Strategies for graded motor imagery for clients with phantom limb pain and cognitive impairment
Individuals with amputations often experience phantom limb pain (PLP) that can limit their participation in rehabilitation, prosthesis training, desired activities, and roles. One nonpharmacological rehabilitation intervention for PLP is graded motor imagery (GMI). There are several components to GM...
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| Published in: | Prosthetics and orthotics international Vol. 46; no. 5; pp. 496 - 499 |
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| Main Authors: | , , , , , , , |
| Format: | Journal Article |
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01-10-2022
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| Abstract | Individuals with amputations often experience phantom limb pain (PLP) that can limit their participation in rehabilitation, prosthesis training, desired activities, and roles. One nonpharmacological rehabilitation intervention for PLP is graded motor imagery (GMI). There are several components to GMI, including right/left discrimination or laterality, motor imagery, sensory retraining, and mirror therapy. Successful implementation of GMI requires a range of cognitive skills, such as attention span, working memory, abstract reasoning, and planning. For individuals with PLP who concurrently display cognitive impairments, GMI protocols can be adapted using strategies derived from clinical practice.
The purpose of this technical clinical report was to discuss the application of clinically implemented cognitive compensation techniques to GMI instruction.
Not applicable.
Clinical expert opinion to explore adaptations for GMI.
Graded motor imagery can be an effective tool for pain treatment; however, some clients may need greater clinician support due to existing cognitive difficulties.
For clients to be successful, active engagement in learning about and implementing GMI techniques is necessary.
When serving the lifetime amputation care needs of patients with cognitive deficits, we find that targeted learning strategies and accommodations can be helpful when introducing GMI concepts and skill development. Enhanced patient education techniques support client learning. |
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| AbstractList | BACKGROUNDIndividuals with amputations often experience phantom limb pain (PLP) that can limit their participation in rehabilitation, prosthesis training, desired activities, and roles. One nonpharmacological rehabilitation intervention for PLP is graded motor imagery (GMI). There are several components to GMI, including right/left discrimination or laterality, motor imagery, sensory retraining, and mirror therapy. Successful implementation of GMI requires a range of cognitive skills, such as attention span, working memory, abstract reasoning, and planning. For individuals with PLP who concurrently display cognitive impairments, GMI protocols can be adapted using strategies derived from clinical practice. OBJECTIVESThe purpose of this technical clinical report was to discuss the application of clinically implemented cognitive compensation techniques to GMI instruction. STUDY DESIGNNot applicable. METHODSClinical expert opinion to explore adaptations for GMI. TECHNIQUEGraded motor imagery can be an effective tool for pain treatment; however, some clients may need greater clinician support due to existing cognitive difficulties. RESULTSFor clients to be successful, active engagement in learning about and implementing GMI techniques is necessary. CONCLUSIONSWhen serving the lifetime amputation care needs of patients with cognitive deficits, we find that targeted learning strategies and accommodations can be helpful when introducing GMI concepts and skill development. Enhanced patient education techniques support client learning. Individuals with amputations often experience phantom limb pain (PLP) that can limit their participation in rehabilitation, prosthesis training, desired activities, and roles. One nonpharmacological rehabilitation intervention for PLP is graded motor imagery (GMI). There are several components to GMI, including right/left discrimination or laterality, motor imagery, sensory retraining, and mirror therapy. Successful implementation of GMI requires a range of cognitive skills, such as attention span, working memory, abstract reasoning, and planning. For individuals with PLP who concurrently display cognitive impairments, GMI protocols can be adapted using strategies derived from clinical practice. The purpose of this technical clinical report was to discuss the application of clinically implemented cognitive compensation techniques to GMI instruction. Not applicable. Clinical expert opinion to explore adaptations for GMI. Graded motor imagery can be an effective tool for pain treatment; however, some clients may need greater clinician support due to existing cognitive difficulties. For clients to be successful, active engagement in learning about and implementing GMI techniques is necessary. When serving the lifetime amputation care needs of patients with cognitive deficits, we find that targeted learning strategies and accommodations can be helpful when introducing GMI concepts and skill development. Enhanced patient education techniques support client learning. |
| Author | Vogsland, Rebecca J Rich, Tonya L Brielmaier, Steven M Marth, Lindsay A Kiecker, Jessica E Macedo, Franz J Ferguson, John E Hansen, Andrew H |
