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An introduction to virtual reality-based Targeted Brain Rehabilitation to treat phantom limb pain in the upper
Calvin C Chandler1, Ryan P Serbin1, James T Frix1
1Atrium Health Musculoskeletal Institute, Charlotte, NC, USA.
Background:
Phantom limb pain (PLP) is a condition that affects an estimated 80% of the 2 million amputees in the United States. Historically, therapists have utilized various interventions including desensitization, mirror therapy, graded motor imagery (GMI) and virtual reality (VR) to address phantom limb pain. Unfortunately, despite these treatment strategies, limitations in current therapeutic interventions result in suboptimal outcomes.
Purpose:
To determine if Targeted Brain Rehabilitation (TBR), a treatment designed to prevent and treat maladaptive cortical reorganization through a VR platform, enhances the individual experience while having a positive impact on PLP. We hypothesize that a single session guided by a therapist of Targeted Brain Rehabilitation (TBR), delivered via a structured virtual reality protocol, would reduce phantom limb pain (PLP) intensity as measured by the Numeric Pain Rating Scale (NPRS).
Study Design:
Case Series.
Methods:
This single-session feasibility and usability study of TBR included 18 patients with upper extremity amputations. The TBR system comprises four sequential phases: (1) laterality recognition, (2) guided motor imagery, (3) virtual mirror feedback, and (4) guided motor execution. Each phase is designed to target specific cortical regions and mechanisms implicated in PLP.
Results:
Participants reported overall high comfortability (8.8±1.1) and high levels of satisfaction (8.9±1.2) with their VR experiences for TBR. The TBR system demonstrated high usability (System Usability Scale: 86.8±11.8) and minimal simulator sickness (Simulator Sickness Questionnaire: 10.5±26.3). Levels of pain reduced significantly following TBR use (Numeric Pain Rating Scale: decreased from 4.9±2.9 to 2.4±2.1, p=0.0013, CI=1.13-3.87).
Conclusion:
This pilot case series highlights the promising potential of Targeted Brain Rehabilitation in managing phantom limb experiences and reducing PLP intensity. Ongoing research aims to establish TBR's long-term effectiveness in pain management, prosthetic utilization, and improving patients' participation in meaningful daily activities.
