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Damercheli S, Morrenhof K, Ahmed K, Ortiz-Catalan M. Performance in myoelectric pattern recognition improves with transcranial direct current stimulation. Sci Rep 2024; 14:11744. [PMID: 38778042 PMCID: PMC11111686 DOI: 10.1038/s41598-024-62185-x] [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: 08/22/2023] [Accepted: 05/14/2024] [Indexed: 05/25/2024] Open
Abstract
Sensorimotor impairments, resulting from conditions like stroke and amputations, can profoundly impact an individual's functional abilities and overall quality of life. Assistive and rehabilitation devices such as prostheses, exo-skeletons, and serious gaming in virtual environments can help to restore some degree of function and alleviate pain after sensorimotor impairments. Myoelectric pattern recognition (MPR) has gained popularity in the past decades as it provides superior control over said devices, and therefore efforts to facilitate and improve performance in MPR can result in better rehabilitation outcomes. One possibility to enhance MPR is to employ transcranial direct current stimulation (tDCS) to facilitate motor learning. Twelve healthy able-bodied individuals participated in this crossover study to determine the effect of tDCS on MPR performance. Baseline training was followed by two sessions of either sham or anodal tDCS using the dominant and non-dominant arms. Assignments were randomized, and the MPR task consisted of 11 different hand/wrist movements, including rest or no movement. Surface electrodes were used to record EMG and the MPR open-source platform, BioPatRec, was used for decoding motor volition in real-time. The motion test was used to evaluate performance. We hypothesized that using anodal tDCS to increase the excitability of the primary motor cortex associated with non-dominant side in able-bodied individuals, will improve motor learning and thus MPR performance. Overall, we found that tDCS enhanced MPR performance, particularly in the non-dominant side. We were able to reject the null hypothesis and improvements in the motion test's completion rate during tDCS (28% change, p-value: 0.023) indicate its potential as an adjunctive tool to enhance MPR and motor learning. tDCS appears promising as a tool to enhance the learning phase of using assistive devices using MPR, such as myoelectric prostheses.
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Affiliation(s)
- Shahrzad Damercheli
- Center for Bionics and Pain Research, Mölndal, Sweden
- Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | - Kelly Morrenhof
- Center for Bionics and Pain Research, Mölndal, Sweden
- Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | - Kirstin Ahmed
- Center for Bionics and Pain Research, Mölndal, Sweden
- Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | - Max Ortiz-Catalan
- Center for Bionics and Pain Research, Mölndal, Sweden.
- Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden.
- Bionics Institute, Melbourne, Australia.
- Medical Bionics Department, University of Melbourne, Melbourne, Australia.
- NeuroBioniX, Melbourne, Australia.
- Prometei Pain Rehabilitation Center, Vinnytsia, Ukraine.
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Zernitz M, Rizzello C, Rigoni M, Van de Winckel A. Case Report: Phantom limb pain relief after cognitive multisensory rehabilitation. FRONTIERS IN PAIN RESEARCH 2024; 5:1374141. [PMID: 38726352 PMCID: PMC11079144 DOI: 10.3389/fpain.2024.1374141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 04/15/2024] [Indexed: 05/12/2024] Open
Abstract
Introduction Relieving phantom limb pain (PLP) after amputation in patients resistant to conventional therapy remains a challenge. While the causes for PLP are unclear, one model suggests that maladaptive plasticity related to cortical remapping following amputation leads to altered mental body representations (MBR) and contributes to PLP. Cognitive Multisensory Rehabilitation (CMR) has led to reduced pain in other neurologic conditions by restoring MBR. This is the first study using CMR to relieve PLP. Methods A 26-year-old woman experienced excruciating PLP after amputation of the third proximal part of the leg, performed after several unsuccessful treatments (i.e., epidural stimulator, surgeries, analgesics) for debilitating neuropathic pain in the left foot for six years with foot deformities resulting from herniated discs. The PLP was resistant to pain medication and mirror therapy. PLP rendered donning a prosthesis impossible. The patient received 35 CMR sessions (2×/day during weekdays, October-December 2012). CMR provides multisensory discrimination exercises on the healthy side and multisensory motor imagery exercises of present and past actions in both limbs to restore MBR and reduce PLP. Results After CMR, PLP reduced from 6.5-9.5/10 to 0/10 for neuropathic pain with only 4-5.5/10 for muscular pain after exercising on the Numeric Pain Rating Scale. McGill Pain Questionnaire scores reduced from 39/78 to 5/78, and Identity (ID)-Pain scores reduced from 5/5 to 0/5. Her pain medication was reduced by at least 50% after discharge. At 10-month follow-up (9/2013), she no longer took Methadone or Fentanyl. After discharge, receiving CMR as outpatient, she learned to walk with a prosthesis, and gradually did not need crutches anymore to walk independently indoors and outdoors (9/2013). At present (3/2024), she no longer takes pain medication and walks independently with the prosthesis without assistive devices. PLP is under control. She addresses flare-ups with CMR exercises on her own, using multisensory motor imagery, bringing the pain down within 10-15 min. Conclusion The case study seems to support the hypothesis that CMR restores MBR which may lead to long-term (12-year) PLP reduction. MBR restoration may be linked to restoring accurate multisensory motor imagery of the remaining and amputated limb regarding present and past actions.
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Affiliation(s)
- Marina Zernitz
- Centro Studi di Riabilitazione Neurocognitiva, Villa Miari, Vicenza, Italy
| | - Carla Rizzello
- Centro Studi di Riabilitazione Neurocognitiva, Villa Miari, Vicenza, Italy
| | - Marco Rigoni
- Centro Studi di Riabilitazione Neurocognitiva, Villa Miari, Vicenza, Italy
| | - Ann Van de Winckel
- Division of Physical Therapy and Rehabilitation Science, Department of Family Medicine and Community Health, Medical School, University of Minnesota Twin Cities, Minneapolis, MN, United States
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Buist M, Damercheli S, Zbinden J, Truong MTN, Mastinu E, Ortiz-Catalan M. Novel Wearable Device for Mindful Sensorimotor Training: Integrating Motor Decoding and Somatosensory Stimulation for Neurorehabilitation. IEEE Trans Neural Syst Rehabil Eng 2024; 32:1515-1523. [PMID: 38512736 DOI: 10.1109/tnsre.2024.3379996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
Sensorimotor impairment is a prevalent condition requiring effective rehabilitation strategies. This study introduces a novel wearable device for Mindful Sensorimotor Training (MiSMT) designed for sensory and motor rehabilitation. Our MiSMT device combines motor training using myoelectric pattern recognition along sensory training using two tactile displays. This device offers a comprehensive solution, integrating electromyography and haptic feedback, lacking in existing devices. The device features eight electromyography channels, a rechargeable battery, and wireless Bluetooth or Wi-Fi connectivity for seamless communication with a computer or mobile device. Its flexible material allows for adaptability to various body parts, ensuring ease of use in diverse patients. The two tactile displays, with 16 electromagnetic actuators each, provide touch and vibration sensations up to 250 Hz. In this proof-of-concept study, we show improved two-point discrimination after 5 training sessions in participants with intact limbs (p=0.047). We also demonstrated successful acquisition, processing, and decoding of myoelectric signals in offline and online evaluations. In conclusion, the MiSMT device presents a promising tool for sensorimotor rehabilitation by combining motor execution and sensory training benefits. Further studies are required to assess its effectiveness in individuals with sensorimotor impairments. Integrating mindful sensory and motor training with innovative technology can enhance rehabilitation outcomes and improve the quality of life for those with sensorimotor impairments.
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Sparling T, Iyer L, Pasquina P, Petrus E. Cortical Reorganization after Limb Loss: Bridging the Gap between Basic Science and Clinical Recovery. J Neurosci 2024; 44:e1051232024. [PMID: 38171645 PMCID: PMC10851691 DOI: 10.1523/jneurosci.1051-23.2023] [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: 06/08/2023] [Revised: 08/28/2023] [Accepted: 09/29/2023] [Indexed: 01/05/2024] Open
Abstract
Despite the increasing incidence and prevalence of amputation across the globe, individuals with acquired limb loss continue to struggle with functional recovery and chronic pain. A more complete understanding of the motor and sensory remodeling of the peripheral and central nervous system that occurs postamputation may help advance clinical interventions to improve the quality of life for individuals with acquired limb loss. The purpose of this article is to first provide background clinical context on individuals with acquired limb loss and then to provide a comprehensive review of the known motor and sensory neural adaptations from both animal models and human clinical trials. Finally, the article bridges the gap between basic science researchers and clinicians that treat individuals with limb loss by explaining how current clinical treatments may restore function and modulate phantom limb pain using the underlying neural adaptations described above. This review should encourage the further development of novel treatments with known neurological targets to improve the recovery of individuals postamputation.Significance Statement In the United States, 1.6 million people live with limb loss; this number is expected to more than double by 2050. Improved surgical procedures enhance recovery, and new prosthetics and neural interfaces can replace missing limbs with those that communicate bidirectionally with the brain. These advances have been fairly successful, but still most patients experience persistent problems like phantom limb pain, and others discontinue prostheses instead of learning to use them daily. These problematic patient outcomes may be due in part to the lack of consensus among basic and clinical researchers regarding the plasticity mechanisms that occur in the brain after amputation injuries. Here we review results from clinical and animal model studies to bridge this clinical-basic science gap.
