The Psychological and Physical Rehabilitation of Amputees

Since physical therapy requires constant interaction with other people, it is a career that requires not only medical knowledge, but knowledge of the human psychology as well. A physical therapist may be well versed in recovery techniques, but how will he or she get the patient motivated if the patient is not motivated to begin with? Every person is different. Rehabilitation of amputees is a delicate process that requires significant work over an extended time period. Many factors are involved during the preoperative phase, as well as the postoperative phase. However, by being aware of the patient’s mental status and providing adequate patient education, the physical therapist and health care team can provide an extremely effective rehabilitation program. By understanding the patient and prescribing the proper exercise program, a physical therapist can help an amputee reach a high level of functionality

The effectiveness and cost-effectiveness of upper limb prostheses

The cost of upper limb prostheses related health care are rising. One reason may be the more frequent prescription of the expensive multi-grip myoelectric hand prostheses. However, signs of non-usage of the additional grip options of these hands are described. In these cases, a more simple prosthesis might also suit the users’ needs. Therefore, we investigated: 1. Factors that affect prosthesis choice and use A qualitative meta-synthesis, focus group and a nationwide survey in which 358 participants selected their top-10 most important items regarding prosthesis use were performed. Based on these results, a measurement tool, the PUF-ULP, was developed, which provides a single score that represents the match between the user and their prosthesis. 2. Cost-effectiveness of upper limb prosthesis A total of 242 upper limb prostheses users completed a quality of life questionnaire, the PUF-ULP, and a cost questionnaire. Results indicated that myoelectric prostheses, especially the multi-grip ones, are the most expensive compared to other prostheses types, while no differences in quality of life or user experiences were apparent. 3. Multi-grip versus standard myoelectric hands Fourteen multi-grip myoelectric hand prosthesis users performed multiple tests with both the multi-grip and standard myoelectric hand. Additionally, the users’ experiences of the multi-grip myoelectric hand prostheses were compared with these of 19 standard myoelectric hand prosthesis users using questionnaires. Results showed no relevant advantages of the multi-grip hand over the standard hand. 4. Development decision aidIn a systematic co-creation process a decision aid about hand prosthesis was developed and implemented nationwide

Children with Limb Deficiency: the Impacts of Using a Prosthetic for Functional Independence

Many emotions, questions, and concerns may arise for parents and caregivers upon learning that their child has a limb deficiency. Educational resources for parents of children with limb deficiencies may be lengthy, time consuming to find and read, and full of medical jargon. The purpose of this scholarly project was to develop an educational booklet that is concise and easy to read for parents and caregivers of children with limb deficiencies. An extensive literature review was conducted addressing the physical and psychological impacts children with limb deficiencies experience during daily activities. Parents with children who have limb deficiencies, individuals with limb deficiencies, and medical professionals who work with this population were consulted to gain a qualitative insight into unaddressed areas of concern. Additional literature which described the use of prosthetic devices and their impacts on functional independence was reviewed. Based on this review of literature, four areas of concern were identified: (1) there is a lack of immediate resources provided to families, (2) limited resources are available for medical professionals to communicate with this population, (3) multiple client factors and performance skills are affected when a child has a limb deficiency, and (4) prosthetic devices are commonly utilized to increase functional independence in children with limb deficiency. A user-friendly, educational booklet for parents and caregivers was developed to address identified areas of concern. The booklet was designed for occupational therapist to give to medical professionals and they, in tum, can give it to parents who have just learned their child has a limb deficiency. This booklet defines common terminology, addresses physical and psychological impacts for both the parents and child, and introduces the rehabilitative process including the use of a prosthetic device. The booklet is a resource that addresses social and emotional aspects of limb deficiencies for children and parents, provides a foundation of knowledge and suggestions for additional resources, and facilitates communication with support groups and medical professionals

