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

Psychological treatments and psychotherapies in the neurorehabilitation of pain. Evidences and recommendations from the italian consensus conference on pain in neurorehabilitation

BACKGROUND: It is increasingly recognized that treating pain is crucial for effective care within neurological rehabilitation in the setting of the neurological rehabilitation. The Italian Consensus Conference on Pain in Neurorehabilitation was constituted with the purpose identifying best practices for us in this context. Along with drug therapies and physical interventions, psychological treatments have been proven to be some of the most valuable tools that can be used within a multidisciplinary approach for fostering a reduction in pain intensity. However, there is a need to elucidate what forms of psychotherapy could be effectively matched with the specific pathologies that are typically addressed by neurorehabilitation teams. OBJECTIVES: To extensively assess the available evidence which supports the use of psychological therapies for pain reduction in neurological diseases. METHODS: A systematic review of the studies evaluating the effect of psychotherapies on pain intensity in neurological disorders was performed through an electronic search using PUBMED, EMBASE, and the Cochrane Database of Systematic Reviews. Based on the level of evidence of the included studies, recommendations were outlined separately for the different conditions. RESULTS: The literature search yielded 2352 results and the final database included 400 articles. The overall strength of the recommendations was medium/low. The different forms of psychological interventions, including Cognitive-Behavioral Therapy, cognitive or behavioral techniques, Mindfulness, hypnosis, Acceptance and Commitment Therapy (ACT), Brief Interpersonal Therapy, virtual reality interventions, various forms of biofeedback and mirror therapy were found to be effective for pain reduction in pathologies such as musculoskeletal pain, fibromyalgia, Complex Regional Pain Syndrome, Central Post-Stroke pain, Phantom Limb Pain, pain secondary to Spinal Cord Injury, multiple sclerosis and other debilitating syndromes, diabetic neuropathy, Medically Unexplained Symptoms, migraine and headache. CONCLUSIONS: Psychological interventions and psychotherapies are safe and effective treatments that can be used within an integrated approach for patients undergoing neurological rehabilitation for pain. The different interventions can be specifically selected depending on the disease being treated. A table of evidence and recommendations from the Italian Consensus Conference on Pain in Neurorehabilitation is also provided in the final part of the pape

Visuo-tactile stimulation, but not type of movement, modulates pain during the vision of a moving virtual limb

Aims: Evidence has revealed a relationship between pain and the observation of limb movement, but it is unknown whether different types of movements have diverse modulating effects. In this immersive virtual reality study we explored the effect of the vision of different virtual arm movements (arm vs. wrist) on pain threshold from heat applied to the wrist. Patients & Methods: Forty healthy participants underwent four conditions in virtual reality while heat pain thresholds were measured. Visuo-tactile stimulation was used to attempt to modulate the feeling of virtual limb ownership. Results: Effects on pain threshold were present for type of stimulation but not type of movement. Conclusions: The type of observed movement does not appear to influence pain modulation, at least not during acute pain states

Phantom phenomena and body scheme after limb amputation: A literature review

Phantom phenomena are subject of various, often inconsistent, descriptions, and new concepts and treatment approaches emerge. The aim of the study is to describe contemporary terminology and developments in the field, and to share personal experience. A review of English and French language literature, published prior to 27th February, 2012, extracted from PubMed/MEDLINE, Google.fr, GoogleScholar databases, and by hand searching of selected full text papers and textbooks with correspondence to personal clinical experience was performed. The terminology and classification of phantom phenomena sensations, relations between intensity and character of phantom pain to the etiology and level of amputations, as well as the influence of presence and intensity of pre-operative limb pain and post-operative stump pain on phantom phenomena are described. The benefits of mirror therapy and early introduction of prosthesis and applying functional prosthesis are also presented, with a glance at other conservative and surgical treatment approaches

Phantom phenomena and body scheme after limb amputation : a literature review

Phantom phenomena are subject of various, often inconsistent, descriptions, and new concepts and treatment approaches emerge. The aim of the study is to describe contemporary terminology and developments in the field, and to share personal experience. A review of English and French language literature, published prior to 27th February, 2012, extracted from PubMed/MEDLINE, Google.fr, GoogleScholar databases, and by hand searching of selected full text papers and textbooks with correspondence to personal clinical experience was performed. The terminology and classification of phantom phenomena sensations, relations between intensity and character of phantom pain to the etiology and level of amputations, as well as the influence of presence and intensity of pre-operative limb pain and post-operative stump pain on phantom phenomena are described. The benefits of mirror therapy and early introduction of prosthesis and applying functional prosthesis are also presented, with a glance at other conservative and surgical treatment approaches

Making sense of phantom limb pain

Phantom limb pain (PLP) impacts the majority of individuals who undergo limb amputation. The PLP experience is highly heterogenous in its quality, intensity, frequency and severity. This heterogeneity, combined with the low prevalence of amputation in the general population, has made it difficult to accumulate reliable data on PLP. Consequently, we lack consensus on PLP mechanisms, as well as effective treatment options. However, the wealth of new PLP research, over the past decade, provides a unique opportunity to re-evaluate some of the core assumptions underlying what we know about PLP and the rationale behind PLP treatments. The goal of this review is to help generate consensus in the field on how best to research PLP, from phenomenology to treatment. We highlight conceptual and methodological challenges in studying PLP, which have hindered progress on the topic and spawned disagreement in the field, and offer potential solutions to overcome these challenges. Our hope is that a constructive evaluation of the foundational knowledge underlying PLP research practices will enable more informed decisions when testing the efficacy of existing interventions and will guide the development of the next generation of PLP treatments