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Affiliation(s)
- Tawnee Sparling
- Department of Physical Medicine and Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, Maryland 20814
| | - Laxmi Iyer
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland 20817
| | - Paul Pasquina
- Department of Physical Medicine and Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, Maryland 20814
| | - Emily Petrus
- Department of Anatomy, Physiology and Genetics, Uniformed Services University, Bethesda, Maryland 20814
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Schone HR, Maimon Mor RO, Kollamkulam M, Gerrand C, Woollard A, Kang NV, Baker CI, Makin TR. Stable Cortical Body Maps Before and After Arm Amputation. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.12.13.571314. [PMID: 38168448 PMCID: PMC10760201 DOI: 10.1101/2023.12.13.571314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Neuroscientists have long debated the adult brain's capacity to reorganize itself in response to injury. A driving model for studying plasticity has been limb amputation. For decades, it was believed that amputation triggers large-scale reorganization of cortical body resources. However, these studies have relied on cross-sectional observations post-amputation, without directly tracking neural changes. Here, we longitudinally followed adult patients with planned arm amputations and measured hand and face representations, before and after amputation. By interrogating the representational structure elicited from movements of the hand (pre-amputation) and phantom hand (post-amputation), we demonstrate that hand representation is unaltered. Further, we observed no evidence for lower face (lip) reorganization into the deprived hand region. Collectively, our findings provide direct and decisive evidence that amputation does not trigger large-scale cortical reorganization.
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Affiliation(s)
- Hunter R. Schone
- Institute of Cognitive Neuroscience, University College London, London, UK
- Laboratory of Brain & Cognition, National Institutes of Mental Health, National Institutes of Health, Bethesda, Maryland, USA
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
| | - Roni O. Maimon Mor
- Institute of Cognitive Neuroscience, University College London, London, UK
- Department of Experimental Psychology, University College London, London, UK
- UCL Institute of Ophthalmology, University College London, London, UK
| | - Mathew Kollamkulam
- Institute of Cognitive Neuroscience, University College London, London, UK
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Craig Gerrand
- Department of Orthopaedic Oncology, Royal National Orthopaedic Hospital NHS Trust, Stanmore, Middlesex, UK
| | | | - Norbert V. Kang
- Plastic Surgery Department, Royal Free Hospital NHS Trust, London, UK
| | - Chris I. Baker
- Laboratory of Brain & Cognition, National Institutes of Mental Health, National Institutes of Health, Bethesda, Maryland, USA
| | - Tamar R. Makin
- Institute of Cognitive Neuroscience, University College London, London, UK
- Wellcome Centre for Human Neuroimaging, UCL Institute of Neurology, London, UK
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
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Weiss T, Koehler H, Croy I. Pain and Reorganization after Amputation: Is Interoceptive Prediction a Key? Neuroscientist 2023; 29:665-675. [PMID: 35950521 PMCID: PMC10623598 DOI: 10.1177/10738584221112591] [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] [Indexed: 11/17/2022]
Abstract
There is an ongoing discussion on the relevance of brain reorganization following amputation for phantom limb pain. Recent attempts to provide explanations for seemingly controversial findings-specifically, maladaptive plasticity versus persistent functional representation as a complementary process-acknowledged that reorganization in the primary somatosensory cortex is not sufficient to explain phantom limb pain satisfactorily. Here we provide theoretical considerations that might help integrate the data reviewed and suppose a possible additional driver of the development of phantom limb pain-namely, an error in interoceptive predictions to somatosensory sensations and movements of the missing limb. Finally, we derive empirically testable consequences based on our considerations to guide future research.
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Affiliation(s)
- Thomas Weiss
- Department of Psychology, Clinical Psychology, Friedrich Schiller University Jena, Jena, Germany
| | - Hanna Koehler
- Department of Psychology, Clinical Psychology, Friedrich Schiller University Jena, Jena, Germany
- Biomagnetic Center, Jena University Hospital, Jena, Germany
| | - Ilona Croy
- Department of Psychology, Clinical Psychology, Friedrich Schiller University Jena, Jena, Germany
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Ritter C, Geisler M, Blume KR, Nehrdich S, Hofmann GO, Koehler H, Miltner WHR, Weiss T. Stimulation of peroneal nerves reveals maintained somatosensory representation in transtibial amputees. Front Hum Neurosci 2023; 17:1240937. [PMID: 37746055 PMCID: PMC10512738 DOI: 10.3389/fnhum.2023.1240937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 08/18/2023] [Indexed: 09/26/2023] Open
Abstract
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.
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Affiliation(s)
- Caroline Ritter
- Department of Clinical Psychology, Institute of Psychology, Friedrich Schiller University Jena, Jena, Germany
- Clinic for Psychosomatics and Psychotherapy, Jena University Hospital, Jena, Germany
| | - Maria Geisler
- Department of Clinical Psychology, Institute of Psychology, Friedrich Schiller University Jena, Jena, Germany
- Clinic for Psychosomatics and Psychotherapy, Jena University Hospital, Jena, Germany
| | - Kathrin R. Blume
- Department of Clinical Psychology, Institute of Psychology, Friedrich Schiller University Jena, Jena, Germany
- Institute of Psychosocial Medicine, Psychotherapy and Psychooncology, Jena University Hospital, Jena, Germany
| | - Sandra Nehrdich
- Department of Clinical Psychology, Institute of Psychology, Friedrich Schiller University Jena, Jena, Germany
- Clinic for Psychosomatics and Psychotherapy, Jena University Hospital, Jena, Germany
| | - Gunther O. Hofmann
- Berufsgenossenschaftliche Kliniken Bergmannstrost Halle/Saale, Halle, Germany
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Jena, Jena, Germany
| | - Hanna Koehler
- Department of Clinical Psychology, Institute of Psychology, Friedrich Schiller University Jena, Jena, Germany
- Biomagnetic Center, Department of Neurology, University Hospital Jena, Jena, Germany
| | - Wolfgang H. R. Miltner
- Department of Clinical Psychology, Institute of Psychology, Friedrich Schiller University Jena, Jena, Germany
| | - Thomas Weiss
- Department of Clinical Psychology, Institute of Psychology, Friedrich Schiller University Jena, Jena, Germany
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Aurucci GV, Preatoni G, Damiani A, Raspopovic S. Brain-Computer Interface to Deliver Individualized Multisensory Intervention for Neuropathic Pain. Neurotherapeutics 2023; 20:1316-1329. [PMID: 37407726 PMCID: PMC10480109 DOI: 10.1007/s13311-023-01396-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2023] [Indexed: 07/07/2023] Open
Abstract
To unravel the complexity of the neuropathic pain experience, researchers have tried to identify reliable pain signatures (biomarkers) using electroencephalography (EEG) and skin conductance (SC). Nevertheless, their use as a clinical aid to design personalized therapies remains scarce and patients are prescribed with common and inefficient painkillers. To address this need, novel non-pharmacological interventions, such as transcutaneous electrical nerve stimulation (TENS) to activate peripheral pain relief via neuromodulation and virtual reality (VR) to modulate patients' attention, have emerged. However, all present treatments suffer from the inherent bias of the patient's self-reported pain intensity, depending on their predisposition and tolerance, together with unspecific, pre-defined scheduling of sessions which does not consider the timing of pain episodes onset. Here, we show a Brain-Computer Interface (BCI) detecting in real-time neurophysiological signatures of neuropathic pain from EEG combined with SC and accordingly triggering a multisensory intervention combining TENS and VR. After validating that the multisensory intervention effectively decreased experimentally induced pain, the BCI was tested with thirteen healthy subjects by electrically inducing pain and showed 82% recall in decoding pain in real time. Such constructed BCI was then validated with eight neuropathic patients reaching 75% online pain precision, and consequently releasing the intervention inducing a significant decrease (50% NPSI score) in neuropathic patients' pain perception. Our results demonstrate the feasibility of real-time pain detection from objective neurophysiological signals, and the effectiveness of a triggered combination of VR and TENS to decrease neuropathic pain. This paves the way towards personalized, data-driven pain therapies using fully portable technologies.
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Affiliation(s)
- Giuseppe Valerio Aurucci
- Laboratory for Neuroengineering, Department of Health Science and Technology, Institute for Robotics and Intelligent Systems, ETH Zürich, 8092, Zurich, Switzerland
| | - Greta Preatoni
- Laboratory for Neuroengineering, Department of Health Science and Technology, Institute for Robotics and Intelligent Systems, ETH Zürich, 8092, Zurich, Switzerland
| | - Arianna Damiani
- Laboratory for Neuroengineering, Department of Health Science and Technology, Institute for Robotics and Intelligent Systems, ETH Zürich, 8092, Zurich, Switzerland
| | - Stanisa Raspopovic
- Laboratory for Neuroengineering, Department of Health Science and Technology, Institute for Robotics and Intelligent Systems, ETH Zürich, 8092, Zurich, Switzerland.
