Immersive Low-Cost Virtual Reality Treatment for Phantom Limb Pain: Evidence from Two Cases

Ambron, Elisabetta; Miller, Alexander L.; Kuchenbecker, Katherine J.; Buxbaum, Laurel J.; Coslett, H. Branch

doi:10.3389/fneur.2018.00067

Cited by 70 publications

(57 citation statements)

References 49 publications

(102 reference statements)

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“…The mirror box’s low cost, low technical complexity, ease of use, and ability to resurrect phantom limbs all contribute to the popularity of this approach to rehabilitation [ 11 ]. Although a number of published studies have emphasized the effectiveness of mirror-like virtual displays for phantom limb pain [ 35 ] or motor recovery [ 36 , 37 ], virtual reality remains a highly technical, expensive tool that may not provide more clinical benefit than conventional rehabilitation protocols can ([ 38 ]; for a review, see [ 37 ]). With a view to rehabilitation, some facets of the virtual mirror box should nevertheless be considered.…”

Section: Discussionmentioning

confidence: 99%

The respective contributions of visual and proprioceptive afferents to the mirror illusion in virtual reality

Giroux¹,

Barra²,

Issam-Eddine³

et al. 2018

PLoS ONE

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The reflection of passive arm displacement in a mirror is a powerful means of inducing a kinaesthetic illusion in the static arm hidden behind the mirror. Our recent research findings suggest that this illusion is not solely visual in origin but results from the combination of visual and proprioceptive signals from the two arms. To determine the respective contributions of visual and proprioceptive signals to this illusion, we reproduced the mirror paradigm in virtual reality. As in the physical version of the mirror paradigm, one of the participant’s arms (the left arm, in our study) could be flexed or extended passively. This movement was combined with displacements of the avatar’s left and right forearms, as viewed in a first-person perspective through a virtual reality headset. In order to distinguish between visual and proprioceptive contributions, two unimodal conditions were applied separately: displacement of the avatar’s forearms in the absence of physical displacement of the left arm (the visual condition), and displacement of the left forearm while the avatar’s forearms were masked (the proprioceptive condition). Of the 34 female participants included in the study, 28 experienced a kinaesthetic mirror illusion in their static (right) arm. The strength of the illusion (expressed in terms of speed and duration) evoked by the bimodal condition was much higher than that observed in either of the two unimodal conditions. Our present results confirm that the involvement of visual signals in the mirror illusion—often considered as a prototypic visual illusion—has been overstated. The mirror illusion also involves non-visual signals (bilateral proprioceptive-somaesthetic signals, in fact) that interact with the visual signals and strengthen the kinaesthetic effect.

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Section: Discussionmentioning

confidence: 99%

The respective contributions of visual and proprioceptive afferents to the mirror illusion in virtual reality

Giroux¹,

Barra²,

Issam-Eddine³

et al. 2018

PLoS ONE

View full text Add to dashboard Cite

show abstract

“…For instance, Murray et al (37) conducted a case study with three patients over two to five sessions; Henriksen et al (38) investigated the feasibility of their VR environment with three upper limb amputees over seven sessions, and Chau and colleagues' case study involved only one PLP patient who participated in five sessions (39). Other VR studies involved a single session with one or more patients (20,(40)(41)(42)(43). One reason that prevents large sample sizes is that patients with PLP usually need the help of caregivers to travel, and most patients lived far from the research laboratory (not in the same province).…”

Section: Discussionmentioning

confidence: 99%

“I Dreamed of My Hands and Arms Moving Again”: A Case Series Investigating the Effect of Immersive Virtual Reality on Phantom Limb Pain Alleviation

et al. 2020

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Phantom limb pain (PLP) is a type of chronic pain that follows limb amputation, brachial plexus avulsion injury, or spinal cord injury. Treating PLP is a well-known challenge. Currently, virtual reality (VR) interventions are attracting increasing attention because they show promising analgesic effects. However, most previous studies of VR interventions were conducted with a limited number of patients in a single trial. Few studies explored questions such as how multiple VR sessions might affect pain over time, or if a patient's ability to move their phantom limb may affect their PLP. Here we recruited five PLP patients to practice two motor tasks for multiple VR sessions over 6 weeks. In VR, patients "inhabit" a virtual body or avatar, and the movements of their intact limbs are mirrored in the avatar, providing them with the illusion that their limbs respond as if they were both intact and functional. We found that repetitive exposure to our VR intervention led to reduced pain and improvements in anxiety, depression, and a sense of embodiment of the virtual body. Importantly, we also found that their ability to move their phantom limbs improved as quantified by shortened motor imagery time with the impaired limb. Although the limited sample size prevents us from performing a correlational analysis, our findings suggest that providing PLP patients with sensorimotor experience for the impaired limb in VR appears to offer long-term benefits for patients and that these benefits may be related to changes in their control of the phantom limbs' movement.

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“…Technological advancements in virtual-reality-based paradigms have also received significant clinical interest and are quickly being developed to offer solutions for restoring the subjective awareness, somatic illusion, and feelings of embodiment that are required to maintain a functional physical body [63,64].…”

Section: Discussionmentioning

confidence: 99%

Acquisition of Ownership Illusion with Self-Disownership in Neurological Patients

2020

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The multisensory regions in frontoparietal cortices play a crucial role in the sense of body and self. Disrupting this sense may lead to a feeling of disembodiment, or more generally, a sense of disownership. Experimentally, this altered consciousness disappears during illusory own-body perceptions, increasing the intensity of perceived ownership for an external virtual limb. In many clinical conditions, particularly in individuals with a discontinuous or absent sense of bodily awareness, the brain may effortlessly create a convincing feeling of body ownership over a surrogate body or body part. The immediate visual input dominates the current bodily state and induces rapid plastic adaptation that reconfigures the dynamics of bodily representation, allowing the brain to acquire an alternative sense of body and self. Investigating strategies to deconstruct the lack of a normal sense of bodily ownership, especially after a neurological injury, may aid the selection of appropriate clinical treatment.

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Immersive Low-Cost Virtual Reality Treatment for Phantom Limb Pain: Evidence from Two Cases

Cited by 70 publications

References 49 publications

The respective contributions of visual and proprioceptive afferents to the mirror illusion in virtual reality

The respective contributions of visual and proprioceptive afferents to the mirror illusion in virtual reality

“I Dreamed of My Hands and Arms Moving Again”: A Case Series Investigating the Effect of Immersive Virtual Reality on Phantom Limb Pain Alleviation

Acquisition of Ownership Illusion with Self-Disownership in Neurological Patients

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