Phantom Motor Execution: treating phantom limb pain with virtual and augmented reality
Els M. Keesom(1), Kajsa Lidstrom-Holmqvist(1,2), Liselotte Hermansson(2), Corry K van der Sluis(1)
(1)University Medical Center Groningen, Groningen, the Netherlands.
(2)Orebro University, Orebro, Sweden
Introduction
Phantom limb pain (PLP) is a deteriorating condition that can greatly diminish quality of life. A novel treatment has been developed to relieve the PLP. The Phantom Motor Execution (PME) program uses augmented reality to treat PLP. The PME treatment will bring to life areas of the brain that have been inactive, which may have effects on their PLP, phantom sensations, self-agency, daily activities or sleep. This study aims to describe patients experiences from undergoing phantom motor execution treatment.
Methods
A descriptive, qualitative design was used. Ethical approval was obtained. Each participant provided written informed consent.
Patients with amputation who have undergone PME treatment in Sweden (n=9) and the Netherlands (n=12) were recruited. In total 21 patients were included: Mean age 56.7 years, 16 males, 5 upper and 16 lower limb amputations.
A semistructured interview was used to collect data. Categories entailed participants’ experiences of PLP, sensations of PLP, effects of PLP on daily life and experiences with the content of PME treatment. The framework approach [3] was chosen for analysis. Reporting of the study followed the COREQ checklist [4] to ensure quality. Interviews were held by an independent researcher at the 1 month follow-up after PME treatment was finished.
Results and discussion
Most participants experienced different degrees of relieve of their PLP due to getting command over their phantom movements and because they learned to relax their phantom limb. A few participants did not experience any change in their PLP. Some participants acknowledged that they were allowed to have a phantom and had learned to perceive it as a positive feeling. Some were able to use exercises learned during treatment in their home situation without having the PME system, others were unable to do so without the visual stimulation of the augmented reality. Due to the therapy, the PLP was experienced as less intrusive in daily life. For some the treatment was energy consuming, due to the mental effort that was required to follow the full treatment.
Conclusions
Most patients experienced relieve because they learned to get control over their phantom and to regard their PL sensations as positive. However, not all patients experienced a decrease in PLP, so further research is needed to improve the PME treatment in order to be able to help these patients as well.
References
1. Ortiz-Catalan et al. Phantom motor execution facilitated by machine learning and augmented reality as treatment for Phantom Limb Pain. The Lancet Vol 388, Issue 10062, 10–16 December 2016, Pages 2885–2894
2. Lendaro et al Phantom Motor Execution as a treatment for Phantom Limb Pain: Protocol of an international, double-blind, randomised, controlled clinical trial. BMJ Open 2018;8:e021039. doi:10.1136/bmjopen-2017-021039
3. Gale NK, Heath G, Cameron E, Rashid S and Redwood S. Using the framework method for the analysis of qualitative data in multi-disciplinary health research. Medical Research Methodology 2013, 13:117
4. Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. International Journal for Quality in Health Care. 2007. Volume 19, Number 6: pp. 349 – 357