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Pilch M, van Rietschoten T, Ortiz-Catalan M, Lendaro E, van der Sluis CK, Hermansson L. Interplay Between Innovation and Intersubjectivity: Therapists Perceptions of Phantom Motor Execution Therapy and Its Effect on Phantom Limb Pain. J Pain Res 2023; 16:2747-2761. [PMID: 37577161 PMCID: PMC10422994 DOI: 10.2147/jpr.s412895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 07/12/2023] [Indexed: 08/15/2023] Open
Abstract
Purpose Interpersonal processes, including therapeutic alliance, may modulate the impact of interventions on pain experience. However, the role of interpersonal context on the effects of technology-enhanced interventions remains underexplored. This study elicited therapists' perspectives on how a novel rehabilitative process, involving Phantom Motor Execution (PME), may impact phantom limb pain. The mediating role of therapeutic alliance, and the way PME influenced its formation, was investigated. Methods A qualitative descriptive design, using a framework method, was used to explore therapists' (n=11) experiences of delivering PME treatment. Semi-structured online-based interviews were conducted. Results A 3-way interaction between therapist, patient, and the PME device was an overarching construct tying four themes together. It formed the context for change in phantom limb experience. The perceived therapeutic effects (theme 1) extended beyond those initially hypothesised and highlighted the mediating role of the key actors and context (theme 2). The therapeutic relationship was perceived as a transformative journey (theme 3), creating an opportunity for communication, collaboration, and bonding. It was seen as a cause and a consequence of therapeutic effects. Future directions, including the role of expertise-informed adaptations and enabling aspects of customised solutions, were indicated (theme 4). Conclusion This study pointed to intrapersonal, interpersonal, and contextual factors that should be considered in clinical implementation of novel rehabilitative tools. The results demonstrated that therapists have unique insights and a crucial role in facilitating PME treatment. The study highlighted the need to consider the biopsychosocial model of pain in designing, evaluating, and implementing technology-supported interventions.
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Affiliation(s)
- Monika Pilch
- Centre for Health Policy & Management, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Tijn van Rietschoten
- University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, the Netherlands
- University of Groningen, Faculty of Medical Sciences, Groningen, the Netherlands
| | - Max Ortiz-Catalan
- Center for Bionics and Pain Research, Mölndal, Sweden
- Bionics Institute, Melbourne, VC, Australia
- Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | - Eva Lendaro
- Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden
- Department of Brain and Cognitive Sciences, McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Corry K van der Sluis
- University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, the Netherlands
| | - Liselotte Hermansson
- Department of Prosthetics and Orthotics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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10
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Kuffler DP. Evolving techniques for reducing phantom limb pain. Exp Biol Med (Maywood) 2023; 248:561-572. [PMID: 37158119 PMCID: PMC10350801 DOI: 10.1177/15353702231168150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Abstract
At least two million people in the United States of America live with lost limbs, and the number is expected to double by 2050, although the incidence of amputations is significantly greater in other parts of the world. Within days to weeks of the amputation, up to 90% of these individuals develop neuropathic pain, presenting as phantom limb pain (PLP). The pain level increases significantly within one year and remains chronic and severe for about 10%. Amputation-induced changes are considered to underlie the causation of PLP. Techniques applied to the central nervous system (CNS) and peripheral nervous system (PNS) are designed to reverse amputation-induced changes, thereby reducing/eliminating PLP. The primary treatment for PLP is the administration of pharmacological agents, some of which are considered but provide no more than short-term pain relief. Alternative techniques are also discussed, which provide only short-term pain relief. Changes induced by various cells and the factors they release are required to change neurons and their environment to reduce/eliminate PLP. It is concluded that novel techniques that utilize autologous platelet-rich plasma (PRP) may provide long-term PLP reduction/elimination.
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Affiliation(s)
- Damien P Kuffler
- Institute of Neurobiology, Medical Sciences Campus, University of Puerto Rico, San Juan 00901, Puerto Rico
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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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12
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Root V, Muret D, Arribas M, Amoruso E, Thornton J, Tarall-Jozwiak A, Tracey I, Makin TR. Complex pattern of facial remapping in somatosensory cortex following congenital but not acquired hand loss. eLife 2022; 11:76158. [PMID: 36583538 PMCID: PMC9851617 DOI: 10.7554/elife.76158] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 12/29/2022] [Indexed: 12/31/2022] Open
Abstract
Cortical remapping after hand loss in the primary somatosensory cortex (S1) is thought to be predominantly dictated by cortical proximity, with adjacent body parts remapping into the deprived area. Traditionally, this remapping has been characterised by changes in the lip representation, which is assumed to be the immediate neighbour of the hand based on electrophysiological research in non-human primates. However, the orientation of facial somatotopy in humans is debated, with contrasting work reporting both an inverted and upright topography. We aimed to fill this gap in the S1 homunculus by investigating the topographic organisation of the face. Using both univariate and multivariate approaches we examined the extent of face-to-hand remapping in individuals with a congenital and acquired missing hand (hereafter one-handers and amputees, respectively), relative to two-handed controls. Participants were asked to move different facial parts (forehead, nose, lips, tongue) during functional MRI (fMRI) scanning. We first confirmed an upright face organisation in all three groups, with the upper-face and not the lips bordering the hand area. We further found little evidence for remapping of both forehead and lips in amputees, with no significant relationship to the chronicity of their phantom limb pain (PLP). In contrast, we found converging evidence for a complex pattern of face remapping in congenital one-handers across multiple facial parts, where relative to controls, the location of the cortical neighbour - the forehead - is shown to shift away from the deprived hand area, which is subsequently more activated by the lips and the tongue. Together, our findings demonstrate that the face representation in humans is highly plastic, but that this plasticity is restricted by the developmental stage of input deprivation, rather than cortical proximity.
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Affiliation(s)
- Victoria Root
- WIN Centre, University of OxfordOxfordUnited Kingdom
- Institute of Cognitive Neuroscience, University College LondonLondonUnited Kingdom
- Medical Research Council Cognition and Brain Sciences Unit (CBU), University of CambridgeCambridgeUnited Kingdom
| | - Dollyane Muret
- Institute of Cognitive Neuroscience, University College LondonLondonUnited Kingdom
| | - Maite Arribas
- Institute of Cognitive Neuroscience, University College LondonLondonUnited Kingdom
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College LondonLondonUnited Kingdom
| | - Elena Amoruso
- Institute of Cognitive Neuroscience, University College LondonLondonUnited Kingdom
- Medical Research Council Cognition and Brain Sciences Unit (CBU), University of CambridgeCambridgeUnited Kingdom
| | - John Thornton
- Wellcome Trust Centre for Neuroimaging, University College LondonLondonUnited Kingdom
| | | | - Irene Tracey
- WIN Centre, University of OxfordOxfordUnited Kingdom
| | - Tamar R Makin
- Institute of Cognitive Neuroscience, University College LondonLondonUnited Kingdom
- Medical Research Council Cognition and Brain Sciences Unit (CBU), University of CambridgeCambridgeUnited Kingdom
- Wellcome Trust Centre for Neuroimaging, University College LondonLondonUnited Kingdom
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Abstract
Pain is driven by sensation and emotion, and in turn, it motivates decisions and actions. To fully appreciate the multidimensional nature of pain, we formulate the study of pain within a closed-loop framework of sensory-motor prediction. In this closed-loop cycle, prediction plays an important role, as the interaction between prediction and actual sensory experience shapes pain perception and subsequently, action. In this Perspective, we describe the roles of two prominent computational theories-Bayesian inference and reinforcement learning-in modeling adaptive pain behaviors. We show that prediction serves as a common theme between these two theories, and that each of these theories can explain unique aspects of the pain perception-action cycle. We discuss how these computational theories and models can improve our mechanistic understandings of pain-centered processes such as anticipation, attention, placebo hypoalgesia, and pain chronification.
