Multimodal virtual reality platform for the rehabilitation of phantom limb pain

Abstract

Amputees usually perceive vivid awareness of their lost body parts after the amputation (phantom limbs). Phantom limb pain (PLP) is intense pain that is felt in the phantom limb. The mechanism of PLP is still unclear, but the major hypothesis is that it is derived from dysfunction of the brain. There are a few neurorehabilitation techniques using a mirror or virtual reality (VR) that present the visual image of a phantom limb to the patients, and this produce the movement perception of their phantom limb. Here, we developed a multimodal (visual, auditory, and tactile) VR system to obtain the perception of voluntary phantom limb movements. We applied this system to five PLP patients for three tactile feedback conditions as a pilot study. In conclusion, four of the five patients reported pain amelioration, up to 86% decrease in the tactile feedback condition. In addition, our results demonstrated that the best suited condition of feedback-sense modalities depends on the patient. These results suggest that this system can be applied to a rehabilitation platform to offer flexible neurorehabilitation regimens for each patient.

Clinical utility of virtual reality in pain management: a comprehensive research review

“…Often medicalpharmacological analgesics are not able to alleviate phantom pain. Through our review, we found two studies Wake, et al, 2015) on PLP and VR neurorehabilitation. Both studies used…”

“…Oculus Rift and the same VR with small differences. This system could be applied to a future pain management platform offering flexible neurorehabilitation regimens for patients with PLP Wake, et al, 2015). Finally, Hoffman, et al, (2014) used Oculus Rift, for burn care with positive results.…”

“…A more advance option of interactivity was CYBERGLOVE II and Microsoft Kinect used at two and three studies respectively. Both interaction devices were used for Phantom Limb Pain Wake, et al, 2015) whereas Microsoft Kinect was also used for cold stimuli experiment (Czub and Piskorz, 2014).…”

Managing limb pain using virtual reality: a systematic review of clinical and experimental studies

“…Two were randomized controlled trials, eight were single group pre-test post-test without a control group comparison, seven were case series, and one was a case study. Eleven studies evaluated participants with upper phantom limb pain, [7,15,16,17,18,19,20,21,22,23,24] one study evaluated participants with upper and lower phantom limb pain. [25] One study evaluated upper limb complex regional pain syndrome, [26] one study evaluated lower limb complex regional pain syndrome, [27] and two studies evaluated upper and lower limb complex regional pain syndrome.…”

“…Movement of virtual limbs was controlled by movements of the affected (painful) limb in five studies [15,19,25,27,31] or movements of the non-affected (non-painful) limb in nine studies. [7,16,17,18,21,22,23,24,30] In one study a virtual arm was controlled by movement of the participant's affected (painful) arm but the virtual hand and fingers were controlled by the participant's non-affected (non-painful) hand and fingers. [26] In three studies participants did not control movement of virtual limbs but instead were required to imitate movements of a virtual limb, [20] and mentally imitate the movements of a virtual body.…”