Efficacy and Mechanisms of Virtual Reality Treatment of Phantom Leg Pain

虚拟现实治疗幻腿痛的疗效及机制

• 批准号: 10693960
• 负责人: LAUREL J BUXBAUM
• 金额: $ 54.9万
• 依托单位: ALBERT EINSTEIN HEALTHCARE NETWORK
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-10 至 2026-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10693960
• 关键词: Adherence; Aftercare; Agreement; Algorithms; Amputation; Anxiety; Auditory; Behavioral; Biological Markers; Brain; Client satisfaction; Clinical; Consent; Data; Development; Dropout; Ensure; Equipment; Esthesia; Feedback; Feeling; Functional Magnetic Resonance Imaging; Functional disorder; Grant; Graph; Home; Human; Image; Individual; Intervention; Investigation; Knee; Laboratories; Leg; Limb structure; Lower Extremity; Magnetic Resonance Imaging; Measures; Mental Depression; Mental Health; Methods; Modification; Motion; Motor; Movement; Nature; Neuroanatomy; Neuronal Plasticity; Pain; Pain in lower limb; Pain management; Participant; Persistent pain; Persons; Phantom Limb; Phantom Limb Pain; Pharmaceutical Preparations; Play; Prediction of Response to Therapy; Predictive Factor; Quality of life; Randomized; Randomized, Controlled Trials; Research; Rest; Safety; Sampling; Sensory; Signal Transduction; Syndrome; System; Tactile; Target Populations; Testing; Treatment Efficacy; Treatment Protocols; Treatment outcome; Upper Extremity; Vision; Visual; Work; arm; classification trees; clinical biomarkers; clinical implementation; comorbidity; comparative efficacy; cost; debilitating pain; design; efficacious treatment; experience; falls; follow-up; head mounted display; imaging biomarker; imaging study; indexing; intense pain; limb amputation; limb loss; multimodality; neural; neuroimaging marker; pain reduction; predicting response; predictive marker; programs; psychologic; regression trees; sensory feedback; telerehabilitation; translational pipeline; treatment optimization; treatment response; ultra high resolution; virtual; virtual reality; visual feedback

Project Summary Limb loss due to amputation is a common problem, occurring in nearly 2 million people in the US. Approximately 90% of individuals with limb amputation experience the persistent sensation of the missing extremity, known as a phantom limb, and up to 85% experience persistent and debilitating pain in the missing limb, termed phantom limb pain (hereafter PLP). We previously demonstrated that Virtual Reality (VR) with active leg movements and vision of a virtual limb significantly reduce phantom limb pain in subjects with below the knee amputations. The work proposed here has several objectives. In Specific Aim 1 we will randomize 40 subjects with PLP to treatment with our Active VR or a commercially available VR pain treatment (Cool!). In Specific Aim 2 we propose to develop a home intervention for PLP using the intervention (Active VR or Cool!) that in Specific Aim 1 proved to be most efficacious. In specific Aim 3 we will obtain multimodal ultra-high resolution (7T) MRI imaging in subjects with PLP before and after treatment, and normal subjects without amputation; we will also attempt to develop imaging biomarkers that predict efficacy of treatment. Imaging studies will address a number of controversies regarding the neural basis of PLP and explore human neuroplasticity more generally. Finally, in Specific Aim 4 we propose to determine factors that could be used in a clinical biomarker-based algorithm to predict response to home-based VR treatment. Using classification and regression tree (CART) analysis with the data from Aim 2, we will identify behavioral and neuroanatomic factors that predict treatment response. By the end of the grant period, we will have determined the relative efficacy of two VR treatments for PLP, assessed the feasibility and efficacy of a low-cost home-based treatment, determined the neuroanatomic changes associated with treatment response using advanced methods, and explored the behavioral and neuroimaging biomarkers predicting treatment response. These data will provide a critical step toward clinical implementation of a VR treatment protocol for PLP and will advance theoretical understanding of the mechanisms and functional neuroanatomy of PLP.

项目总结