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Affiliation(s)
- Zhe Sage Chen
- Department of Psychiatry, New York University Grossman School of Medicine, New York, NY 10016, USA,Department of Neuroscience and Physiology, New York University Grossman School of Medicine, New York, NY 10016, USA,Neuroscience Institute, NYU Grossman School of Medicine, New York, NY 10016, USA,Interdisciplinary Pain Research Program, NYU Langone Health, New York, NY 10016, USA,Corresponding author
| | - Jing Wang
- Department of Neuroscience and Physiology, New York University Grossman School of Medicine, New York, NY 10016, USA,Neuroscience Institute, NYU Grossman School of Medicine, New York, NY 10016, USA,Interdisciplinary Pain Research Program, NYU Langone Health, New York, NY 10016, USA,Department of Anesthesiology, Perioperative Care and Pain Medicine, New York University Grossman School of Medicine, New York, NY 10016, USA,Corresponding author
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14
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Akbulut A, Gungor F, Tarakci E, Aydin MA, Zaim AH, Catal C. Identification of phantom movements with an ensemble learning approach. Comput Biol Med 2022; 150:106132. [PMID: 36195047 DOI: 10.1016/j.compbiomed.2022.106132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 08/27/2022] [Accepted: 09/18/2022] [Indexed: 11/20/2022]
Abstract
Phantom limb pain after amputation is a debilitating condition that negatively affects activities of daily life and the quality of life of amputees. Most amputees are able to control the movement of the missing limb, which is called the phantom limb movement. Recognition of these movements is crucial for both technology-based amputee rehabilitation and prosthetic control. The aim of the current study is to classify and recognize the phantom movements in four different amputation levels of the upper and lower extremities. In the current study, we utilized ensemble learning algorithms for the recognition and classification of phantom movements of the different amputation levels of the upper and lower extremity. In this context, sEMG signals obtained from 38 amputees and 25 healthy individuals were collected and the dataset was created. Studies of processing sEMG signals in amputees are rather limited, and studies are generally on the classification of upper extremity and hand movements. Our study demonstrated that the ensemble learning-based models resulted in higher accuracy in the detection of phantom movements. The ensemble learning-based approaches outperformed the SVM, Decision tree, and kNN methods. The accuracy of the movement pattern recognition in healthy people was up to 96.33%, this was at most 79.16% in amputees.
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Affiliation(s)
- Akhan Akbulut
- Department of Computer Engineering, Istanbul Kültür University, 34536 Istanbul, Turkey.
| | - Feray Gungor
- Department of Physiotherapy and Rehabilitation, Istanbul University-Cerrahpasa, 34147, Istanbul, Turkey.
| | - Ela Tarakci
- Department of Physiotherapy and Rehabilitation, Istanbul University-Cerrahpasa, 34147, Istanbul, Turkey.
| | - Muhammed Ali Aydin
- Department of Computer Engineering, Istanbul University-Cerrahpasa, 34520 Istanbul, Turkey.
| | - Abdul Halim Zaim
- Department of Computer Engineering, Istanbul Commerce University, 34840 Istanbul, Turkey.
| | - Cagatay Catal
- Department of Computer Science and Engineering, Qatar University, Doha 2713, Qatar.
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15
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Boomgaardt J, Dastan K, Chan T, Shilling A, Abd-Elsayed A, Kohan L. An Algorithm Approach to Phantom Limb Pain. J Pain Res 2022; 15:3349-3367. [PMID: 36320223 PMCID: PMC9618240 DOI: 10.2147/jpr.s355278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 10/14/2022] [Indexed: 11/06/2022] Open
Abstract
Phantom limb pain (PLP) is a common condition that occurs following both upper and lower limb amputation. First recognized and described in 1551 by Ambroise Pare, research into its underlying pathology and effective treatments remains a very active and growing field. To date, however, there is little consensus regarding the optimal management of phantom limb pain. With few large well-designed clinical trials of which to make treatment recommendations, as well as significant heterogeneity in clinical response to available treatments, the management of PLP remains challenging. Below we summarize the current state of knowledge in the field, as well as propose an algorithm for the approach to the treatment of PLP.
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Affiliation(s)
- Jacob Boomgaardt
- Department of Physical Medicine and Rehabilitation, University of Virginia, Charlottesville, VA, USA
| | - Kovosh Dastan
- Department of Physical Medicine and Rehabilitation, University of Virginia, Charlottesville, VA, USA
| | - Tiffany Chan
- Department of Anesthesiology, University of Virginia, Charlottesville, VA, USA
| | - Ashley Shilling
- Department of Anesthesiology, University of Virginia, Charlottesville, VA, USA
| | - Alaa Abd-Elsayed
- Department of Anesthesiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Lynn Kohan
- Department of Anesthesiology, University of Virginia, Charlottesville, VA, USA,Correspondence: Lynn Kohan, Department of Anesthesiology, University of Virginia, 545 Ray C Hunt Suite 3168, Charlottesville, VA, 22903, USA, Tel +1-434-243-5676, Fax +1-434-243-5689, Email
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16
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Pu S, Wu Y, Tong F, Du WJ, Liu S, Yang H, Zhang C, Zhou B, Chen Z, Zhou X, Han Q, Du D. Mechanosensitive Ion Channel TMEM63A Gangs Up with Local Macrophages to Modulate Chronic Post-amputation Pain. Neurosci Bull 2022; 39:177-193. [PMID: 35821338 PMCID: PMC9905372 DOI: 10.1007/s12264-022-00910-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 05/16/2022] [Indexed: 11/25/2022] Open
Abstract
Post-amputation pain causes great suffering to amputees, but still no effective drugs are available due to its elusive mechanisms. Our previous clinical studies found that surgical removal or radiofrequency treatment of the neuroma at the axotomized nerve stump effectively relieves the phantom pain afflicting patients after amputation. This indicated an essential role of the residual nerve stump in the formation of chronic post-amputation pain (CPAP). However, the molecular mechanism by which the residual nerve stump or neuroma is involved and regulates CPAP is still a mystery. In this study, we found that nociceptors expressed the mechanosensitive ion channel TMEM63A and macrophages infiltrated into the dorsal root ganglion (DRG) neurons worked synergistically to promote CPAP. Histology and qRT-PCR showed that TMEM63A was mainly expressed in mechanical pain-producing non-peptidergic nociceptors in the DRG, and the expression of TMEM63A increased significantly both in the neuroma from amputated patients and the DRG in a mouse model of tibial nerve transfer (TNT). Behavioral tests showed that the mechanical, heat, and cold sensitivity were not affected in the Tmem63a-/- mice in the naïve state, suggesting the basal pain was not affected. In the inflammatory and post-amputation state, the mechanical allodynia but not the heat hyperalgesia or cold allodynia was significantly decreased in Tmem63a-/- mice. Further study showed that there was severe neuronal injury and macrophage infiltration in the DRG, tibial nerve, residual stump, and the neuroma-like structure of the TNT mouse model, Consistent with this, expression of the pro-inflammatory cytokines TNF-α, IL-6, and IL-1β all increased dramatically in the DRG. Interestingly, the deletion of Tmem63a significantly reduced the macrophage infiltration in the DRG but not in the tibial nerve stump. Furthermore, the ablation of macrophages significantly reduced both the expression of Tmem63a and the mechanical allodynia in the TNT mouse model, indicating an interaction between nociceptors and macrophages, and that these two factors gang up together to regulate the formation of CPAP. This provides a new insight into the mechanisms underlying CPAP and potential drug targets its treatment.
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Affiliation(s)
- Shaofeng Pu
- Pain Management Center, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China
| | - Yiyang Wu
- Pain Management Center, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China
| | - Fang Tong
- State Key Laboratory of Medical Neurobiology and MOE Frontier Center for Brain Science, Institutes of Brain Science, Fudan University, Shanghai, 200032, China
| | - Wan-Jie Du
- State Key Laboratory of Medical Neurobiology and MOE Frontier Center for Brain Science, Institutes of Brain Science, Fudan University, Shanghai, 200032, China
| | - Shuai Liu
- State Key Laboratory of Medical Neurobiology and MOE Frontier Center for Brain Science, Institutes of Brain Science, Fudan University, Shanghai, 200032, China
| | - Huan Yang
- State Key Laboratory of Medical Neurobiology and MOE Frontier Center for Brain Science, Institutes of Brain Science, Fudan University, Shanghai, 200032, China
| | - Chen Zhang
- State Key Laboratory of Medical Neurobiology and MOE Frontier Center for Brain Science, Institutes of Brain Science, Fudan University, Shanghai, 200032, China
| | - Bin Zhou
- State Key Laboratory of Medical Neurobiology and MOE Frontier Center for Brain Science, Institutes of Brain Science, Fudan University, Shanghai, 200032, China
| | - Ziyue Chen
- State Key Laboratory of Medical Neurobiology and MOE Frontier Center for Brain Science, Institutes of Brain Science, Fudan University, Shanghai, 200032, China
| | - Xiaomeng Zhou
- State Key Laboratory of Medical Neurobiology and MOE Frontier Center for Brain Science, Institutes of Brain Science, Fudan University, Shanghai, 200032, China
| | - Qingjian Han
- State Key Laboratory of Medical Neurobiology and MOE Frontier Center for Brain Science, Institutes of Brain Science, Fudan University, Shanghai, 200032, China.
| | - Dongping Du
- Pain Management Center, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China.
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17
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Damercheli S, Ramne M, Ortiz-Catalan M. transcranial Direct Current Stimulation (tDCS) for the treatment and investigation of Phantom Limb Pain (PLP). PSYCHORADIOLOGY 2022; 2:23-31. [PMID: 38665143 PMCID: PMC10917199 DOI: 10.1093/psyrad/kkac004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 04/08/2022] [Accepted: 04/11/2022] [Indexed: 04/28/2024]
Abstract
Phantom limb pain (PLP) is a complex medical condition that is often difficult to treat, and thus can become detrimental to patients' quality of life. No standardized clinical treatments exist and there is no conclusive understanding of the underlying mechanisms causing it. Noninvasive brain stimulation (NIBS) has been used to find correlations between changes in brain activity and various brain conditions, including neurological disease, mental illnesses, and brain disorders. Studies have also shown that NIBS can be effective in alleviating pain. Here, we examined the literature on a particular type of NIBS, known as transcranial direct current stimulation (tDCS), and its application to the treatment of PLP. We first discuss the current hypotheses on the working mechanism of tDCS and then we examine published evidence of its efficacy to treat PLP. We conclude this article by discussing how tDCS alone, and in combination with brain imaging techniques such as electroencephalography (EEG) and magnetic resonance imagining, could be applied to further investigate the mechanisms underlying PLP.
