Clinical Trial of the Virtual Integration Environment to Treat Phantom Limb Pain With Upper Extremity Amputation

Abstract

Background: Phantom limb pain (PLP) is commonly seen following upper extremity (UE) amputation. Use of both mirror therapy, which utilizes limb reflection in a mirror, and virtual reality therapy, which utilizes computer limb simulation, has been used to relieve PLP. We explored whether the Virtual Integration Environment (VIE), a virtual reality UE simulator, could be used as a therapy device to effectively treat PLP in individuals with UE amputation.Methods: Participants with UE amputation and PLP were recruited at Walter Reed National Military Medical Center (WRNMMC) and instructed to follow the limb movements of a virtual avatar within the VIE system across a series of study sessions. At the end of each session, participants drove virtual avatar limb movements during a period of “free-play” utilizing surface electromyography recordings collected from their residual limbs. PLP and phantom limb sensations were assessed at baseline and following each session using the Visual Analog Scale (VAS) and Short Form McGill Pain Questionnaire (SF-MPQ), respectively. In addition, both measures were used to assess residual limb pain (RLP) at baseline and at each study session. In total, 14 male, active duty military personnel were recruited for the study.Results: Of the 14 individuals recruited to the study, nine reported PLP at the time of screening. Eight of these individuals completed the study, while one withdrew after three sessions and thus is not included in the final analysis. Five of these eight individuals noted RLP at baseline. Participants completed an average of 18, 30-min sessions with the VIE leading to a significant reduction in PLP in seven of the eight (88%) affected limbs and a reduction in RLP in four of the five (80%) affected limbs. The same user reported an increase in PLP and RLP across sessions. All participants who denied RLP at baseline (n = 3) continued to deny RLP at each study session.Conclusions: Success with the VIE system confirms its application as a non-invasive and low-cost therapy option for PLP and phantom limb symptoms for individuals with upper limb loss.

Influência da Realidade Virtual e Aumentada no tratamento da dor do membro fantasma: Revisão integrativa

“…Onze estudos utilizaram exclusivamente a RV (Ambron, 2018;Henriksen, 2017;Kulkarni, 2020;Nissler, 2019;Osumi, 2019;Perry, 2018;Rutledge, 2019;Snow, 2017;Wake, 2015) para o tratamento e reabilitação de pacientes amputados com Dor do Membro Fantasma (DMF), a partir de instrumentos como: fones de ouvido e Oculus Rift DK2, além de materiais complementares e questionários para coleta dos dados. E outros utilizaram exclusivamente a RA, os quais utilizaram de materiais como micro-vibradores, faixa elástica, amplificador EMG e vibrador correspondente Ortiz-Catalan, 2016;Rothgangel, 2018).…”

“…No que se refere ao membro amputado, 12 pesquisaram métodos para membros superiores (Henriksen, 2017;Kulkarni, 2020;Nissler, 2019;Osumi, 2019;Perry, 2018;Snow, 2017;Wake, 2015;Ortiz-Catalan, 2016;, somente 02 estudos foram direcionados aos membros inferiores (Ambron, 2018;Rothgangel, 2018) e outros 02 abrangeram tanto membros inferiores, como superiores (Rutledge, 2019;Lendaro, 2020).…”

“…Em relação ao tipo de estudo, 04 classificaram-se como estudos de caso (Osumi, 2019;Snow, 2017;Wake, 2015;Lendaro, 2020) outros 07 estudos classificaram-se como estudos experimentais prospectivos longitudinais Ambron, 2018;Henriksen, 2017;Kulkarni, 2020;Rutledge, 2019;Ortiz-Catalan, 2016). Além de outros tipos de metodologias utilizadas como: 01 estudo transversal (Nissler, 2019), 01 estudo quantitativo , 01 análise 01 fatorial exploratória (Osumi, 2019), 01 ensaio clínico (Perry, 2018), 01 estudo controlado randomizado multicêntrico com 3 braços (Rothgangel, 2018).…”

Clinical evaluation of the revolutionizing prosthetics modular prosthetic limb system for upper extremity amputees

“…The VIE allows individuals to direct the movements of a virtual avatar using surface electromyogram (sEMG) signals captured from their residual limbs, digitized through an electrically-isolated data acquisition system, and filtered using signal analysis algorithms. Our laboratory has previously described the utility of the VIE in training individuals with upper extremity amputation in this pattern recognition platform for prosthetic control 21 , 22 . Motions included hand open, wrist flexion, extension, pronation, and supination, several user-selected grasps, “no movement”, and elbow flexion and extension with trans-humeral amputation.…”

“…Signal feature extraction and motion classification occurred using machine learning-based pattern recognition software and a Linear Discriminant Analysis classifier. The same software interfaces are used to control the MPL prosthesis 17 , 21 , 22 .…”