Amputation, Prosthesis Use, and Phantom Limb Pain (eBook)

Craig Murray is a Senior Lecturer at Lancaster University with research specialization in health, clinical psychology, and embodiment. He has more than 100 journal, book, and conference publications. These include papers in key Health Psychology (British Journal of Health Psychology; Health Informatics; Health Psychology; Health, Risk and Society; Qualitative Health Research, Psychology, Health and Medicine; Social Science and Medicine) Mental Health (Journal of Nervous and Mental Disease; Journal of Mental Health) and Rehabilitation (CyberPsychology and Behavior; Disability and Rehabilitation; International Journal on Disability and Human Development) journal titles. He has published widely on the topic of amputation, prosthesis use and phantom limb pain and led funded research programmes on these topics. This work has received international media attention (including television: Canadian Discovery Channel, Australian Broadcasting Corporation radio and television, and America’s CNN; and press: e.g. The Times, Australia’s Sydney Morning Herald, China’s People Daily, Russian Newsweek, New Yorker magazine). He is editor of ‘Psychological Scientific Perspectives on out-of-body experiences’ (2009, Nova Science Publishers, New York).

Contents 5
Contributors 7
Chapter 1 10
Developing an Interdisciplinary Perspective on Amputation, Prosthesis Use, and Phantom Limb Pain: An Introduction 10
Chapter 2 15
Need-Directed Design of Prostheses and Enabling Resources 15
2.1 .Introduction 15
2.2 .Prosthesis Acceptance: A Question of Need 16
2.3 .Prosthetic Technology: Need-Directed Design 20
2.3.1 .Consumer Design Priorities 20
2.3.1.1 .Design for Comfort 20
2.3.1.2 .Design for Cost 21
2.3.1.3 .Design for Anthropomorphism 22
2.3.1.4 .Design for Sensation 22
2.3.2 .Design for Function 23
2.4 .Enabling Resources: Meeting Needs 23
2.4.1 .Healthcare Services 23
2.4.2 .Social Support Mechanisms 25
2.5 .Concluding Remarks 26
References 27
Chapter 3 30
Ethical and Medico-Legal Issues in Amputee Prosthetic Rehabilitation 30
3.1 .Introduction 30
3.2 .Attitudes Pertaining to Autonomy: Consent 32
3.3 .Non-malefience 34
3.4 .Justice: Resource Allocation and Distributive Costs 34
3.5 .Rationing 35
3.6 .Best Interest Principle: High-Tech or Low-Tech 36
3.7 .Withdrawal of Prostheses 37
3.8 .Concluding Comments 38
References 38
Chapter 4 39
Monitoring of Upper Limb Prosthesis Activity in Trans-Radial Amputees 39
4.1 .Upper Limb Prostheses: Background 40
4.2 .Justification for the Study 41
4.3 .Upper Limb Prostheses and Their Evaluation 42
4.3.1 .Introduction 42
4.3.2 .Current Approaches to Prosthesis Evaluation 43
4.3.2.1 .Questionnaires, Interviews and Clinical Records 43
4.3.2.2 .Direct-Observation Based Functionality Tests 44
4.3.2.3 .Conclusion 44
4.3.3 .Activity Monitoring 45
4.3.3.1 .Background 45
4.3.3.2 .Sensor Technologies 45
4.3.3.3 .Lower Limb and Whole Body Activity Monitors 45
4.3.3.4 .Upper Limb Activity Monitors 46
4.3.4 .Activity Monitoring and Upper Limb Prosthesis Evaluation 47