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Affiliation(s)
- Shahrzad Damercheli
- Center for Bionics and Pain Research, Mölndal 43130, Sweden
- Department of Electrical Engineering, Chalmers University of Technology, Gothenburg 41296, Sweden
| | - Malin Ramne
- Center for Bionics and Pain Research, Mölndal 43130, Sweden
- Department of Electrical Engineering, Chalmers University of Technology, Gothenburg 41296, Sweden
| | - Max Ortiz-Catalan
- Center for Bionics and Pain Research, Mölndal 43130, Sweden
- Department of Electrical Engineering, Chalmers University of Technology, Gothenburg 41296, Sweden
- Operational Area 3, Sahlgrenska University Hospital, Mölndal 43180, Sweden
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg 41345, Sweden
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18
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Lendaro E, Earley EJ, Ortiz-Catalan M. Statistical analysis plan for an international, double-blind, randomized controlled clinical trial on the use of phantom motor execution as a treatment for phantom limb pain. Trials 2022; 23:138. [PMID: 35152915 PMCID: PMC8842736 DOI: 10.1186/s13063-021-05962-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 12/21/2021] [Indexed: 11/19/2022] Open
Abstract
Background Phantom limb pain (PLP) is a detrimental condition that can greatly diminish the quality of life. Purposeful control over the phantom limb activates the affected neural circuitry and leads to dissolution of the pathological relationship linking sensorimotor and pain processing (which gives rise to PLP). An international, double-blind, randomized controlled clinical trial (RCT) on the use of phantom motor execution (PME) as a treatment for PLP is currently undertaken, where PME is compared to an active placebo treatment, namely phantom motor imagery (PMI). Methods and design Sixty-seven subjects suffering from PLP in upper or lower limbs are randomly assigned in 2:1 ratio to PME or PMI interventions respectively. Subjects allocated to either treatment receive 15 interventions where they are exposed to the same VR-AR environments using the same device. The only difference between interventions is whether phantom movements are performed (PME) or imagined (PMI). Results The primary outcome of the study is to examine whether 15 sessions of PME can induce a greater PLP relief, compared to PMI. The secondary objectives are to examine whether 15 sessions of PME provide a greater improvement in different aspects related to PLP compared to PMI, such as pain duration, pain intensity as measured by other metrics, and the patient’s own impression about the effect of treatment. Long-term retention of treatment benefits will be assessed as change in all the variables (both primary and secondary) between baseline and follow-up timepoints (at 1, 3, and 6 months post-treatment). Conclusion This manuscript serves as the formal statistical analysis plan (version 1.0) for the international, double-blind, randomized controlled clinical trial on the use of PME as a treatment for PLP. The statistical analysis plan was completed on 3 August 2021. Trial registration ClinicalTrials.govNCT03112928. Registered on April 13, 2017 SAP version: version: 1.0, date: 2021/08/03 Protocol version: This document has been written based on information contained in the study protocol published in Lendaro et al. (BMJ Open 8:e021039, 2018), in July 2018. SAP revisions: Not applicable
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19
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Lendaro E, Balouji E, Baca K, Muhammad AS, Ortiz-Catalan M. Common Spatial Pattern EEG decomposition for Phantom Limb Pain detection. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:726-729. [PMID: 34891394 DOI: 10.1109/embc46164.2021.9630561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Phantom Limb Pain (PLP) is a chronic condition frequent among individuals with acquired amputation. PLP has been often investigated with the use of functional MRI focusing on the changes that take place in the sensorimotor cortex after amputation. In the present study, we investigated whether a different type of data, namely electroencephalographic (EEG) recordings, can be used to study the condition. We acquired resting state EEG data from people with and without PLP and then used machine learning for a binary classification task that differentiates the two. Common Spatial Pattern (CSP) decomposition was used as the feature extraction method and two validation schemes were followed for the classification task. Six classifiers (LDA, Log, QDA, LinearSVC, SVC and RF) were optimized through grid search and their performance compared. Two validation approaches, namely all-subjects validation and leave-one-out cross-validation (LOOCV), resulted in high classification accuracy. Most notably, the 93.7% accuracy achieved with SVC in LOOCV holds promise for good diagnostic capabilities using EEG biomarkers. In conclusion, our findings indicate that EEG data is a promising target for future research aiming at elucidating the neural mechanisms underlying PLP and its diagnosis.
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20
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Ambron E, Buxbaum LJ, Miller A, Stoll H, Kuchenbecker KJ, Coslett HB. Virtual Reality Treatment Displaying the Missing Leg Improves Phantom Limb Pain: A Small Clinical Trial. Neurorehabil Neural Repair 2021; 35:1100-1111. [PMID: 34704486 DOI: 10.1177/15459683211054164] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Phantom limb pain (PLP) is a common and in some cases debilitating consequence of upper- or lower-limb amputation for which current treatments are inadequate. OBJECTIVE This small clinical trial tested whether game-like interactions with immersive VR activities can reduce PLP in subjects with transtibial lower-limb amputation. METHODS Seven participants attended 5-7 sessions in which they engaged in a visually immersive virtual reality experience that did not require leg movements (Cool! TM), followed by 10-12 sessions of targeted lower-limb VR treatment consisting of custom games requiring leg movement. In the latter condition, they controlled an avatar with 2 intact legs viewed in a head-mounted display (HTC Vive TM). A motion-tracking system mounted on the intact and residual limbs controlled the movements of both virtual extremities independently. RESULTS All participants except one experienced a reduction of pain immediately after VR sessions, and their pre session pain levels also decreased over the course of the study. At a group level, PLP decreased by 28% after the treatment that did not include leg movements and 39.6% after the games requiring leg motions. Both treatments were successful in reducing PLP. CONCLUSIONS This VR intervention appears to be an efficacious treatment for PLP in subjects with lower-limb amputation.
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Affiliation(s)
- Elisabetta Ambron
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,University of Delaware, Newark, DE, USA
| | - Laurel J Buxbaum
- Moss Rehabilitation Research Institute, Elkins Park, Philadelphia, PA, USA.,Thomas Jefferson University, Philadelphia, PA, USA
| | - Alexander Miller
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Harrison Stoll
- Moss Rehabilitation Research Institute, Elkins Park, Philadelphia, PA, USA
| | | | - H Branch Coslett
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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21
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Zaheer A, Malik AN, Masood T, Fatima S. Effects of phantom exercises on pain, mobility, and quality of life among lower limb amputees; a randomized controlled trial. BMC Neurol 2021; 21:416. [PMID: 34706654 PMCID: PMC8554869 DOI: 10.1186/s12883-021-02441-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 10/15/2021] [Indexed: 01/16/2023] Open
Abstract
Background The objective of the current study is to evaluate the effects of phantom exercises on phantom limb pain, mobility status, and quality of life in lower limb amputees treated with mirror therapy and routine physiotherapy. Methods It is a randomized controlled trial in which 24 unilateral lower limb amputees (above and below the knee) were randomly assigned to two equal groups i.e., control group (mirror therapy and conventional physical therapy) and experimental group in which, phantom exercises were given, additionally. Physical therapy included conventional therapeutic exercises while phantom exercises include imagining the movement of the phantom limb and attempting to execute these movements Data were collected at baseline, after 2 and 4 weeks of intervention using VAS (pain), AMP (mobility) and RAND SF-36 Version 1.0 (QOL) questionnaires. All statistical analyses were done with IBM SPSS 25.0 with 95% CI. Results Twenty-four amputees (17 males and 7 females) participated in this trial. The Mean age of the participants in experimental and control groups was 45.3 ± 11.1 years and 40.5 ± 12.5 years respectively. After the intervention, the pain (VAS score) was significantly lower in the experimental group (p = 0.003). Similarly, the experimental group demonstrated a significantly better score in the “bodily pain” domain of SF-36 (p = 0.012). Both groups significantly (p < 0.05) improved in other domains of SF-36 and ambulatory potential with no significant (p > 0.05) between-group differences. Conclusions The Addition of phantom exercises resulted in significantly better pain management in lower limb amputees treated with mirror therapy and routine physiotherapy. Trial registration This study is registered in the U.S National Library of Medicine. The clinical trials registration number for this study is NCT04285138 (ClinicalTrials.gov Identifier) (Date: 26/02/2020). Supplementary Information The online version contains supplementary material available at 10.1186/s12883-021-02441-z.
