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- Lendaro, Eva, 1989
(författare)
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On the use of Phantom Motor Execution for the treatment of Phantom Limb Pain
- 2020
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Phantom limb pain (PLP) is a common complaint among amputees and despite having been studied for centuries, it remains a mysterious object of debate among researcher. To date, a vast number of ways to treat PLP has been proposed in the literature, however none of them has proven to be universally effective, thus creating uncertainty on how to operate clinically. The uncertainty is largely attributable to the scarcity of well conducted randomized controlled trials (RCTs) to prove the efficacy of PLP treatments. Phantom Motor Execution (PME) -exertion of voluntary phantom limb movements – aims at restoring the control over the phantom limb and the exercise of such control has been hypothesized to reverse neural changes implicated in PLP. Preliminary evidence supporting this hypothesis has been provided by clinical investigations on upper limb amputees. The main purpose of this Licentiate thesis was to enable a RCT on the use of PME for the treatment of PLP in order to provide robust and unbiased evidence for clinical practice. However, the implementation and kick-off of this clinical investigation required to complete few preparatory steps. For example, most amputees and PLP patients have lower limb amputation, thus PME needed to be adapted and validated for this population. Further, the RCT protocol needed to be carefully planned and made openly accessible, as per guidelines for conducting and publishing clinical RCT. Finally, a secondary aim of this thesis emerged with the need of providing long term relief from PLP to patient. Preliminary evidence seemed to indicate that in order to maintain pain relief, periodic rehearsal of the phantom motor skills acquired through PME is necessary. This raised the question of whether it is beneficial and possible to translate the technology from clinic to home use, question that was explored employing both quantitative and qualitative methods from engineering, medical anthropology, and user interface design. The work conducted within this thesis resulted in the extension of PME to lower limb patients by proposal and validation of a new and more user-friendly recording configuration to record EMG signals. The use of PME was then shown to be efficacious in relieving PLP with a case study on a patient. The protocol for the RCT was then designed and published. These two first steps permitted the establishment of the RCT, which is currently ongoing and expected to close in March 2021. With regard to the secondary aim of this thesis, the work conducted enabled PME to be used by the patients in the comfort of their home, while it also allowed investigate the benefits and challenges generally faced (not only by PME) in the transition from the clinic to home and its effects on treatment adherence. The work conducted is presented in the three appended publications. Future work includes the presentation of the results of the RCT. Further, having a way to modulate PLP is an incredibly useful tool to study the neural basis of PLP. By capitalizing on this tool, we are currently conducting brain imaging studies using fMRI and electroencephalography that are the main focus of the work that lies ahead.
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- Lendaro, Eva, 1989, et al.
(författare)
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Out of the clinic, into the home: The in-home use of phantom motor execution aided by machine learning and augmented reality for the treatment of phantom limb pain
- 2020
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Ingår i: Journal of Pain Research. - 1178-7090. ; 13, s. 195-209
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: Phantom motor execution (PME) facilitated by augmented/virtual reality (AR/ VR) and serious gaming (SG) has been proposed as a treatment for phantom limb pain (PLP). Evidence of the efficacy of this approach was obtained through a clinical trial involving individuals with chronic intractable PLP affecting the upper limb, and further evidence is currently being sought with a multi-sited, international, double blind, randomized, controlled clinical trial in upper and lower limb amputees. All experiments have been conducted in a clinical setting supervised by a therapist. Here, we present a series of case studies (two upper and two lower limb amputees) on the use of PME as a self-treatment. We explore the benefits and the challenges encountered in translation from clinic to home use with a holistic, mixed-methods approach, employing both quantitative and qualitative methods from engineering, medical anthropology, and user interface design. Patients and Methods: All patients were provided with and trained to use a myoelectric pattern recognition and AR/VR device for PME. Patients took these devices home and used them independently over 12 months. Results: We found that patients were capable of conducting PME as a self-treatment and incorporated the device into their daily life routines. Use patterns and adherence to PME practice were not only driven by the presence of PLP but also influenced by patients’ perceived need and social context. The main barriers to therapy adherence were time and availability of single-use electrodes, both of which could be resolved, or attenuated, by informed design considerations. Conclusion: Our findings suggest that adherence to treatment, and thus related outcomes, could be further improved by considering disparate user types and their utilization patterns. Our study highlights the importance of understanding, from multiple disciplinary angles, the tight coupling and interplay between pain, perceived need, and use of medical devices in patient-initiated therapy.
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