Effect of one session of mirror therapy on phantom limb pain and recognition of limb laterality in military traumatic lower limb amputees: a pilot study

Abstract

Up to 70 % of military amputees suffer phantom limb pain (PLP), which is difficult to treat. PLP has been attributed to cortical reorganisation and associated with impaired laterality. Repeated sessions of mirror therapy (MT) can benefit PLP; however, anecdotal evidence suggests one MT session could be effective. In a one-group pretest and post-test design, 16 UK military unilateral lower limb amputees (median age: 31.0, 95% CI 25.0 to 36.8 years) undertook one 10 min MT session. Visual analogue scale (VAS) pain and laterality (accuracy and reaction time) measurements were taken pre-MT and post-MT. Median VAS PLP did not differ significantly between pre-MT 15 mm (2–53 mm) and post-MT 12 mm (1–31) (p=0.875) scores. For the amputated limb, there were no significant differences between pre-MT and post-MT scores for laterality accuracy, 95.3%, 95% CI 90.5% to 97.6% and 96.7%, 95% CI 90.0% to 99.4%, respectively (p=0.778), or reaction time, 1.42 s, 95% CI 1.11 to 2.11 s and 1.42 s, 95% CI 1.08 to 2.02 s, respectively (p=0.629). Laterality was also not different between limbs for accuracy, p=0.484, or reaction time, p=0.716, and did not correlate with PLP severity. No confounding variables predicted individual responses to MT. Therefore, one 10 min MT session does not affect laterality and is not effective as standard treatment for PLP in military lower limb amputees. However, substantial PLP improvement for one individual and resolution of a stuck phantom limb for another infers that MT may benefit specific patients. No correlation found between PLP and laterality implies associated cortical reorganisation may not be the main driver for PLP. Further research, including neuroimaging, is needed to help clinicians effectively target PLP.

Graded motor imagery and its phases for individuals with phantom limb pain following amputation: A scoping review

“…In 84% of works, no information about the race or ethnicity of participants was reported. [28][29][30][31][32][35][36][37][38][39][40][41][42][43][44][45][46][47][48]50,[52][53][54][55][56][57][58][59][60][63][64][65][67][68][69][71][72][73][74][77][78][79][80][81][82][83][84][85][86][87][88] Some works included participants within a narrow age range (e.g. 20-30 years old…”

“…Fifty-six works (92%) used only one of the phases of graded motor imagery, [28][29][30][31][32][33][34][35][37][38][39][40][41][42][43][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60]74,[76][77][78][79][80][82][83][84][85]87,89 and only two works (3%) used all three graded motor imagery phases. 36,86 Figure 5 summarizes the number of works using each phase.…”

Visual responsiveness in sensorimotor cortex is increased following amputation and reduced after mirror therapy

“…While a number of studies and groups have independently demonstrated a benefit from using mirror therapy in the treatment of phantom limb pain (Ramachandran and Rogers-Ramachandran, 1996; MacLachlan et al, 2004; Chan et al, 2007; Sumitani et al, 2008; Mercier and Sirigu, 2009; Finn et al, 2017; Ol et al, 2018), other groups have not reported similar successes (Brodie et al, 2007; Thieme et al, 2016; Richardson and Kulkarni, 2017; Wareham and Sparkes, 2018). In this study we followed mirror therapy treatment protocols that had previously been shown to be effective compared with limb movements alone (mirror covered) or imagined movement in a randomized, controlled, cross-over design (Chan et al, 2007).…”

“…All of these may have influence on the effectiveness of mirror therapy. It is also worth noting that those groups which did not report PLP reduction employed only a single session of mirror therapy (Brodie et al, 2007; Wareham and Sparkes, 2018), whereas the studies demonstrating efficacy of the therapy had sustained treatment sessions of a period of time. Recently, it was reported that amputee with greater severity of PLP require a longer duration of treatment (more sessions) before an effect can be seen, compared to fewer treatment sessions required for pain reduction in amputees with less severe phantom pain (Griffin et al, 2017), and this finding likely affects the negative conclusions drawn from analyses of prior studies (Thieme et al, 2016; Richardson and Kulkarni, 2017).…”

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

“…Na correlação feedback e Realidade Virtual/Aumentada, Perry et al (2013) aborda o uso eficaz de um Ambiente de Integração Virtual na analgesia não somente de pacientes que referem a dor no membro fantasma, como também na condição da dor do membro residual, que acomete principalmente militares amputados.Em estudo anterior,Osumi et al (2017) também abordou o uso da Realidade Virtual na analgesia da dor do membro fantasma, mas dessa vez concluiu houve melhoria das representações de movimento deste membro, em uma sessão de curta duração. Em um comparativo de tratamentos,Wareham et al (2020) utilizou a terapia de espelho em militares amputados, também em uma sessão de curta duração, mas não alcançou resultados consideráveis no tratamento da dor do membro fantasma. As diferenças podem-se advir de diferenças nos quadros dos pacientes, como por exemplo, o formato ao qual foi realizada a amputação: cirúrgica ou traumaticamente, dentre outros fatores.…”