| | - Philip Siddall
- Department of Pain Management, HammondCare, Greenwich Hospital Greenwich, Sydney, NSW 2065, Australia; (P.A.); (P.S.)
- Sydney Medical School-Northern, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (A.C.); (J.W.M.); (P.J.W.)
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Browne JD, Fraiser R, Cai Y, Leung D, Leung A, Vaninetti M. Unveiling the phantom: What neuroimaging has taught us about phantom limb pain. Brain Behav 2022; 12:e2509. [PMID: 35218308 PMCID: PMC8933774 DOI: 10.1002/brb3.2509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 12/05/2021] [Accepted: 01/11/2022] [Indexed: 11/08/2022] Open
Abstract
Phantom limb pain (PLP) is a complicated condition with diverse clinical challenges. It consists of pain perception of a previously amputated limb. The exact pain mechanism is disputed and includes mechanisms involving cerebral, peripheral, and spinal origins. Such controversy limits researchers' and clinicians' ability to develop consistent therapeutics or management. Neuroimaging is an essential tool that can address this problem. This review explores diffusion tensor imaging, functional magnetic resonance imaging, electroencephalography, and magnetoencephalography in the context of PLP. These imaging modalities have distinct mechanisms, implications, applications, and limitations. Diffusion tensor imaging can outline structural changes and has surgical applications. Functional magnetic resonance imaging captures functional changes with spatial resolution and has therapeutic applications. Electroencephalography and magnetoencephalography can identify functional changes with a strong temporal resolution. Each imaging technique provides a unique perspective and they can be used in concert to reveal the true nature of PLP. Furthermore, researchers can utilize the respective strengths of each neuroimaging technique to support the development of innovative therapies. PLP exemplifies how neuroimaging and clinical management are intricately connected. This review can assist clinicians and researchers seeking a foundation for applications and understanding the limitations of neuroimaging techniques in the context of PLP.
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Affiliation(s)
- Jonathan D Browne
- School of Medicine, California University of Science and Medicine, Colton, California, USA
| | - Ryan Fraiser
- Center for Pain Medicine, University of California San Diego, La Jolla, California, USA
| | - Yi Cai
- Center for Pain Medicine, University of California San Diego, La Jolla, California, USA
| | - Dillon Leung
- College of Letters and Science, University of California Berkeley, Berkeley, California, USA
| | - Albert Leung
- Center for Pain Medicine, University of California San Diego, La Jolla, California, USA
| | - Michael Vaninetti
- Center for Pain Medicine, University of California San Diego, La Jolla, California, USA
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Moradi D, Eyvazpour R, Rahimi F, Jahan A, Rasta SH, Esmaeili M. Electroencephalographic Activity in Patients with Claustrophobia: A Pilot Study. JOURNAL OF MEDICAL SIGNALS & SENSORS 2021; 11:262-268. [PMID: 34820298 PMCID: PMC8588885 DOI: 10.4103/jmss.jmss_62_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 12/17/2020] [Accepted: 03/07/2021] [Indexed: 11/04/2022]
Abstract
Background Exposure to small confined spaces evokes physiological responses such as increased heart rate in claustrophobic patients. However, little is known about electrocortical activity while these people are functionally exposed to such phobic situations. The aim of this study was to examine possible changes in electrocortical activity in this population. Method Two highly affected patients with claustrophobia and two healthy controls participated in this in vivo study during which electroencephalographic (EEG) activity was continuously recorded. Relative power spectral density (rPSD) was compared between two situations of being relaxed in a well-lit open area, and sitting in a relaxed chair in a small (90 cm × 180 cm × 155 cm) chamber with a dim light. This comparison of rPSDs in five frequency bands of EEG was intended to investigate possible patterns of change in electrical activity during fear-related situation. This possible change was also compared between claustrophobic patients and healthy controls in all cortical areas. Results Statistical models showed that there is a significant interaction between groups of participants and experimental situations in all frequency bands (P < 0.01). In other words, claustrophobic patients showed significantly different changes in electrical activity while going from rest to the test situation. Clear differences were observed in alpha and theta bands. In the theta band, while healthy controls showed an increase in rPSD, claustrophobic patients showed an opposite decrease in the power of electrical activity when entering the confined chamber. In alpha band, both groups showed an increase in rPSD, though this increase was significantly higher for claustrophobic patients. Conclusion The effect of in vivo exposure to confined environments on EEG activity is different in claustrophobic patients than in healthy controls. Most of this contrast is observed in central and parietal areas of the cortex, and in the alpha and theta bands.
