Patent Application
20110065505
1. Field of the Invention
Embodiments of the present invention relate to a virtual reality systems that use a phantom limb and not the normal limb to provide visual feedback to the brain to ameliorate, reduce, treat or eliminate phantom limb pain (PLP). The systems include a gaming console so that it can be accessible, affordable and interactive.
More particularly, embodiments of the present invention relate to a virtual reality systems that use the phantom limb and not the normal limb to provide visual feedback to the brain to ameliorate, reduce, treat or eliminate phantom limb pain (PLP). The system include a gaming console so that it can be accessible, affordable and interactive.
2. Description of the Related Art
Phantom limb pain (PLP) is a genuine phenomenon in patients who have undergone an amputation. PLP is most common after an amputation of the limb. This pain can occur soon after the amputation or may develop later. The intensity of the pain varies from mild to intractable, which can disrupt the patient's life. PLP can then interfere with daily activity of living, sleeping, appetite and concentration. Incidents of patients suffering PLP varies from 30% to 80%. PLP occurs in 50-70% of amputees in the first year after limb amputation. If the patient had severe pain prior to amputation, then the patient will generally have severe pain after the amputation too. Such patients are also more likely to develop the phantom pain.
There is no single treatment that can alleviate this pain. Various modalities have been tried. So far, the only therapies that have shown promise are the “mirror box” therapy developed by Dr. Ramchandran and “virtual reality” therapy developed by Dr. Pettifer. Both of these techniques use the normal limb to perform tasks and fool or trick the brain a created presence of the phantom limb. This provides visual feedback to the brain, which is the most important aspect that helps in treating and managing phantom limb pain.
Thus, only therapies that provide visual feedback of the missing limb appear effective in dealing with PLP. Even though such methods as set forth above are effective, there is still a need in the art for a visual feedback systems to help the patients with phantom limb pain, especially visual feedback systems that accessible, affordable and interactive.
Embodiments of this invention provide visual feedback systems including an optional virtual feedback digital processing unit, a game console in communication with the virtual feedback digital processing unit, a game console controller in communication with the game console or the virtual feedback digital processing unit, a display unit in communication with the game console or the virtual feedback digital processing unit, a receiving signal sensor in communication with the game console or the virtual feedback digital processing unit, a first transmitting sensor associated with a normal limb and a second transmitting sensor associated with a missing limb. In all embodiments, the connections may be wired or wireless depending on console configuration and personal preferences. The transmitting sensors transmit signals relating to motion of the normal and amputated or missing limbs that are received by the receiving sensor to produce an output signal. The game console and/or the virtual feedback digital processing unit, then, uses the output signal from the receiving sensor and a generated image the missing limb stored in the virtual feedback digital processing unit as input to display the patient's missing limb or both limbs on the display unit to provide visual feedback to the patient. Additional transmitting signals can be associated with other parts of the patient's body so that larger parts of the body or the whole body may be simulated. The game console may then use motion detected by the transmitting sensors as input for displaying the patients' missing limb or the missing limb and other body parts involved in computer simulated games so that the patient gets a visual feedback of using the missing limb stimulating the brain areas previously associated with the missing limb and ameliorating, reducing, treating or eliminating phantom limb pain (PLP).
Embodiments of this invention provide visual feedback methods including generating an image of a patient's missing limb using computer software programs or using a mirror image of the patient's normal limb. The methods also include storing the generated image in the visual feedback digital processing unit of a system of this invention. The methods also include using the generated images to display the patient including the missing limb on the display unit. The methods also include manipulating the images to provide visual feedback to the patient associated with simulated use of the missing limb and ameliorating, reducing, treating or eliminating phantom limb pain (PLP).
Embodiments of this invention provide visual feedback methods including generating an image of a patient's missing limb using computer software programs or using a mirror image of the patient's normal limb. The methods also include storing the generated image in the visual feedback digital processing unit of a system of this invention. The methods also include using the generated images to display the patient including the missing limb on the display unit. The methods also include using motion sensor information associated with motion of the normal limb and a portion of the body adjacent the missing limb, where motion of the normal limb and the portion of the body adjacent the missing limb as input to a game console to simulate motion of the missing limb or the normal and missing limbs in motion activated games such as sports games, exercise games, or other games that rely on motion to activate and manipulate the game and ameliorating, reducing, treating or eliminating phantom limb pain (PLP).
The invention can be better understood with reference to the following detailed description together with the appended illustrative drawings in which like elements are numbered the same:
The inventors have found that a visual feedback system can be constructed for reducing phantom limb pain (PLP), where an image of a missing limb is generated and used to visually display the missing limb in activities to provide a visual feedback to a patient. The visual feedback results in a decrease of PLP in a patient that has lost a limb through injury and/or amputation. Certain embodiments of this invention use a game console as the platform for simulating visual activities using the missing limb making the system readily accessible, affordable and interactive. Such systems are ideally suited for treating phantom limb pain in patients with elective amputation due to ischemia, diabetes mellitus, infection, tumors or cancer. Such systems are also ideally suited for treating phantom limb pain in patients with traumatic amputation. Such systems are also ideally suited for treating phantom limb pain in members of the armed forces where the limbs were blown off in the war. Such systems are also ideally suited for treating phantom limb pain in with stroke who are undergoing rehabilitation.
