{"id":2352,"date":"2019-11-13T12:00:41","date_gmt":"2019-11-13T12:00:41","guid":{"rendered":"https:\/\/www.mub.eps.manchester.ac.uk\/science-engineering\/?p=2352"},"modified":"2023-06-21T09:23:42","modified_gmt":"2023-06-21T08:23:42","slug":"how-manchester-is-laying-phantom-limb-pain-to-rest","status":"publish","type":"post","link":"https:\/\/www.mub.eps.manchester.ac.uk\/science-engineering\/2019\/11\/13\/how-manchester-is-laying-phantom-limb-pain-to-rest\/","title":{"rendered":"How Manchester is laying phantom limb pain to rest"},"content":{"rendered":"

Almost every individual who undergoes an amputation experiences sensation in their missing limb. Just imagine it\u2026 part of your brain knows that your limb has been removed – whether medically or as the result of an accident – but at some other level, it still believes the limb exists.<\/p>\n

Of the more than 80 per cent of individuals who undergo an amputation and continue to feel sensation in the limb, the vast majority will experience pain. It might feel like the limb is burning; that it\u2019s being electrocuted; that it\u2019s being crushed, or even that it is bent and twisted into an impossible position. The person may even continue to feel the sensation of whatever caused them to lose the limb, such as a crushing pressure.<\/p>\n

It\u2019s an unpleasant condition and one that is still little understood.<\/p>\n

Cracking an age-old mystery<\/h2>\n

\"Human<\/p>\n

Research into the phenomenon first took place at the turn of the 19th century, when physician and novelist Silas Weir Mitchell\u00a0suggested phantom limb syndrome was caused by irritation to the peripheral nervous system at the site of the amputation. To be honest, the theories haven\u2019t moved on much from there.<\/p>\n

A later theory put forward that the condition was caused by the brain reorganising itself when it failed to receive a stimulus from the missing body part. This confusion caused the nervous system to send pain signals \u2013 a typical response when it senses something is wrong.<\/p>\n

However, phantom limb syndrome has also been noted in babies born without a limb. Even though they never had a chance to use it or feel sensation in it, the infants still react as though the limb were there.<\/p>\n

This discovery prompted a new line of thinking \u2013 that the human brain is hardwired to assume the nervous system and body fits a particular mould, and therefore to expect a certain response from each area of that body. The confusion caused by a part of the body not being there is interpreted by the brain as pain.<\/p>\n

Reflection therapy<\/h2>\n

\"Child<\/p>\n

While we may be some way off fully understanding the cause, there\u2019s no questioning the existence of the condition.<\/p>\n

\u201cFor the people who experience phantom limb pain it can be really debilitating,\u201d explains Steve Pettifer, Professor of Computer Science at the Department of Computer Science<\/a>. \u201cThis is partly because of the sensation of pain and also because of the strangeness of knowing that that pain is \u2018not really there\u2019 \u2013 the limb is not there, but the pain is very, very real.\u201d<\/p>\n

So, how do you treat a condition if you don\u2019t know what causes it? Well Prof Pettifer potentially has the solution.<\/p>\n

Through his work with a psychologist, Prof Pettifer came up with a way to reimagine the \u2018mirror box\u2019 technique.<\/p>\n

While treating phantom limb pain has historically been almost as difficult as understanding what causes it, mirror box therapy is one method that\u2019s been shown to have some success in alleviating the symptoms. Invented by neuroscientist VS Ramachandran, the therapy allows the recipient to feel a sense of relief from phantom limb pain by providing an image of the lost limb that they can move, scratch or unclench. The image is, in reality, a reflection of their remaining limb.<\/p>\n

Prof Pettifer and his team at The University of Manchester have taken this one step further by developing a new virtual reality therapy for people experiencing sensations in a phantom limb. Much like the mirror box method, the therapy provides the recipient with an image of their missing limb, allowing them to experience alleviation from some of the sensations they have been feeling.<\/p>\n