| Author_xml | – sequence: 1 givenname: Tonya L orcidid: 0000-0002-9419-7259 surname: Rich fullname: Rich, Tonya L organization: Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN, USA – sequence: 2 givenname: Lindsay A orcidid: 0000-0003-2060-6272 surname: Marth fullname: Marth, Lindsay A organization: Minneapolis VA Health Care System, Minneapolis, MN, USA – sequence: 3 givenname: Steven M orcidid: 0000-0002-8548-992 surname: Brielmaier fullname: Brielmaier, Steven M organization: Minneapolis VA Health Care System, Minneapolis, MN, USA – sequence: 4 givenname: Jessica E surname: Kiecker fullname: Kiecker, Jessica E organization: Minneapolis VA Health Care System, Minneapolis, MN, USA – sequence: 5 givenname: Rebecca J orcidid: 0000-0003-4928-2793 surname: Vogsland fullname: Vogsland, Rebecca J organization: Minneapolis VA Health Care System, Minneapolis, MN, USA – sequence: 6 givenname: Franz J surname: Macedo fullname: Macedo, Franz J organization: Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN, USA – sequence: 7 givenname: John E orcidid: 0000-0002-9944-1003 surname: Ferguson fullname: Ferguson, John E organization: Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN, USA – sequence: 8 givenname: Andrew H orcidid: 0000-0002-2599-6436 surname: Hansen fullname: Hansen, Andrew H organization: Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN, USA |
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| Cites_doi | 10.1155/2018/5080123 10.1212/WNL.0000000000006955 10.1177/1545968311433209 10.1016/j.nicl.2015.09.018 10.1016/j.avsg.2018.07.070 10.1177/2049463715590884 10.1016/j.pscychresns.2020.111151 10.1080/09593985.2017.1288283 10.1097/MLR.0000000000000497 10.1515/nf-2017-A018 10.1002/pmrj.12556 10.1016/j.ejpain.2006.06.002 10.1016/j.physio.2019.06.009 |
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| References | Moran (R13-20230824) 2019; 92 Batsford (R8-20230824) 2017; 33 Alviar (R2-20230824) 2016; 10 Brodie (R11-20230824) 2007; 11 Whittaker (R14-20230824) 2019; 56 Flor (R5-20230824) 2017; 23 Duarte (R6-20230824) 2020; 304 Trevelyan (R3-20230824) 2016; 10 Limakatso (R10-20230824) 2021; 13 Fuchs (R7-20230824) 2018; 2018 Moseley (R9-20230824) 2012; 26 Kean (R17-20230824) 2016; 54 Limakatso (R12-20230824) 2020; 109 Barr (R1-20230824) 2018; 10 Jutzeler (R4-20230824) 2015; 9 |
| References_xml | – volume: 2018 start-page: 5080123 year: 2018 ident: R7-20230824 article-title: Psychological factors associated with phantom limb pain: a review of recent findings publication-title: Pain Res Manag doi: 10.1155/2018/5080123 contributor: fullname: Fuchs – volume: 92 start-page: e823 year: 2019 ident: R13-20230824 article-title: Type 2 diabetes mellitus, brain atrophy, and cognitive decline publication-title: Neurology doi: 10.1212/WNL.0000000000006955 contributor: fullname: Moran – volume: 26 start-page: 646 year: 2012 ident: R9-20230824 article-title: Targeting cortical representations in the treatment of chronic pain: a review publication-title: Neurorehabil Neural Repair doi: 10.1177/1545968311433209 contributor: fullname: Moseley – volume: 9 start-page: 599 year: 2015 ident: R4-20230824 article-title: Relationship between chronic pain and brain reorganization after deafferentation: a systematic review of functional MRI findings publication-title: Neuroimage Clin doi: 10.1016/j.nicl.2015.09.018 contributor: fullname: Jutzeler – volume: 56 start-page: 261 year: 2019 ident: R14-20230824 article-title: Short-term mortality, morbidity and recovery milestones after major lower limb amputation: a prospective evaluation of outcomes in a tertiary center publication-title: Ann Vasc Surg doi: 10.1016/j.avsg.2018.07.070 contributor: fullname: Whittaker – volume: 10 start-page: 70 year: 2016 ident: R3-20230824 article-title: Perceptions of phantom limb pain in lower limb amputees and its effect on quality of life: a qualitative study publication-title: Br J Pain doi: 10.1177/2049463715590884 contributor: fullname: Trevelyan – volume: 10 start-page: CD006380 year: 2016 ident: R2-20230824 article-title: Pharmacologic interventions for treating phantom limb pain publication-title: Cochrane Database Syst Rev contributor: fullname: Alviar – volume: 304 start-page: 111151 year: 2020 ident: R6-20230824 article-title: Cortical plasticity in phantom limb pain: a fMRI study on the neural correlates of behavioral clinical manifestations publication-title: Psychiatry Res Neuroimaging doi: 10.1016/j.pscychresns.2020.111151 contributor: fullname: Duarte – volume: 33 start-page: 173 year: 2017 ident: R8-20230824 article-title: Non-pharmacological conservative therapy for phantom limb pain: a systematic review of randomized controlled trials publication-title: Physiother Theory Pract doi: 10.1080/09593985.2017.1288283 contributor: fullname: Batsford – volume: 54 start-page: 414 year: 2016 ident: R17-20230824 article-title: Comparative responsiveness of the PROMIS pain interference short forms, brief pain inventory, PEG, and SF-36 bodily pain subscale publication-title: Med Care doi: 10.1097/MLR.0000000000000497 contributor: fullname: Kean – volume: 23 start-page: A111 year: 2017 ident: R5-20230824 article-title: Origin of phantom limb pain: a dynamic network perspective publication-title: Neuroforum doi: 10.1515/nf-2017-A018 contributor: fullname: Flor – volume: 10 start-page: CD005260 year: 2018 ident: R1-20230824 article-title: Prosthetic rehabilitation for older dysvascular people following a unilateral transfemoral amputation publication-title: Cochrane Database Syst Rev contributor: fullname: Barr – volume: 13 start-page: 1216 year: 2021 ident: R10-20230824 article-title: Treatment recommendations for phantom limb pain in people with amputations: an Expert Consensus Delphi Study publication-title: PM R doi: 10.1002/pmrj.12556 contributor: fullname: Limakatso – volume: 11 start-page: 428 year: 2007 ident: R11-20230824 article-title: Analgesia through the looking-glass? A randomized controlled trial investigating the effect of viewing a “virtual” limb upon phantom limb pain, sensation and movement publication-title: Eur J Pain doi: 10.1016/j.ejpain.2006.06.002 contributor: fullname: Brodie – volume: 109 start-page: 65 year: 2020 ident: R12-20230824 article-title: The effectiveness of graded motor imagery for reducing phantom limb pain in amputees: a randomized controlled trial publication-title: Physiotherapy doi: 10.1016/j.physio.2019.06.009 contributor: fullname: Limakatso |
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