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Affiliation(s)
- Anna Zaheer
- Faculty of Rehabilitation and Allied Health Sciences, Riphah International University, Lahore, Pakistan.
| | - Arshad Nawaz Malik
- Faculty of Rehabilitation and Allied Health Sciences, Riphah International University, Islamabad Campus, Rawalpindi, Pakistan
| | - Tahir Masood
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Jouf University, Sakakah, Saudi Arabia
| | - Sahar Fatima
- Faculty of Allied Health Sciences, University Institute of Physical Therapy, The University of Lahore, Lahore, Pakistan
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22
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King H, Forrester M. Electroacupuncture For Alleviation Of Phantom Limb Pain. JOURNAL OF REHABILITATION MEDICINE - CLINICAL COMMUNICATIONS 2021; 4:1000063. [PMID: 34276906 PMCID: PMC8278009 DOI: 10.2340/20030711-1000063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/10/2021] [Indexed: 11/21/2022]
Abstract
Phantom limb pain is clinically defined as the perception of pain or discomfort in a limb that no longer exists. Most amputees will experience phantom limb pain, which is associated with a low health-related quality of life. Phantom limb pain represents an important challenge in finding an effective therapy. The scientific evidence for best practice is weak, and is characterized by various clinical reports describing the pragmatic use of drugs and interventional techniques. Recent approaches to restore the sensory motor input have shown promise. One such technique is electroacupuncture. We report here a case study of a male in his 30s who sustained severe injuries, including a high transfemoral amputation, as a result of being hit by a car. An electroacupuncture treatment protocol was used. Over the course of 3 months, electroacupuncture alleviated the patient’s phantom limb pain, minimized his use of drugs, and improved his sleep and quality of life. The effect of electroacupuncture treatment lasted for 3–4 months, and successful top-up treatment maintained his pain relief. The results are in line with a study comparing massage and electroacupuncture in patients with spinal cord injury with neurogenic pain; a limited number of patients treated with electroacupuncture were significantly alleviated of their pain for months. This case report suggests that electroacupuncture may be useful in patients with phantom limb pain. LAY ABSTRACT Since phantom limb pain was first described by the French military surgeon Ambroise Pare in the 16th century, the number of studies has increased every year. Although many hypotheses have been proposed regarding the mechanisms of pain and many treatments approaches tried, there is a lack of successful treatments to induce long-term pain relief, improve sleep and quality of life in patients with phantom limb pain. A novel treatment approach used in patients with spinal cord injury pain is electroacupuncture. This case report used a long-term electroacupuncture protocol in a patient with phantom limb pain.
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Affiliation(s)
- Holly King
- Physiotherapy, HK Physio Limited, Sidmouth, UK
| | - Max Forrester
- Medical Acupuncture, Dr Max Forrester Acupuncture, Taunton, UK
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23
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Gautron L. The Phantom Satiation Hypothesis of Bariatric Surgery. Front Neurosci 2021; 15:626085. [PMID: 33597843 PMCID: PMC7882491 DOI: 10.3389/fnins.2021.626085] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 01/06/2021] [Indexed: 01/26/2023] Open
Abstract
The excitation of vagal mechanoreceptors located in the stomach wall directly contributes to satiation. Thus, a loss of gastric innervation would normally be expected to result in abrogated satiation, hyperphagia, and unwanted weight gain. While Roux-en-Y-gastric bypass (RYGB) inevitably results in gastric denervation, paradoxically, bypassed subjects continue to experience satiation. Inspired by the literature in neurology on phantom limbs, I propose a new hypothesis in which damage to the stomach innervation during RYGB, including its vagal supply, leads to large-scale maladaptive changes in viscerosensory nerves and connected brain circuits. As a result, satiation may continue to arise, sometimes at exaggerated levels, even in subjects with a denervated or truncated stomach. The same maladaptive changes may also contribute to dysautonomia, unexplained pain, and new emotional responses to eating. I further revisit the metabolic benefits of bariatric surgery, with an emphasis on RYGB, in the light of this phantom satiation hypothesis.
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Affiliation(s)
- Laurent Gautron
- Department of Internal Medicine, Center for Hypothalamic Research, The University of Texas Southwestern Medical Center, Dallas, TX, United States
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24
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DI Pino G, Piombino V, Carassiti M, Ortiz-Catalan M. Neurophysiological models of phantom limb pain: what can be learnt. Minerva Anestesiol 2021; 87:481-487. [PMID: 33432796 DOI: 10.23736/s0375-9393.20.15067-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Phantom Limb Pain (PLP) is a dysesthesic painful sensations perceived in the lost limb, resulting from complex interactions between structural and functional nervous systems changes. We analyze its main pathogenetic models and speculate on candidate therapeutic targets. The neuroma model considers PLP to arise from spontaneous activity of residual limb injured axons. Other peripheral-origin models attribute PLP to damage of somatosensory receptors or vascular changes. According to the cortical remapping model, the loss of bidirectional nervous flow and the need to enhance alternative functions trigger reorganization and arm and face skin afferents "invade" the hand territory. On the contrary, the persistent representation model suggests that continued inputs preserve the lost limb representation and that, instead to a shrinkage, PLP is associated with larger representation and stronger cortical activity. In the neuromatrix model, the mismatch between body representation, which remains intact despite limb amputation, and real body appearance generates pain. Another hypothesis is that proprioceptive memories associate specific limb positions with pre-amputation pain and may be recalled by those positions. Finally, the stochastic entanglement model offers a direct relationship between sensorimotor neural reorganization and pain. Amputation disrupts motor and somatosensory circuits, allowing for maladaptive wiring with pain circuits and causing pain without nociception. Relief of PLP depends solely on motor and somatosensory circuitry engagement, making anthropomorphic visual feedback dispensable. Existing and apparently contradicting theories might not be mutually exclusive. All of them involve several intertwined potential mechanisms by which replacing the amputated limb by an artificial one could counteract PLP.
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Affiliation(s)
- Giovanni DI Pino
- Research Unit of Neurophysiology and Neuroengineering of Human-Technology Interaction (NeXTlab), Campus Bio-Medico University, Rome, Italy -
| | - Valeria Piombino
- Research Unit of Neurophysiology and Neuroengineering of Human-Technology Interaction (NeXTlab), Campus Bio-Medico University, Rome, Italy
| | - Massimiliano Carassiti
- Unit of Anesthesia, Intensive Care and Pain Management, Department of Medicine, Campus Bio-Medico University, Rome, Italy
| | - Max Ortiz-Catalan
- Center for Bionics and Pain Research, Mölndal, Sweden.,Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden.,Operational Area 3, Sahlgrenska University Hospital, Mölndal, Sweden.,Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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25
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26
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Yanagisawa T, Fukuma R, Seymour B, Tanaka M, Hosomi K, Yamashita O, Kishima H, Kamitani Y, Saitoh Y. BCI training to move a virtual hand reduces phantom limb pain: A randomized crossover trial. Neurology 2020; 95:e417-e426. [PMID: 32675074 PMCID: PMC7455320 DOI: 10.1212/wnl.0000000000009858] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 02/12/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine whether training with a brain-computer interface (BCI) to control an image of a phantom hand, which moves based on cortical currents estimated from magnetoencephalographic signals, reduces phantom limb pain. METHODS Twelve patients with chronic phantom limb pain of the upper limb due to amputation or brachial plexus root avulsion participated in a randomized single-blinded crossover trial. Patients were trained to move the virtual hand image controlled by the BCI with a real decoder, which was constructed to classify intact hand movements from motor cortical currents, by moving their phantom hands for 3 days ("real training"). Pain was evaluated using a visual analogue scale (VAS) before and after training, and at follow-up for an additional 16 days. As a control, patients engaged in the training with the same hand image controlled by randomly changing values ("random training"). The 2 trainings were randomly assigned to the patients. This trial is registered at UMIN-CTR (UMIN000013608). RESULTS VAS at day 4 was significantly reduced from the baseline after real training (mean [SD], 45.3 [24.2]-30.9 [20.6], 1/100 mm; p = 0.009 < 0.025), but not after random training (p = 0.047 > 0.025). Compared to VAS at day 1, VAS at days 4 and 8 was significantly reduced by 32% and 36%, respectively, after real training and was significantly lower than VAS after random training (p < 0.01). CONCLUSION Three-day training to move the hand images controlled by BCI significantly reduced pain for 1 week. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that BCI reduces phantom limb pain.