ReLiPh: rehabilitation for lower limb with phantom pain

O membro fantasma ou sensação fantasma, ao longo dos anos, têm se destacado por ser originada de diferentes causas. Pesquisas e estudos mostram que, após uma amputação, na maioria dos casos, experienciam a sensação de membro fantasma e em muitos desses casos dolorosos. A presente tese baseia-se em uma pequena parte deste amplo tópico. Baseada na terapia de espelho usada na reabilitação e tratamento da dor fantasma. Ao longo do projeto, nós estudamos quais são os componentes mais relevantes para a reorganização/reestruturação, a fim de eliminar os sintomas negativos e futuros distúrbios/perturbações. Associada na relação do cérebro com o corpo, ou seja, as imagens formadas pelo cérebro em relação ao corpo físico desempenhando um papel crucial na relação do membro fantasma e da dor no membro fantasma, bem como no processo de cura e tratamento através de exercícios e no relacionamento da imagem que o cérebro tem do corpo físico. Esta dissertação tem como objetivo na construção de uma nova abordagem tecnológica, baseando-se nos princípios e critérios utilizados na terapia de espelho. A metodologia assenta na criação de um ambiente de realidade virtual controlado por um dispositivo que captura a atividade muscular em tempo real. Implementado num jogo baseado em movimentos/exercícios simples e naturais, sem uso de força ou esforço. Os elevados resultados verificados e testados, em indivíduos saudáveis e em um estudo de caso, na redução da dor fantasma, gerando um interesse e motivação, além de um melhor senso de presença e foco durante o seu uso. Concluindo, o projeto abre novas direções futuras de como novas abordagens tecnológicas podem ser usados nas pesquisas médicas na área do membro e na dor fantasma, em ambientes controlados e contextualizados. Melhorando a eficácia e eficiência, garantindo uma maior flexibilidade nos diferentes casos de amputação.The phantom limb or phantom sensation, over the years, has stood out being originated from different causes. Research and studies show that after an amputation, in most cases, they experience the sensation of a phantom limb and in many of those painful feelings. This thesis is based on a small part of this wide topic. Based on the mirror therapy used in rehabilitation and treatment for phantom pain. Throughout the project, we study what are the most relevant components to reorganization/restructuring in order to eliminate negative symptoms and future disturbances. Moreover it is established in the relationship of the brain with the body, that the images formed by the brain in relation to the physical body play a crucial role in the relationship with the phantom limb and phantom limb pain, as well as in the process of healing and treatment throughout exercises and the relationship of the image that the brain has to the physical body. This dissertation aims to build a new technological approach, based on the principles and criteria used in mirror therapy. The methodology is based on the creation of a virtual reality environment controlled by a device which captures the muscle activity in real time. Implemented in a game based on natural and simple effortless exercises without the use of strength. The high results verified and tested, in healthy subjects and in a case study, to reduce phantom pain, generating an interest and motivation, as well as a better sense of presence and focus during its use. In conclusion, the project opens up new future directions of how new technological approaches can be used in medical research in the field of phantom limbs and in phantom pain, in a controlled and contextualized environments and/or movements. Improving effectiveness and efficiency ensuring greater flexibility in different cases of amputation

Virtual Body Ownership Illusions for Mental Health: A Narrative Review.

Over the last 20 years, virtual reality (VR) has been widely used to promote mental health in populations presenting different clinical conditions. Mental health does not refer only to the absence of psychiatric disorders but to the absence of a wide range of clinical conditions that influence people\u2019s general and social well-being such as chronic pain, neurological disorders that lead to motor o perceptual impairments, psychological disorders that alter behaviour and social cognition, or physical conditions like eating disorders or present in amputees. It is known that an accurate perception of oneself and of the surrounding environment are both key elements to enjoy mental health and well-being, and that both can be distorted in patients suffering from the clinical conditions mentioned above. In the past few years, multiple studies have shown the effectiveness of VR to modulate such perceptual distortions of oneself and of the surrounding environment through virtual body ownership illusions. This narrative review aims to review clinical studies that have explored the manipulation of embodied virtual bodies in VR for improving mental health, and to discuss the current state of the art and the challenges for future research in the context of clinical care

Muscle Activity in Upper Extremity Amputees

Purpose – Three interdependent studies designed as preliminary investigations of phantom and prosthetic limb control in upper extremity amputees. The purpose was to (1) compare muscle activation patterns of the phantom limb to anatomically expected patterns (2) compare muscle activation patterns of the phantom limb and those used to control a prosthesis (3) compare the use of upper arm muscle activity in phantom limb movements between users of different types of prosthetic devices. These studies aimed to expand the understanding of the role of the peripheral nervous system in movements of phantom and prosthetic limbs. Methods – Fifteen participants with varying levels of upper extremity amputations participated. Kinesiologic EMG (surface/fine wire) was utilized to examine residual limb muscle activation patterns during movements of the phantom and prosthesis. A series of phantom movements based on level of amputation were executed. After completing phantom limb movements participants donned their prosthesis and completed movements of the device. Muscles were considered active when the threshold of activity exceeded two standard deviations above rest trial. Visual analysis of EMG activity and goodness of fit Pearson Chi-Square tests were used to examine frequency occurrences in muscle activation patterns. Results –The majority of muscle activation patterns for the completion of phantom limb movements, regardless of the level of amputation, varied from anatomically expected muscle activation patterns. The majority of participants also used different muscle activation patterns to control similar movements of the phantom limb and prosthetic device. Finally, muscle activation patterns to control the movement of a phantom hand were different based on the type of device participants used, with body-powered prosthetic users activating muscles of the upper arm more frequently than myoelectric prosthetic users. Significance – This dissertation was a preliminary study into novel theories regarding phantom and prosthetic control. Results emphasize a dire need for future research to explore the injury response of the PNS, how this impacts phantom limb experiences, how these changes impact or is impacted by the CNS, and how to utilize the body’s natural response to injury to enhance control and function of prosthetic devices