The present methodology is different from the prior art in that we use a generated image of the phantom limb itself and a sensor associated with a portion of the body adjacent the missing limb to visually simulate activities involving the missing limb such a boxing, wrestling, fighting, bowling, playing tennis, playing football, playing soccer, swimming, playing chess, playing any other game or performing any other activity. Thus, our system provides visual feedback relating to use of the missing limb itself and not to use of the normal limb. It utilizes portable, simple, therapeutic entertainment instead of regimented tasks. It will be affordable unlike virtual reality systems that costs a million dollars. It will be easily accessible for patients in their home. It will be interactive, entertaining and fun. It will be useful for all ages.
While some embodiments of the present invention may utilize a separate system to produce or generate an image of a patient's missing limb, other embodiments may use games specifically designed to generate the missing limbs at set up time removing the need for a separate processing unit.
We believe that it could become a standard of care for the treatment of phantom limb pain because of its portability, affordability and patient compliance.
Embodiments of this invention broadly relate to visual feedback systems including a game console and a game console controller in communication the game console or the virtual feedback digital processing unit. The systems also include a display unit in communication the game console or the virtual feedback digital processing unit. The systems also include a receiving signal sensor in communication with the game console or the virtual feedback digital processing unit, a first transmitting sensor associated with a normal limb and in communication and in communication the game console or the virtual feedback digital processing unit, and a second transmitting sensor associated with a missing limb and in communication the game console or the virtual feedback digital processing unit. The communication comprises wired or wireless communication pathways. The transmitting sensors transmit signals relating to motion of the normal and/or missing limbs that are received by the receiving sensor to produce an output signal. The game console, uses the output signal from the receiving sensor and a generated image the missing limb as input to display a patient's missing limb or both limbs on the display unit to provide visual feedback to the patient's brain to ameliorate, reduce, treat or eliminate phantom limb pain (PLP). The systems may also include a virtual feedback digital processing unit, where the virtual feedback unit generates an image of the patient's missing limb and supplies it to the game console. The systems may also transmitting sensors associated with other parts of the patient's body so that larger parts of the body or the whole body may be displayed on the display unit for games that display larger portion of the body. The systems may utilize any game that requires motion of the patient's missing limb.
Embodiments of this invention broadly relate to visual feedback systems including a virtual feedback digital processing unit, a game console in communication with the virtual feedback digital processing unit, and a game console controller in communication with the game console or the virtual feedback digital processing unit. The systems also include a display unit in communication with the game console or the virtual feedback digital processing unit. The systems also include a receiving signal sensor in communication with the game console or the virtual feedback digital processing unit, a first transmitting sensor associated with a normal limb and a second transmitting sensor associated with a missing limb. The communication comprises wired or wireless communication pathways. The transmitting sensors transmit signals relating to motion of the normal and amputated or missing limbs that are received by the receiving sensor to produce an output signal, the game console and/or the virtual feedback digital processing unit use the output signal from the receiving sensor and a generated image the missing limb stored in the virtual feedback digital processing unit as input to display the patient's missing limb or both limbs on the display unit to provide visual feedback to the to the patient's brain to ameliorate, reduce, treat or eliminate phantom limb pain (PLP). The systems may also include transmitting sensors associated with other parts of the patient's body so that larger parts of the body or the whole body may be displayed on the display unit for games that display larger portion of the body. The systems may utilize any game that requires motion of the patient's missing limb.
Embodiments of this invention broadly relate to methods for providing visual feedback including generating an image of a patient's missing limb using computer software programs or using a mirror image of the patient's normal limb. The methods also include storing the generated image in the visual feedback digital processing unit and using the generated image to display the patient including the missing limb on a display unit. The methods also include manipulating the image to provide visual feedback of the patient using the missing limb in computer simulated activities to ameliorate, reduce, treat, or eliminate phantom limb pain (PLP).
Embodiments of this invention broadly relate to methods for providing visual feedback including generating an image of a patient's missing limb using computer software programs or using a mirror image of the patient's normal limb and using the generated images to display the patient including the missing limb on a display unit. The methods also include attaching transmitting motion sensors to the normal limb and a portion of the body adjacent the missing limb and transmitting signals from the sensors when the patient moves the normal limb and/or the portion of the body adjacent the missing limb. The methods also include receiving the transmitted signals as input to a game console and simulating motion of the missing limb or the normal and missing limbs. The methods also include displaying the simulated motion of the missing limb or the normal and missing limbs in a motion activated game, where the displayed simulate motion of the missing limb ameliorates, reduces, treats, or eliminates phantom limb pain (PLP).
