Phantom limb related phenomena and their rehabilitation after lower limb amputation. 2009

R Casale, and L Alaa, and M Mallick, and H Ring
Department of Clinical Neurophysiology, Foundation S. Maugeri IRCCS, Scientific Institute of Montescano, Montescano, Italy. rcasale@fsm.it

This paper reviewed the various hypotheses on phantom limb and phantom limb pain as well as all the related rehabilitation techniques to control these symptoms. The uncertainty in their pathophysiology strongly affects all the rehabilitation approaches so far used, as no single parameter has been found to predict or control phantom limb pain as well as no single factor can be quoted as an indicator of rehabilitation success for lower limb amputation. Within a comprehensive rehabilitation plan, behavioral interventions, stimulation techniques, feedback, physical therapies designed to possibly reverse the maladaptive memory traces and enhance its extinction have been described. Although substantially not clinically useful, pharmacological and surgical interventions also have been briefly considered. A reassessment of the actual strategies used is suggested with a role for rehabilitation not only after the amputation but also in the pre-emptive control of the pre-existing painful condition. In this process, rehabilitation should take into account many parameters, not always related to the traditional role of rehabilitation. Pain assessment before and after amputation, its natural history and clinical picture such as its quality, variations, level of the amputation, dominance, time interval between amputation and rehabilitation, as well as all the other phantom limb related phenomena should be considered and treated.

UI MeSH Term Description Entries
D010591 Phantom Limb Perception of painful and nonpainful phantom sensations that occur following the complete or partial loss of a limb. The majority of individuals with an amputated extremity will experience the impression that the limb is still present, and in many cases, painful. (From Neurol Clin 1998 Nov;16(4):919-36; Brain 1998 Sep;121(Pt 9):1603-30) Pseudomelia,Phantom Limb Pain,Phantom Pain,Phantom Sensation,Limb Pain, Phantom,Limb Pains, Phantom,Limb, Phantom,Limbs, Phantom,Pain, Phantom,Pain, Phantom Limb,Pains, Phantom,Pains, Phantom Limb,Phantom Limb Pains,Phantom Limbs,Phantom Pains,Phantom Sensations,Pseudomelias,Sensation, Phantom,Sensations, Phantom
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000671 Amputation, Surgical The surgical removal of part of, or all of, a limb or other appendage or outgrowth of the body. Amputation,Amputation, Multiple, Surgical,Multiple Amputation, Surgical,Surgical Amputation Procedures,Amputation Procedure, Surgical,Amputation Procedures, Surgical,Amputation, Surgical Multiple,Amputations,Amputations, Surgical,Amputations, Surgical Multiple,Multiple Amputations, Surgical,Procedure, Surgical Amputation,Procedures, Surgical Amputation,Surgical Amputation,Surgical Amputation Procedure,Surgical Amputations,Surgical Multiple Amputation,Surgical Multiple Amputations
D000673 Amputation, Traumatic Loss of a limb or other bodily appendage by accidental injury. Amputations, Traumatic,Traumatic Amputation,Traumatic Amputations
D035002 Lower Extremity The region of the lower limb in animals, extending from the gluteal region to the FOOT, and including the BUTTOCKS; HIP; and LEG. Extremity, Lower,Lower Limb,Membrum inferius,Extremities, Lower,Limb, Lower,Limbs, Lower,Lower Extremities,Lower Limbs

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