Mirror visual feedback during unilateral finger movements is related to the desynchronization of cortical electroencephalographic somatomotor alpha rhythms

Using a mirror adequately oriented, the motion of just one hand induces the illusion of the movement with the other hand. Here, we tested the hypothesis that such a mirror phenomenon may be underpinned by an electroencephalographic (EEG) event‐related desynchronization/synchronization (ERD/ERS) of central alpha rhythms (around 10 Hz) as a neurophysiological measure of the interactions among cerebral cortex, basal ganglia, and thalamus during movement preparation and execution. Eighteen healthy right‐handed male participants performed standard auditory‐triggered unilateral (right) or bilateral finger movements in the No Mirror (M−) conditions. In the Mirror (M+) condition, the unilateral right finger movements were performed in front of a mirror oriented to induce the illusion of simultaneous left finger movements. EEG activity was recorded from 64 scalp electrodes, and the artifact‐free event‐related EEG epochs were used to compute alpha ERD. In the M− conditions, a bilateral prominent central alpha ERD was observed during the bilateral movements, while left central alpha ERD and right alpha ERS were seen during unilateral right movements. In contrast, the M+ condition showed significant bilateral and widespread alpha ERD during the unilateral right movements. These results suggest that the above illusion of the left movements may be related to alpha ERD measures reflecting excitatory desynchronizing signals in right lateral premotor and primary somatomotor areas possibly in relation to basal ganglia‐thalamic loops

Chronic non-specific low back pain - sub-groups or a single mechanism?

Copyright 2008 Wand and O'Connell; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Background: Low back pain is a substantial health problem and has subsequently attracted a considerable amount of research. Clinical trials evaluating the efficacy of a variety of interventions for chronic non-specific low back pain indicate limited effectiveness for most commonly applied interventions and approaches. Discussion: Many clinicians challenge the results of clinical trials as they feel that this lack of effectiveness is at odds with their clinical experience of managing patients with back pain. A common explanation for this discrepancy is the perceived heterogeneity of patients with chronic non-specific low back pain. It is felt that the effects of treatment may be diluted by the application of a single intervention to a complex, heterogeneous group with diverse treatment needs. This argument presupposes that current treatment is effective when applied to the correct patient. An alternative perspective is that the clinical trials are correct and current treatments have limited efficacy. Preoccupation with sub-grouping may stifle engagement with this view and it is important that the sub-grouping paradigm is closely examined. This paper argues that there are numerous problems with the sub-grouping approach and that it may not be an important reason for the disappointing results of clinical trials. We propose instead that current treatment may be ineffective because it has been misdirected. Recent evidence that demonstrates changes within the brain in chronic low back pain sufferers raises the possibility that persistent back pain may be a problem of cortical reorganisation and degeneration. This perspective offers interesting insights into the chronic low back pain experience and suggests alternative models of intervention. Summary: The disappointing results of clinical research are commonly explained by the failure of researchers to adequately attend to sub-grouping of the chronic non-specific low back pain population. Alternatively, current approaches may be ineffective and clinicians and researchers may need to radically rethink the nature of the problem and how it should best be managed

Current knowledge on selected rehabilitative methods used in post-stroke recovery

Understanding brain plasticity after stroke is important in developing rehabilitation strategies. Active movement therapies show considerable promise but their individual application is still not fully implemented. Among the analysed, available therapeutic modalities, some became widely used in therapeutic practice. Thus, we selected three relatively new methods, i.e. mirror therapy, motor imagery and constraint-induced movement therapy (CIMT). Mirror therapy was initially used in the treatment of phantom pain in patients with amputated limbs and later, in stroke patients. Motor imagery is widely used in sport to improve performance, which raises the possibility of applying it both as a rehabilitative method and in accessing the motor network independently of recovery. Whereas CIMT is based on the paradigm that impairment of arm function is exacerbated by learned non-use and that this, in turn, leads to loss of cortical representation in the upper limb