\u201cThe idea with the virtual reality set-up is that we give people back a virtual version of their missing limb,\u201d he explains. \u201cSo if you\u2019ve lost your left arm, when you\u2019re in the virtual environment, you will see a left arm where you\u2019d expect your missing left arm to be and you can move and control that by moving and gesturing with your right arm. What you see is your missing arm making those gestures.\u201d<\/p>\n

Among the people who have received this therapy, most have reported a reduction in phantom limb pain. This has been shown to last anywhere from a few hours to a few days.<\/p>\n

The next step is to make the technology available within people\u2019s homes. To date, amputees have been invited in to the University to try out the therapy, but as virtual reality technology has become more economical, it has opened up the opportunity for it to be used in the home. Prof Pettifer and his team hope this will allow them to reach more people and gain a valuable insight into its success – and to rule it out as being a placebo.<\/p>\n

Steering clear of uncanny valley<\/h2>\n

\"Virtual<\/p>\n

Interestingly, the success of the therapy does not depend on the image of the limb being an exact match to the missing limb \u2013 or even close to realistic. \u201cWe have created a neutral representation of the limb that\u2019s not obviously male or female, not obviously any particular skin colour or tone. This is to avoid the effect of \u2018uncanny valley\u2019,\u201d says Prof Pettifer.<\/p>\n

If you\u2019ve watched almost any movie in the last 20 years, you\u2019ll no doubt be familiar with the concept of uncanny valley. While CG has certainly come on leaps and bounds since the Stars Wars<\/em> prequels, early Harry Potter<\/em>, Twilight<\/em> and The Polar Express<\/em> (*shudder*), as the technology has improved, so too has the frequency of our trips to uncanny valley.<\/p>\n

\u201cUncanny valley occurs as you get more and more realistic in your human representation but without quite achieving it – the effect can be more revolting than a crude cartoon,\u201d says Prof Pettifer. \u201cSo, for example, we never question the appearance of The Simpsons<\/em>. But as you become more and more realistic but never quite perfect, the brain perceives it as unpleasant as it doesn\u2019t feel right.\u201d<\/p>\n

As a result, his team have intentionally stayed away from uncanny valley by keeping their imaging fairly crude and cartoon-like.<\/p>\n

Interestingly, this is a decision that was also made by a team of our Mechanical Engineering postgrads<\/a> when they created a 3D-printed bionic limb for amputees<\/a>. The creation won the Digital Innovation Challenge at the 2018 4.0 Summit in Manchester.<\/p>\n

The bionic limb looks very much like what it is \u2013 a robot hand (meaning the wearer can enjoy those Luke Skywalker vibes). \u201cWe didn\u2019t want to replicate a human hand, but embrace the fact that it\u2019s not,\u201d said the team\u2019s leader, Alex Agboola-Dobson, at the time.<\/p>\n

Only time will tell if virtual reality proves to have a legitimate therapeutic effect on the phenomenon of phantom limb pain. \u201cThe long-term goal would be that you can have this as a therapy that people can use in the home. But we\u2019re a long way from that at the moment,\u201d says Prof Pettifer.<\/p>\n

However, there may one day be a time when lost limbs can be biologically regenerated. Don\u2019t miss Part Two, when we talk to Professor Sarah Cartmell about her research on bone and tissue regeneration.<\/p>\n

Don\u2019t miss part two by <\/strong>subscribing to The Hub on our homepage<\/strong><\/a>.<\/strong><\/p>\n

\u00a0<\/strong><\/p>\n

Words \u2013 Hayley Cox<\/em><\/strong><\/p>\n

Images \u2013 Prof Steve <\/em><\/strong>Pettifer, Laura Dahl<\/a>, Eden, Janine and Jim<\/a>, Johan Larsson<\/a><\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

Phantom limb pain affects a staggering 80 per cent of people who have undergone amputation. 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