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Mirror therapy for phantom limb pain

Phantom limb pain commonly occurs after an arm and/or leg amputation. Learn how mirror therapy helps heal service members.

The brain can “feel” pain even after an arm and/or leg amputation, but a new treatment using mirrors can provide some relief. This common phenomenon, known as phantom limb pain (PLP), occurs in at least 75% of Operation Enduring Freedom (OEF)/Operation Iraqi Freedom (OIF) veteran amputees. Although its causes aren’t fully understood, one theory is that there’s a mismatch between what your brain sees and what it feels.

Mirror therapy offers a promising treatment for those suffering from PLP. A long mirror is placed between the patient’s legs and set to face the intact limb. As the patient moves and watches the intact limb in the mirror’s reflection, the brain is “tricked” into seeing the missing limb. The brain “sees” the phantom limb moving in the mirror and quiets busy activity or bad memories. The mirror positively stimulates the brain, causing reorganization or rewiring; this helps relieve PLP.

Healthcare providers have successfully used mirror therapy to help single-limb amputees. They’ve also adjusted the approach for double-limb amputees. Using an adapted method, a physical therapist (PT) acts as the mirror. The PT sits beside the patient and then mimics or “mirrors” the amputee’s phantom limbs with his/her intact limbs. For example, if a patient complains of calf cramps, the PT can stretch his/her own calves while the patient observes and feels relief in their phantom limbs. They’re currently working on using virtual reality to take the approach a step further.

What’s the big IDEO?

The Intrepid Dynamic Exoskeletal Orthosis (IDEO), a new orthotic technology designed for limb-salvage patients, helps Warfighters return to running, sports, and combat.

The U.S. Army has developed a device that will not only reduce the number of amputations but will help severely injured Warfighters return to duty. In the past, Warfighters with crushed and battered legs faced amputation or, at best, dysfunction due to pain and weakness. Now, with the introduction of the U.S. Army’s newest orthotic technology, amputations and decreased mobility may be a thing of the past for some.

The Intrepid Dynamic Exoskeletal Orthosis (IDEO) is the latest orthotic technology designed for Warfighters whose legs were crushed in combat. It uses technology similar to that of prosthetics worn by amputees and is higher in user satisfaction and performance compared with other braces available. Unlike other braces, IDEO does not depend on ankle movement, so Warfighters with fused ankle bones, where function is limited, can use them with little pain. With each step, IDEO stores energy and transfers it to the back of the brace, which springs the leg forward (similar to running-blade prosthetics). This allows the wearer to continue rebuilding the muscles in his or her leg while also working on functional movement.

In a study conducted by the Center for the Intrepid, eight of ten patients fitted with IDEO were able to run at least two miles without stopping. All ten Warfighters returned to weightlifting, many returned to playing sports or participating in mini-triathlons, and three returned to combat—two with Special Forces and one Army Ranger. The published report emphasized that the success of these patients was due not only to the innovative IDEO but also to the intense rehabilitation program and—most important—the motivation and drive of the individuals.

In combination with rehabilitation programs, IDEO looks like the newest in a wave of innovations that will help Warfighters return to normal function. If you are interested in learning more about IDEO and other innovative rehabilitation programs, please visit the U.S. Army Institute for Surgical Research and the Brooke Army Medical Center’s Center for the Intrepid.

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