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Affiliation(s)
- Dunya Moradi
- Department of Medical Bioengineering, Faculty of Advanced Medical Sciences, Tabriz University of Medical Sciences, Bonab, Iran
| | - Reza Eyvazpour
- Department of Electronics, Faculty of Electrical and Computer Engineering, University of Tabriz, Bonab, Iran
| | - Fariborz Rahimi
- Department of Electrical Engineering, Faculty of Engineering, University of Bonab, Bonab, Iran
| | - Ali Jahan
- Department of Speech and Language Pathology, Faculty of Rehabilitation Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Seyed Hossein Rasta
- Department of Medical Bioengineering, Faculty of Advanced Medical Sciences, Tabriz University of Medical Sciences, Bonab, Iran.,Department of Biomedical Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Mahdad Esmaeili
- Department of Medical Bioengineering, Faculty of Advanced Medical Sciences, Tabriz University of Medical Sciences, Bonab, Iran
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Osumi M, Shimizu D, Nishi Y, Morioka S. Electrical stimulation of referred sensation area alleviates phantom limb pain. Restor Neurol Neurosci 2021; 39:101-110. [PMID: 33682735 DOI: 10.3233/rnn-201132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Patients with brachial plexus avulsion (BPA) usually experience phantom sensations and phantom limb pain (PLP) in the deafferented limb. It has been suggested that evoking the sensation of touch in the deafferented limb by stimulating referred sensation areas (RSAs) on the cheek or shoulder might alleviate PLP. However, feasible rehabilitation techniques using this approach have not been reported. OBJECTIVE The present study sought to examine the analgesic effects of simple electrical stimulation of RSAs in BPA patients with PLP. METHODS Study 1: Electrical stimulation of RSAs for 60 minutes was conducted for six BPA patients suffering from PLP to examine short-term analgesic effects. Study 2: A single case design experiment was conducted with two BPA patients to investigate whether electrical stimulation of RSAs was more effective for alleviating PLP than control electrical stimulation (electrical stimulation of sites on side opposite to the RSAs), and to elucidate the long-term effects of electrical stimulation of RSAs. RESULTS Study 1: Electrical stimulation of RSAs evoked phantom touch sensations in the deafferented limb, and significantly alleviated PLP (p < 0.05). Study 2: PLP was alleviated more after electrical stimulation on RSAs compared with control electrical stimulation (p < 0.05). However, the analgesic effects of electrical stimulation on RSAs were observed only in the short term, not in the long term (p > 0.05). CONCLUSIONS Electrical stimulation of RSAs not only evoked phantom touch sensation but also alleviated PLP in the short term. The results indicate that electrical stimulation of RSAs may provide a useful practical rehabilitation technique for PLP. Future studies will be required to clarify the mechanisms underlying immediate PLP alleviation via electrical stimulation of RSAs.
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Affiliation(s)
- Michihiro Osumi
- Graduate School of Health Science, Kio University, Nara, Japan.,Neurorehabilitation Research Center, Kio University, Nara, Japan
| | - Daisuke Shimizu
- School of Rehabilitation, Hyogo University of Health Sciences, Kobe, Japan
| | - Yuki Nishi
- Graduate School of Health Science, Kio University, Nara, Japan.,Neurorehabilitation Research Center, Kio University, Nara, Japan
| | - Shu Morioka
- Graduate School of Health Science, Kio University, Nara, Japan.,Neurorehabilitation Research Center, Kio University, Nara, Japan
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Acquisition of Ownership Illusion with Self-Disownership in Neurological Patients. Brain Sci 2020; 10:brainsci10030170. [PMID: 32183477 PMCID: PMC7139520 DOI: 10.3390/brainsci10030170] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 03/10/2020] [Accepted: 03/13/2020] [Indexed: 12/26/2022] Open
Abstract
The multisensory regions in frontoparietal cortices play a crucial role in the sense of body and self. Disrupting this sense may lead to a feeling of disembodiment, or more generally, a sense of disownership. Experimentally, this altered consciousness disappears during illusory own-body perceptions, increasing the intensity of perceived ownership for an external virtual limb. In many clinical conditions, particularly in individuals with a discontinuous or absent sense of bodily awareness, the brain may effortlessly create a convincing feeling of body ownership over a surrogate body or body part. The immediate visual input dominates the current bodily state and induces rapid plastic adaptation that reconfigures the dynamics of bodily representation, allowing the brain to acquire an alternative sense of body and self. Investigating strategies to deconstruct the lack of a normal sense of bodily ownership, especially after a neurological injury, may aid the selection of appropriate clinical treatment.
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