Myoelectric and Progressive Motor Training for Phantom Limb Pain in People with Amputations During War: A Feasibility Report

Purpose: Phantom limb pain (PLP) is a common condition after limb amputation which is notoriously difficult to treat. The Russian full-scale invasion of Ukraine has resulted in over 100,000 people with amputated limbs and persistent PLP. This study reports on the feasibility of implementing two novel treatment approaches, Phantom Motor Execution (PME) and Progressive Motor Training (PMT), during the Russian war on Ukraine. Methods: PME and PMT follow the principle of facilitating motor training of the phantom limb and are grounded on the Stochastic Entanglement hypothesis for the pathogenesis of PLP. PME employs myoelectric pattern recognition on residual limb muscles to control virtual and augmented reality environments (mixed reality). PMT uses mixed reality to guide patients to imagine or execute predefined movements according to their evolving motor skills, and it is suitable for patients where myoelectric signals are not viable. Nineteen participants with major limb amputation were treated with PME (N=8) and PMT (N=11). Results: Participants who completed 9 sessions reported a reduction of PLP greater than 50%. Participants received half of the training time per session and less sessions than reported in previous studies, yet clinically meaningful pain reductions were observed. Conclusion: This study demonstrates the feasibility of implementing PME and PMI for the treatment of PLP during war time and constraint resources. Ukrainian clinicians found the technologies and treatment approaches efficient and effective at reducing PLP and have introduced them as part of their clinical practice.