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Revolutionizing Phantom Limb Pain Management: Targeted Brain Rehabilitation in Upper Extremity Amputees
Ryan P Serbin, MD
1; Bryan J Loeffler, MD
2; R. Glenn Gaston, MD
2; James T Frix, MD
11Atrium Health Musculoskeletal Institute, Charlotte, NC; 2OrthoCarolina Hand Center, Charlotte, NC
Title: Revolutionizing Phantom Limb Pain Management: Targeted Brain Rehabilitation in Upper Extremity Amputees
Introduction: Phantom limb pain (PLP) affects a significant proportion of upper extremity amputees, often inadequately controlled with current treatment strategies. While surgical interventions like Regenerative Peripheral Nerve Interfaces (RPNI) and Targeted Muscle Reinnervation (TMR) have shown promise in mitigating PLP, a comprehensive approach targeting both central and peripheral mechanisms is necessary for optimal management. We introduce Targeted Brain Rehabilitation (TBR), a novel virtual reality (VR) therapy designed to address the limitations of current therapies and provide an accessible, engaging solution for PLP management in upper extremity amputees.
Methods: A two-phase study was conducted: (1) A survey of 36 upper extremity amputees to inform the design of the TBR system, and (2) A single-session feasibility and usability study with 10 upper extremity amputees (5 transradial, 3 partial hand, 1 transhumeral, 1 bilateral partial hand). TBR incorporates four phases: laterality recognition, guided motor imagery, virtual mirror feedback, and guided motor execution, each targeting specific cortical regions and mechanisms implicated in PLP.
Results: The survey revealed that ease of use (77.8%) and decreased PLP (58.3%) were the most desired features and treatment outcomes, respectively. TBR demonstrated excellent usability (SUS: 87.8±10.6), minimal simulator sickness (SSQ: 0.7±2.4), and significant pain reduction (NPRS decreased from 5.0±2.0 to 2.0±1.6, p=0.0067). Participants identified the guided motor execution phase as most helpful for phantom limb position (60%), control (70%), and pain reduction (60%). Notably, 90% of participants reported changes in phantom limb position after a single session.
Conclusion: TBR shows promise as an engaging, accessible, and potentially effective adjunct to surgical interventions like RPNI and TMR for PLP management in upper extremity amputees. By leveraging principles of neuroplasticity and cortical reorganization, TBR offers a novel approach to addressing both central and peripheral mechanisms of PLP. Further research is warranted to establish the long-term efficacy of TBR in conjunction with RPNI and TMR, optimize treatment protocols, and investigate potential applications in related conditions involving maladaptive cortical changes in upper extremity amputees.
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