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Affiliation(s)
- Takufumi Yanagisawa
- From the Institute for Advanced Co-Creation Studies (T.Y.), Osaka University; Departments of Neurosurgery (T.Y., R.F., M.T., K.H., H.K., Y.S.) and Neuromodulation and Neurosurgery (K.H., Y.S.), Osaka University Graduate School of Medicine; Department of Neuroinformatics (T.Y., R.F., Y.K.), ATR Computational Neuroscience Laboratories, Kyoto, Japan; Computational and Biological Learning Laboratory, Department of Engineering (B.S.), University of Cambridge, UK; Center for Information and Neural Networks (B.S.), National Institute for Information and Communications Technology, Osaka; RIKEN Center for Advanced Intelligence Project (O.Y.), Tokyo; Department of Computational Brain Imaging (O.Y.), ATR Neural Information Analysis Laboratories, Kyoto; and Graduate School of Informatics (Y.K.), Kyoto University, Japan.
| | - Ryohei Fukuma
- From the Institute for Advanced Co-Creation Studies (T.Y.), Osaka University; Departments of Neurosurgery (T.Y., R.F., M.T., K.H., H.K., Y.S.) and Neuromodulation and Neurosurgery (K.H., Y.S.), Osaka University Graduate School of Medicine; Department of Neuroinformatics (T.Y., R.F., Y.K.), ATR Computational Neuroscience Laboratories, Kyoto, Japan; Computational and Biological Learning Laboratory, Department of Engineering (B.S.), University of Cambridge, UK; Center for Information and Neural Networks (B.S.), National Institute for Information and Communications Technology, Osaka; RIKEN Center for Advanced Intelligence Project (O.Y.), Tokyo; Department of Computational Brain Imaging (O.Y.), ATR Neural Information Analysis Laboratories, Kyoto; and Graduate School of Informatics (Y.K.), Kyoto University, Japan
| | - Ben Seymour
- From the Institute for Advanced Co-Creation Studies (T.Y.), Osaka University; Departments of Neurosurgery (T.Y., R.F., M.T., K.H., H.K., Y.S.) and Neuromodulation and Neurosurgery (K.H., Y.S.), Osaka University Graduate School of Medicine; Department of Neuroinformatics (T.Y., R.F., Y.K.), ATR Computational Neuroscience Laboratories, Kyoto, Japan; Computational and Biological Learning Laboratory, Department of Engineering (B.S.), University of Cambridge, UK; Center for Information and Neural Networks (B.S.), National Institute for Information and Communications Technology, Osaka; RIKEN Center for Advanced Intelligence Project (O.Y.), Tokyo; Department of Computational Brain Imaging (O.Y.), ATR Neural Information Analysis Laboratories, Kyoto; and Graduate School of Informatics (Y.K.), Kyoto University, Japan
| | - Masataka Tanaka
- From the Institute for Advanced Co-Creation Studies (T.Y.), Osaka University; Departments of Neurosurgery (T.Y., R.F., M.T., K.H., H.K., Y.S.) and Neuromodulation and Neurosurgery (K.H., Y.S.), Osaka University Graduate School of Medicine; Department of Neuroinformatics (T.Y., R.F., Y.K.), ATR Computational Neuroscience Laboratories, Kyoto, Japan; Computational and Biological Learning Laboratory, Department of Engineering (B.S.), University of Cambridge, UK; Center for Information and Neural Networks (B.S.), National Institute for Information and Communications Technology, Osaka; RIKEN Center for Advanced Intelligence Project (O.Y.), Tokyo; Department of Computational Brain Imaging (O.Y.), ATR Neural Information Analysis Laboratories, Kyoto; and Graduate School of Informatics (Y.K.), Kyoto University, Japan
| | - Koichi Hosomi
- From the Institute for Advanced Co-Creation Studies (T.Y.), Osaka University; Departments of Neurosurgery (T.Y., R.F., M.T., K.H., H.K., Y.S.) and Neuromodulation and Neurosurgery (K.H., Y.S.), Osaka University Graduate School of Medicine; Department of Neuroinformatics (T.Y., R.F., Y.K.), ATR Computational Neuroscience Laboratories, Kyoto, Japan; Computational and Biological Learning Laboratory, Department of Engineering (B.S.), University of Cambridge, UK; Center for Information and Neural Networks (B.S.), National Institute for Information and Communications Technology, Osaka; RIKEN Center for Advanced Intelligence Project (O.Y.), Tokyo; Department of Computational Brain Imaging (O.Y.), ATR Neural Information Analysis Laboratories, Kyoto; and Graduate School of Informatics (Y.K.), Kyoto University, Japan
| | - Okito Yamashita
- From the Institute for Advanced Co-Creation Studies (T.Y.), Osaka University; Departments of Neurosurgery (T.Y., R.F., M.T., K.H., H.K., Y.S.) and Neuromodulation and Neurosurgery (K.H., Y.S.), Osaka University Graduate School of Medicine; Department of Neuroinformatics (T.Y., R.F., Y.K.), ATR Computational Neuroscience Laboratories, Kyoto, Japan; Computational and Biological Learning Laboratory, Department of Engineering (B.S.), University of Cambridge, UK; Center for Information and Neural Networks (B.S.), National Institute for Information and Communications Technology, Osaka; RIKEN Center for Advanced Intelligence Project (O.Y.), Tokyo; Department of Computational Brain Imaging (O.Y.), ATR Neural Information Analysis Laboratories, Kyoto; and Graduate School of Informatics (Y.K.), Kyoto University, Japan
| | - Haruhiko Kishima
- From the Institute for Advanced Co-Creation Studies (T.Y.), Osaka University; Departments of Neurosurgery (T.Y., R.F., M.T., K.H., H.K., Y.S.) and Neuromodulation and Neurosurgery (K.H., Y.S.), Osaka University Graduate School of Medicine; Department of Neuroinformatics (T.Y., R.F., Y.K.), ATR Computational Neuroscience Laboratories, Kyoto, Japan; Computational and Biological Learning Laboratory, Department of Engineering (B.S.), University of Cambridge, UK; Center for Information and Neural Networks (B.S.), National Institute for Information and Communications Technology, Osaka; RIKEN Center for Advanced Intelligence Project (O.Y.), Tokyo; Department of Computational Brain Imaging (O.Y.), ATR Neural Information Analysis Laboratories, Kyoto; and Graduate School of Informatics (Y.K.), Kyoto University, Japan
| | - Yukiyasu Kamitani
- From the Institute for Advanced Co-Creation Studies (T.Y.), Osaka University; Departments of Neurosurgery (T.Y., R.F., M.T., K.H., H.K., Y.S.) and Neuromodulation and Neurosurgery (K.H., Y.S.), Osaka University Graduate School of Medicine; Department of Neuroinformatics (T.Y., R.F., Y.K.), ATR Computational Neuroscience Laboratories, Kyoto, Japan; Computational and Biological Learning Laboratory, Department of Engineering (B.S.), University of Cambridge, UK; Center for Information and Neural Networks (B.S.), National Institute for Information and Communications Technology, Osaka; RIKEN Center for Advanced Intelligence Project (O.Y.), Tokyo; Department of Computational Brain Imaging (O.Y.), ATR Neural Information Analysis Laboratories, Kyoto; and Graduate School of Informatics (Y.K.), Kyoto University, Japan
| | - Youichi Saitoh
- From the Institute for Advanced Co-Creation Studies (T.Y.), Osaka University; Departments of Neurosurgery (T.Y., R.F., M.T., K.H., H.K., Y.S.) and Neuromodulation and Neurosurgery (K.H., Y.S.), Osaka University Graduate School of Medicine; Department of Neuroinformatics (T.Y., R.F., Y.K.), ATR Computational Neuroscience Laboratories, Kyoto, Japan; Computational and Biological Learning Laboratory, Department of Engineering (B.S.), University of Cambridge, UK; Center for Information and Neural Networks (B.S.), National Institute for Information and Communications Technology, Osaka; RIKEN Center for Advanced Intelligence Project (O.Y.), Tokyo; Department of Computational Brain Imaging (O.Y.), ATR Neural Information Analysis Laboratories, Kyoto; and Graduate School of Informatics (Y.K.), Kyoto University, Japan
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Sensinger JW, Dosen S. A Review of Sensory Feedback in Upper-Limb Prostheses From the Perspective of Human Motor Control. Front Neurosci 2020; 14:345. [PMID: 32655344 PMCID: PMC7324654 DOI: 10.3389/fnins.2020.00345] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 03/23/2020] [Indexed: 12/22/2022] Open
Abstract
This manuscript reviews historical and recent studies that focus on supplementary sensory feedback for use in upper limb prostheses. It shows that the inability of many studies to speak to the issue of meaningful performance improvements in real-life scenarios is caused by the complexity of the interactions of supplementary sensory feedback with other types of feedback along with other portions of the motor control process. To do this, the present manuscript frames the question of supplementary feedback from the perspective of computational motor control, providing a brief review of the main advances in that field over the last 20 years. It then separates the studies on the closed-loop prosthesis control into distinct categories, which are defined by relating the impact of feedback to the relevant components of the motor control framework, and reviews the work that has been done over the last 50+ years in each of those categories. It ends with a discussion of the studies, along with suggestions for experimental construction and connections with other areas of research, such as machine learning.
