Synopsis of an engineering solution for a painful problem Phantom Limb Pain

This paper is synopsis of a recently proposed solution for treating patients who suffer from Phantom Limb Pain (PLP). The underpinning approach of this research and development project is based on an extension of “mirror box” therapy which has had some promising results in pain reduction. An outline of an immersive individually tailored environment giving the patient a virtually realised limb presence, as a means to pain reduction is provided. The virtual 3D holographic environment is meant to produce immersive, engaging and creative environments and tasks to encourage and maintain patients’ interest, an important aspect in two of the more challenging populations under consideration (over-60s and war veterans). The system is hoped to reduce PLP by more than 3 points on an 11 point Visual Analog Scale (VAS), when a score less than 3 could be attributed to distraction alone

Synopsis of an engineering solution for a painful problem: Phantom limb pain

This paper is synopsis of a recently proposed solution for treating patients who suffer from Phantom Limb Pain (PLP). The underpinning approach of this research and development project is based on an extension of "mirror box" therapy which has had some promising results in pain reduction. An outline of an immersive individually tailored environment giving the patient a virtually realised limb presence, as a means to pain reduction is provided. The virtual 3D holographic environment is meant to produce immersive, engaging and creative environments and tasks to encourage and maintain patients' interest, an important aspect in two of the more challenging populations under consideration (over-60s and war veterans). The system is hoped to reduce PLP by more than 3 points on an 11 point Visual Analog Scale (VAS), when a score less than 3 could be attributed to distraction alone. Copyright © 2014 SCITEPRESS - Science and Technology Publications. All rights reserved.Published versio

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

An Overview of the Body Schema and Body Image: Theoretical Models, Methodological Settings and Pitfalls for Rehabilitation of Persons with Neurological Disorders

Given the widespread debate on the definition of the terms "Body Schema" and "Body Image", this article presents a broad overview of the studies that have investigated the nature of these types of body representations, especially focusing on the innovative information about these two representations that could be useful for the rehabilitation of patients with different neurological disorders with motor deficits (especially those affecting the upper limbs). In particular, we analyzed (i) the different definitions and explicative models proposed, (ii) the empirical settings used to test them and (iii) the clinical and rehabilitative implications derived from the application of interventions on specific case reports. The growing number of neurological diseases with motor impairment in the general population has required the development of new rehabilitation techniques and a new phenomenological paradigm placing body schema as fundamental and intrinsic parts for action in space. In this narrative review, the focus was placed on evidence from the application of innovative rehabilitation techniques and case reports involving the upper limbs, as body parts particularly involved in finalistic voluntary actions in everyday life, discussing body representations and their functional role

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

A robot hand testbed designed for enhancing embodiment and functional neurorehabilitation of body schema in subjects with upper limb impairment or loss.

Many upper limb amputees experience an incessant, post-amputation "phantom limb pain" and report that their missing limbs feel paralyzed in an uncomfortable posture. One hypothesis is that efferent commands no longer generate expected afferent signals, such as proprioceptive feedback from changes in limb configuration, and that the mismatch of motor commands and visual feedback is interpreted as pain. Non-invasive therapeutic techniques for treating phantom limb pain, such as mirror visual feedback (MVF), rely on visualizations of postural changes. Advances in neural interfaces for artificial sensory feedback now make it possible to combine MVF with a high-tech "rubber hand" illusion, in which subjects develop a sense of embodiment with a fake hand when subjected to congruent visual and somatosensory feedback. We discuss clinical benefits that could arise from the confluence of known concepts such as MVF and the rubber hand illusion, and new technologies such as neural interfaces for sensory feedback and highly sensorized robot hand testbeds, such as the "BairClaw" presented here. Our multi-articulating, anthropomorphic robot testbed can be used to study proprioceptive and tactile sensory stimuli during physical finger-object interactions. Conceived for artificial grasp, manipulation, and haptic exploration, the BairClaw could also be used for future studies on the neurorehabilitation of somatosensory disorders due to upper limb impairment or loss. A remote actuation system enables the modular control of tendon-driven hands. The artificial proprioception system enables direct measurement of joint angles and tendon tensions while temperature, vibration, and skin deformation are provided by a multimodal tactile sensor. The provision of multimodal sensory feedback that is spatiotemporally consistent with commanded actions could lead to benefits such as reduced phantom limb pain, and increased prosthesis use due to improved functionality and reduced cognitive burden

Integrating Guided Motor Imagery and Cross Education into Rehabilitation: Scientific Review and Clinical Application

BACKGROUND: Guided motor imagery and cross education are two concepts that build upon motor programs. Guided motor imagery consists of imagining a specific action, thereby activating the respective motor program without an actual movement. Cross education incorporates contralateral training to activate the motor program of an action to the resting limb. These techniques yield neurological actions that can lead to improved performance outcomes when integrated into physical therapy programs. PURPOSE: This literature review investigated guided motor imagery and cross education within the scientific literature, identified and summarized evident themes and provided suggestions for incorporating these methods into rehabilitation programs. METHODS: An electronic search was conducted of peer-reviewed articles on guided motor imagery and cross education and their relation to rehabilitation. DISCUSSION: Despite the paucity of research, evidence exists for the effectiveness of these methods and provides insights regarding how these techniques may be successfully integrated into physical therapy regimens. A summary of evidence and suggestions are provided for physical therapists