4.4 .Methods 49
4.4.1 .Introduction 49
4.4.1.1 .Tasks and Objects Used in the Evaluation Study 50
4.4.1.2 .Final Experimental Design 51
4.4.1.3 .Calculating Acceleration from Marker Data 52
4.4.1.4 .Subjects 53
4.4.1.5 .Data Collection 54
4.4.1.6 .Data Structure and Segmentation 54
4.4.1.7 .Activity Classification 55
4.5 .Results 58
4.5.1 .Subjects and Data 58
4.5.2 .The Neural Network and Task Classification 60
4.6 .Discussion and Conclusions 62
4.6.1 .Discussion 62
4.6.1.1 .Subject-Specific or Generalised Neural Network? 62
4.6.1.2 .Between Day Performance 64
4.6.1.3 .Data from Single or Multiple Locations on the Body? 64
4.6.1.4 .Functional vs. Non-functional Tasks 64
4.6.2 .Future Work 65
4.7 .Conclusion 66
References 66
Chapter 5 70
Adaptation to Amputation and Prosthesis Use 70
5.1 .Introduction 70
5.2 .Adaptation 71
5.2.1 .Emotional Well-being 73
5.2.2 .Body Image, Stigma and Social Discomfort 74
5.2.3 .Summary 76
5.3 .Psychosocial Factors Impacting on Adaptation 76
5.3.1 .Coping 77
5.3.2 .Social Support 78
5.4 .Cultural Factors 80
5.5 .Importance for Health Service Providers 81
5.6 .Conclusion 82
References 82
Chapter 6 85
Understanding Adjustment and Coping to Limb Loss and Absence through Phenomenologies of Prosthesis Use 85
6.1 .Introduction 85
6.2 .Study Background 87
6.3 .Embodied Experience 88
6.4 .Personal Meanings 91
6.5 .Social Meanings 94
6.6 .General Discussion 97
6.6.1 .Embodied Experience 97
6.6.2 .Personal Meanings 98
6.6.3 .Social Meanings 101
6.7 .Conclusion 102
References 102
Chapter 7 104
Return to Work After Amputation 104
7.1 .Introduction 105
7.2 .Lower Limb Amputation and Work 105
7.2.1 .Successful Return to Work 105
7.2.2 .Type of Work 106
7.2.3 .Time of Return to Work 107
7.2.4 .Factors Influencing Return to Work 107
7.2.4.1 .General Factors 107
7.2.4.2 .Factors Related to Impairments and Disabilities Due to Amputation 108
7.2.4.3 .Rehabilitation 109
7.2.4.4 .Prosthesis 109
7.2.4.5 .Work and Policies Related Factors 109
7.3 .Upper Limb Amputation and Work 111
7.3.1 .Successful Return to Work 111
7.3.2 .Type of Work 111
7.3.3 .Time to Return to Work 112
7.3.4 .Factors Influencing Return to Work 112
7.3.4.1 .General Factors 112
7.3.4.2 .Factors Related to Impairments and Disabilities Due to Amputation 113
7.3.4.3 .Rehabilitation 113
7.3.4.4 .Prosthesis 113
7.3.4.5 .Work and Policies-Related Factors 114
7.4 .Conclusion 114
References 115
Chapter 8 118
Gender, Sexuality and Prosthesis Use: Implications for Rehabilitation 118
8.1 .Introduction 118
8.2 .A Qualitative Exploration of Gender, Sexuality and Prosthesis Use: Study Background 122
8.2.1 .Data Examples of Gendered Concerns, Sexuality, Romantic Relationships and Prosthesis Use 122
8.2.1.1 .The Prosthesis and Gendered Identities 123
8.2.1.2 .Barriers and Facilitators to Forming Romantic and Sexual Relationships 125
8.3 .Discussion 128
References 129
Chapter 9 131
Post Amputation Chronic Pain Profile and Management 131
9.1 .Introduction 131
9.1.1 .Acute Post-Operative Pain 132
9.1.2 .Nociceptive Pain in the Stump 132
