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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

Authors Lendaro E, Middleton A, Brown S, Ortiz-Catalan M

Received 2 July 2019

Accepted for publication 19 December 2019

Published 21 January 2020 Volume 2020:13 Pages 195—209

DOI https://doi.org/10.2147/JPR.S220160

Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr E Alfonso Romero-Sandoval


Eva Lendaro, 1 Alexandra Middleton, 2 Shannon Brown, 1 Max Ortiz-Catalan 1

1Biomechatronics and Neurorehabilitation Laboratory, Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden; 2Department of Anthropology, Princeton University, Princeton, NJ, USA

Correspondence: Max Ortiz-Catalan
Department of Electrical Engineering, Biomechatronics and Neurorehabilitation Laboratory, Chalmers University of Technology, Hörsalsvägen 9, SE - 412 96, Gothenburg, Sweden
Tel +46 70-423 13 52
Email maxo@chalmers.se

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.

Keywords: phantom limb pain, neuropathic pain, augmented reality, phantom motor execution, ethnography, user interaction design

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