The Effectiveness of Electromyographic Biofeedback, Mirror Therapy, and Tactile Stimulation in Decreasing Chronic Residual Limb Pain and Phantom Limb Pain for a Patient with a Shoulder Disarticulation: A Case Report
PURPOSE: Approximately 1.3 million people in the United States live with limb loss, and most experience some form of residual limb pain or phantom limb pain (PLP). The purpose of this case report was to determine the effectiveness of mirror therapy, biofeedback, and tactile stimulation in decreasing chronic residual limb pain and PLP in a patient with an upper limb traumatic amputation.
CASE DESCRIPTION: A 48-year-old male employed as a mechanical construction worker was working on a conveyer belt when the belt caught his arm resulting in a traumatic shoulder disarticulation. According to the International Classification of Functioning, Disability, and Health (ICF), the patient’s activity limitations included difficulty with sleeping, household chores, yard work, and cooking. Participation limitations included decreased recreational activities with his 15-year-old son, limited personal interactions with his wife, and decreased confidence with general daily activities.
Interventions included electromyographic (EMG) biofeedback training to infraspinatus and pectoralis major muscles in short/quick, sustained, and gradual contraction with decreasing sensitivity of electrodes. Treatment strategies also included mirror therapy, scapular proprioceptive neuromuscular facilitation (PNF), high-voltage electrical stimulation, retrograde massage, scar mobilizations, tactile cuing, and soft tissue mobilization.
OUTCOMES/DISCUSSION: The patient demonstrated a 30% decrease in Disability of the Arm, Shoulder, and Hand (DASH) score, decreased pain with Numeric Pain Rating (NPR) from 9/10 to 3/10, increased amplitude of contraction of infraspinatus and pectoral muscles, decreased sensitivity of myoelectric electrodes, and decreased edema. The patient reported increased confidence in social interactions with friends and personal interactions with his wife. The patient was able to participate in recreational activities with his teenage son.
CONCLUSION: The outcomes support the use of multiple interventions including EMG biofeedback, mirror therapy, and tactile stimulation when treating a patient with functional deficits, residual limb and phantom limb pain.
CLINICAL MERIT/SIGNIFICANCE: It is important to address muscular control through the use of biofeedback for pre-prosthetic training, improving the patient perception of movement, decreasing the patient’s fear of movement, and enhancing the overall patient’s perception of self-improvement.
Thomas, Stephanie and Smith, Kayla, "The Effectiveness of Electromyographic Biofeedback, Mirror Therapy, and Tactile Stimulation in Decreasing Chronic Residual Limb Pain and Phantom Limb Pain for a Patient with a Shoulder Disarticulation: A Case Report" (2016). Physical Therapy Collection. 37.