9.1.3 .Neuropathic Pain of the Stump 132
9.1.4 .Phantom Limb Pain 133
9.2 .Treatment and Management 134
9.2.1 .Acute Post-Operative Pain 134
9.2.2 .Management of Nociceptive Stump Pain 134
9.2.3 .Management of Neuropathic Stump Pain and Phantom Pain 135
9.2.3.1 .Non-Pharmacological Interventions 135
9.2.3.2 .Pharmacological Treatment 135
9.2.3.3 .Antidepressants 135
9.2.3.4 .Anticonvulsants 135
9.2.3.5 .Other Drugs 136
9.2.3.6 .Local Creams 136
9.2.3.7 .Injection Treatments 136
9.2.3.8 .Neurostimulation 137
9.2.3.9 .Low Back Pain 137
9.2.3.10 .Proximal Joint Arthritis Related Pain 137
9.3 .Conclusion 137
References 138
Chapter 10 139
Phantom Limb Pain Prevalence, Mechanisms and Associated Factors
10.1 .Background 139
10.1.1 .Phantom Phenomena in Amputated Limbs 140
10.1.2 .Phantom Limb Pain 141
10.1.2.1 .Description and Intensity of PLP 142
10.1.2.2 .Temporal Elements of PLP 143
10.1.2.3 .Mechanism for PLP 143
10.1.2.3.1 .Peripheral Nerve Involvement 143
10.1.2.3.2 .Evidence of Spinal Cord Involvement 144
10.1.2.3.3 .The Brain/Higher Centres 144
10.1.2.4 .Pain/Neuronal Memory and PLP 146
10.1.2.5 .The Neuromatrix Theory 147
10.1.2.6 .Treatment of PLP 148
10.1.2.6.1 .Pre-Emptive Treatment for PLP 148
10.1.2.6.1.1 .Evidence in Support of Pre-Emption 148
10.1.2.6.1.2 .Evidence Against Pre-Emption 149
10.1.2.6.1.3 .Pre-Emption – A Summary 150
10.1.2.7 .Factors Associated with PLP 150
10.1.2.7.1 .Psychosociocultural Factors 151
References 153
Chapter 11 159
Management of Phantom Limb Pain 159
11.1 .Introduction 159
11.2 .Pain Assessment 160
11.3 .Pharmacological Management of PLP 161
11.4 .The World Health Organisation Analgesic Ladder 161
11.5 .Antidepressant Therapy 162
11.5.1 .Side-Effects 162
11.5.1.1 .Tricyclics 162
11.5.1.2 .SSRIs 163
11.5.1.3 .SSNRIs 163
11.5.2 .Advice to Patients 163
11.6 .Anticonvulsant Therapy 163
11.6.1 .Side-Effects 164
11.6.2 .Advice to Patients 164
11.7 .Other Drugs 164
11.8 .Conclusion of Pharmacological Therapies 164
11.9 .Non-Pharmacological Therapy for PLP 165
11.9.1 .Neuromodulation 165
11.9.1.1 .Peripheral Stimulation – Transcutaneous Electrical Nerve Stimulation 165
11.9.1.2 .Central Stimulation 165
11.9.1.3 .Spinal Cord Stimulation (SCS) 165
11.9.1.4 .Deep Brain Stimulation 166
11.10 .Psychological Factors Affecting Phantom Limb Pain 166
11.11 .Psychological and Cognitive Interventions for PLP 168
11.11.1 .Cortical Reorganisation and PLP 168
11.11.2 .Imagined and Virtual Visuo-Motor Feedback for Chronic Pain 169
11.11.3 .PLP Treatment Plan 171
References 172
Chapter 12 176
Virtual Solutions to Phantom Problems: Using Immersive Virtual Reality to Treat Phantom Limb Pain 176
12.1 .Introduction 176
12.2 .Augmented Virtual Reality: The Dublin Psychoprosthetics Group 180
12.2.1 .Empirical Work with the Augmented Mirror Box 181
12.3 .Virtual Agency: Cole and Colleagues 183
12.3.1 .Empirical Work with the Virtual Agency System 183
12.4 .Immersive Virtual Reality: Murray and Colleagues 185
12.4.1 .Empirical Work with the Immersive Virtual Reality System 187
12.5 .Summary and Discussion 193
References 196
Index 198