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Affiliation(s)
- Jonathon W. Sensinger
- Institute of Biomedical Engineering, University of New Brunswick, Fredericton, NB, Canada
| | - Strahinja Dosen
- Department of Health Science and Technology, The Faculty of Medicine, Integrative Neuroscience, Aalborg University, Aalborg, Denmark
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Singh S, Melnik R. Domain Heterogeneity in Radiofrequency Therapies for Pain Relief: A Computational Study with Coupled Models. Bioengineering (Basel) 2020; 7:E35. [PMID: 32272567 PMCID: PMC7355452 DOI: 10.3390/bioengineering7020035] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 03/25/2020] [Accepted: 04/02/2020] [Indexed: 12/11/2022] Open
Abstract
The objective of the current research work is to study the differences between the predicted ablation volume in homogeneous and heterogeneous models of typical radiofrequency (RF) procedures for pain relief. A three-dimensional computational domain comprising of the realistic anatomy of the target tissue was considered in the present study. A comparative analysis was conducted for three different scenarios: (a) a completely homogeneous domain comprising of only muscle tissue, (b) a heterogeneous domain comprising of nerve and muscle tissues, and (c) a heterogeneous domain comprising of bone, nerve and muscle tissues. Finite-element-based simulations were performed to compute the temperature and electrical field distribution during conventional RF procedures for treating pain, and exemplified here for the continuous case. The predicted results reveal that the consideration of heterogeneity within the computational domain results in distorted electric field distribution and leads to a significant reduction in the attained ablation volume during the continuous RF application for pain relief. The findings of this study could provide first-hand quantitative information to clinical practitioners about the impact of such heterogeneities on the efficacy of RF procedures, thereby assisting them in developing standardized optimal protocols for different cases of interest.
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Affiliation(s)
- Sundeep Singh
- MS2Discovery Interdisciplinary Research Institute, Wilfrid Laurier University, 75 University Avenue West, Waterloo, ON N2L 3C5, Canada;
| | - Roderick Melnik
- MS2Discovery Interdisciplinary Research Institute, Wilfrid Laurier University, 75 University Avenue West, Waterloo, ON N2L 3C5, Canada;
- BCAM—Basque Center for Applied Mathematics, Alameda de Mazarredo 14, E-48009 Bilbao, Spain
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Harper HE, Hirt PA, Lev-Tov H. The use of virtual reality in non-burn dermatological care - a review of the literature. J DERMATOL TREAT 2020; 33:48-53. [PMID: 32174192 DOI: 10.1080/09546634.2020.1743812] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Aim: Virtual Reality (VR) is the artificial depiction of a three-dimensional (3D) environment using computer-generated technology which allows users to interact with a simulated setting. VR has been used in a variety of clinical scenarios due to its efficacy as a distraction intervention, reducing anxiety and pain associated with medical procedures. The aim of this review is to provide clinicians with an overview of VR use in clinical dermatology.Methods: A search on VR use in clinical dermatology was conducted using PubMed Medline, Embase, Cochrane, Google Scholar and ClinicalTrials.Gov in July 2019. Results related to burn care were excluded.Results: This review identifies studies that utilized VR in the management of skin diseases and discusses considerations for its future use.Conclusion: The findings of these studies indicate that VR has beneficial effects as a complementary tool in the treatment of dermatological conditions.
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Affiliation(s)
| | - Penelope A Hirt
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Hadar Lev-Tov
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
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Singh S, Melnik R. Thermal ablation of biological tissues in disease treatment: A review of computational models and future directions. Electromagn Biol Med 2020; 39:49-88. [PMID: 32233691 DOI: 10.1080/15368378.2020.1741383] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Percutaneous thermal ablation has proven to be an effective modality for treating both benign and malignant tumours in various tissues. Among these modalities, radiofrequency ablation (RFA) is the most promising and widely adopted approach that has been extensively studied in the past decades. Microwave ablation (MWA) is a newly emerging modality that is gaining rapid momentum due to its capability of inducing rapid heating and attaining larger ablation volumes, and its lesser susceptibility to the heat sink effects as compared to RFA. Although the goal of both these therapies is to attain cell death in the target tissue by virtue of heating above 50°C, their underlying mechanism of action and principles greatly differs. Computational modelling is a powerful tool for studying the effect of electromagnetic interactions within the biological tissues and predicting the treatment outcomes during thermal ablative therapies. Such a priori estimation can assist the clinical practitioners during treatment planning with the goal of attaining successful tumour destruction and preservation of the surrounding healthy tissue and critical structures. This review provides current state-of-the-art developments and associated challenges in the computational modelling of thermal ablative techniques, viz., RFA and MWA, as well as touch upon several promising avenues in the modelling of laser ablation, nanoparticles assisted magnetic hyperthermia and non-invasive RFA. The application of RFA in pain relief has been extensively reviewed from modelling point of view. Additionally, future directions have also been provided to improve these models for their successful translation and integration into the hospital work flow.
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Affiliation(s)
- Sundeep Singh
- MS2Discovery Interdisciplinary Research Institute, Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Roderick Melnik
- MS2Discovery Interdisciplinary Research Institute, Wilfrid Laurier University, Waterloo, Ontario, Canada.,BCAM - Basque Center for Applied Mathematics, Bilbao, Spain
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Lendaro E, Middleton A, Brown S, Ortiz-Catalan M. Out of the Clinic, into the Home: The in-Home Use of Phantom Motor Execution Aided by Machine Learning and Augmented Reality for the Treatment of Phantom Limb Pain. J Pain Res 2020; 13:195-209. [PMID: 32021409 PMCID: PMC6983479 DOI: 10.2147/jpr.s220160] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 12/19/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose Phantom motor execution (PME) facilitated by augmented/virtual reality (AR/VR) and serious gaming (SG) has been proposed as a treatment for phantom limb pain (PLP). Evidence of the efficacy of this approach was obtained through a clinical trial involving individuals with chronic intractable PLP affecting the upper limb, and further evidence is currently being sought with a multi-sited, international, double blind, randomized, controlled clinical trial in upper and lower limb amputees. All experiments have been conducted in a clinical setting supervised by a therapist. Here, we present a series of case studies (two upper and two lower limb amputees) on the use of PME as a self-treatment. We explore the benefits and the challenges encountered in translation from clinic to home use with a holistic, mixed-methods approach, employing both quantitative and qualitative methods from engineering, medical anthropology, and user interface design. Patients and Methods All patients were provided with and trained to use a myoelectric pattern recognition and AR/VR device for PME. Patients took these devices home and used them independently over 12 months. Results We found that patients were capable of conducting PME as a self-treatment and incorporated the device into their daily life routines. Use patterns and adherence to PME practice were not only driven by the presence of PLP but also influenced by patients' perceived need and social context. The main barriers to therapy adherence were time and availability of single-use electrodes, both of which could be resolved, or attenuated, by informed design considerations. Conclusion Our findings suggest that adherence to treatment, and thus related outcomes, could be further improved by considering disparate user types and their utilization patterns. Our study highlights the importance of understanding, from multiple disciplinary angles, the tight coupling and interplay between pain, perceived need, and use of medical devices in patient-initiated therapy.
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Affiliation(s)
- Eva Lendaro
- Biomechatronics and Neurorehabilitation Laboratory, Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | | | - Shannon Brown
- Biomechatronics and Neurorehabilitation Laboratory, Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | - Max Ortiz-Catalan
- Biomechatronics and Neurorehabilitation Laboratory, Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden
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Lendaro E, Guo L, Novoa MJM, Sandsjo L, Ortiz-Catalan M. Seamless Integrated Textrode-Band for Real-time Lower Limb Movements Classification to Facilitate Self-Administrated Phantom Limb Pain Treatment. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2019:1753-1756. [PMID: 31946236 DOI: 10.1109/embc.2019.8856979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Phantom Motor Execution (PME) is a mechanism-based approach for the treatment of Phantom Limb Pain (PLP), which could potentially be self-administered in the home environment. However, the placement of electrodes aimed to acquire myoelectric signals from the residual stump muscles can be regarded as a difficult and time-consuming process by the patient. Thus, to increase patient compliance, the process must be made easier, faster, and cost effective. In this study, we developed and investigated a seamless integrated textrode-band for myoelectric recordings. The textrode-band can be easily donned/doffed, is reusable and washable. We demonstrated the viability of such concept by analyzing the signal-to-noise ratio (SNR), as well as offline and real time motion decoding performance, that in our experience are compatible with the PME treatment.
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Abstract
PURPOSE OF REVIEW Phantom sensations are incompletely understood phenomena which take place following an amputation or deafferentation of a limb. They can present as kinetic, kinesthetic, or exteroceptive perceptions. It is estimated that phantom limb pain (PLP) affects anywhere from 40 to 80% of amputees. RECENT FINDINGS Psychiatric illnesses such as depression, anxiety, and mood disorders have higher prevalence in amputees than in the general population. Pharmacologic treatment has been used as first-line therapy for amputees suffering from PLP with agents including gabapentinoids, amitriptyline, and other tricyclic anti-depressants, opioids, and local anesthetics. Non-invasive treatment modalities exist for PLP including sensory motor training, mirror visual therapy, and non-invasive neuromodulation. Non-invasive neuromodulation includes interventions like transcutaneous electrical nerve stimulation (TENS) and transcranial magnetic stimulation. While many promising therapies for PLP exist, more clinical trials are required to determine the efficacy and protocols needed for maximum benefit in patients suffering from PLP.
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