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

Abstract

Objective Three-phase graded motor imagery (limb laterality, explicit motor imagery, and mirror therapy) has been successful in chronic pain populations. However, when applied to phantom limb pain, an amputation-related pain, investigations often use mirror therapy alone. We aimed to explore evidence for graded motor imagery and its phases to treat phantom limb pain. Data Sources A scoping review was conducted following the JBI Manual of Synthesis and Preferred Reporting Items for Systematic Review and Meta-Analyses extension for Scoping Reviews. Thirteen databases, registers, and websites were searched. Review Methods Published works on any date prior to the search (August 2023) were included that involved one or more graded motor imagery phases for participants ages 18+ with amputation and phantom limb pain. Extracted data included study characteristics, participant demographics, treatment characteristics, and outcomes. Results Sixty-one works were included representing 19 countries. Most were uncontrolled studies (31%). Many participants were male (75%) and had unilateral amputations (90%) of varying levels, causes, and duration. Most works examined one treatment phase (92%), most often mirror therapy (84%). Few works (3%) reported three-phase intervention. Dosing was inconsistent across studies. The most measured outcome was pain intensity (95%). Conclusion Despite the success of three-phase graded motor imagery in other pain populations, phantom limb pain research focuses on mirror therapy, largely ignoring other phases. Participant demographics varied, making comparisons difficult. Future work should evaluate graded motor imagery effects and indicators of patient success. The represented countries indicate that graded motor imagery phases are implemented internationally, so future work could have a widespread impact.

Physiotherapy techniques used in the sensation of the phantom limb in patients with amputation of the superior member, systematic review

“…Estos estudios demuestran que los tratamientos a utilizar son diversos y recalcan que la terapia del espejo es la más utilizada por ser de bajo costo y de fácil aplicación. (22) además de ser eficaz en reducir la intensidad del dolor con una duración más prolongada sin importar la fisiología, edad o extremidad amputada. (21) Pero para Mallik las imágenes mentales pueden superar a la TE, al comparar estos dos tratamientos mediante la puntuación de la escala EVA esta se mantuvo en los dos grupos, pero en la reducción del dolor si hay diferencias, por ello las IM son prometedoras como tratamiento, sin embargo, se debe tener en cuenta el estado mental del paciente ya que este puede interferir en los resultados.…”

“…Independientemente de eso es un método sencillo y económico de aplicación en el mismo domicilio de ser necesario. Falbo Jean K et al (22) 2021 Tipo de estudio: revisión de alcance Objetivo: explorar evidencia de las imágenes motoras graduadas para tratar el dolor del miembro fantasma con sus fases es decir con la lateralidad de las extremidades, terapia del espejo e imágenes explicitas. Muestra: se trabajó con 61 estudios incluidos según los criterios de inclusión y exclusión Indicadores de evaluación en los servicios: se realizó de acuerdo con el Manual del JBI que ayudo a sintetizar la información.…”

Case Report: Phantom limb pain relief after cognitive multisensory rehabilitation

“…Current treatments for PLP reduction include pain medication, peripheral nerve stimulation, repetitive transcranial magnetic stimulation, transcranial direct current stimulation, graded motor imagery, mirror therapy, phantom motor execution, virtual and augmented reality, eye movement desensitization and reprocessing, as well as surgical methods such as targeted muscle reinnervation and regenerative peripheral nerve interfaces ( 3 , 7 – 21 ). However, reviews and clinical trials on these therapies demonstrate mixed results, with heterogeneity among patients and little evidence to support efficacy due to small sample studies, poor methodological quality, and lack of long-term follow-up periods ( 3 , 7 – 20 , 22 , 23 ).…”