Phantom limb pain is a genuine phenomenon in patients who have amputations done. It is most common after an amputation of the limb. This pain can occur soon after the amputation or may develop later. The intensity of the pain varies form mild to intractable that could disrupt the patient's life. It can then interfere with daily activity of living, sleep, appetite and concentration. Incidence of such phantom pain varies from 30%-80%. It occurs in 50-70% in the first year. If the patient had severe pain prior to the amputation, then they have such pain after the amputation too. They are also more likely to develop the phantom pain.
The exact cause of this persistent pain is not known. But various different mechanisms are described: (1) Peripheral mechanism: It may be as a result of continuous from ectopic discharge form the severed nerves due; (2) Central mechanism: It may be due to the reorganization in the cerebral cortex and the thalamus; (3) Psychogenic mechanism: PLP may be psychogenic in origin; and (4) Spinal mechanism: It could be secondary to the deafferentation mechanism in the spinal cord.
As there is no identifiable single cause there is no single treatment for it. Various modalities have been tried. These treatments are based on case reports. There are no randomized trials or meta-analysis for the pain physician to help guide the therapy for this pain. There is also no consensus about the most effective therapy. The modalities that have been tried are: (1) Preemptive analgesia; (2) Medications, (3) Physical means, (4) Interventional pain procedures, and (5) Complementary therapy.
There is some evidence in the literature that preemptive analgesia prior to the amputation and adequate analgesia postoperatively may prevent central sensitization and cortical reorganization thereby either delaying or preventing the development of phantom limb pain. So, regional anesthesia may play a role in management of these patients.
Various classes of drugs like NSAIDS, opiate, anticonvulsants and antidepressants have been sued in the management of phantom limb pain. NSAIDS have a limited role and may be useful early on. Opiates are widely used, especially methadone because of its NMDA antagonistic activity and analgesic effect on the neuropathic pain. However often times the patients are not prescribed adequate amounts of opiates for fear of development of addiction or being affected by the regulatory agencies. Anticonvulsants are used because of their membrane stabilizing effects so they help with the shooting pain. Antidepressants help with the pain as well as the depression. On one drug is useful so we have to make a cocktail of drugs to control this pam. They may need these medications for prolonged periods so the side effects from the medications could be another problem.
These have been tried, but with limited success. Transcutaneous Electrical Nerve Stimulation (TENS) activates the large fibers in the substantia gelatinosa in the spinal cord and thereby close the gate. So, the responses from the small fibers do not have access to the spinal cord. This diminishes the traffic of the impulses to the spinothalamic tract leading to pain relief.
Electroconvulsive therapy (ECT) has been tried in the cases of intractable phantom limb pain with some success. The hypothesis is that it works by induction of thalamo-cortical changes. It might be an effective therapy but there is no conclusive evidence to prove that. The major side effect is development of retrograde and anterograde amnesia.
Myoelectric prosthesis has been tried but it too has not proven to be beneficial with in reducing or controlling the phantom limb pain.
Procedures like peripheral nerve blocks, sympathetic nerve blocks, and epidural steroid injections have been tried for the phantom limb pain, stump pain and pain from the neuroma. Neurodestructive procedures have also been tried to get control of the pain. Doral Root Entry Zone (DREZ) lesions have been done to ablate the afferent input in the spinal cord. Even a spinal cord stimulator and deep brain stimulation have been tried. All these measures provide either no relief or temporary pain relief from the phantom limb pain.
These include acupuncture, biofeedback, massage and vibration therapies. Visual imagery has been helpful. Dr. Ramchandran a neurologist interested in neuroplasticity first suggested that phantom limb pain may be due to changes in the brain rather than the peripheral nerves. In the somatosensory homunculus, the body is represented in an orderly manner. Input from the face is located next to the input from the hand Ramchandran put forth the theory that when the arm is amputated that cortical area is vacated because of the lack of the peripheral input. This territory is then invaded by the surrounding neurons of the face as shown in
The visual mirror feedback theory has now been proven by double blind placebo controlled trials in alleviation of the phantom limb pain. fMRI has also shown that when there is visual feedback from the limb, the area invaded by surrounding neurons regresses and the pain gets better when the mirror box is used as shown in
Referring now to
Embodiments of this invention include use a game console such as an Nintendo Wii console, Sony PS console, XBOX console or similar game consoles. The consoles are used to display simulated activities involving the missing limb or limbs, decreasing PLP. Movements displayed by the console are sensed using a receiving sensor from transmitting sensors associated with a patients' healthy limb or limbs and the patient's missing limb or limbs.
In certain embodiments, we first produce a mirror image of the patients' healthy limb to produce a usable image of a patient's missing limb. One way of producing the mirror image is to place the normal limb of the amputee in a mirror box producing an image of the phantom arm. The mirror image will be stored in the visual feedback computer unit as an image of the missing limb. When this image is projected on the display unit, the patient will see his/her own missing limb or the phantom limb. This will then provide the visual feedback to the brain, which is the essential component of the treatment of phantom limb pain. The computer unit can include exercises or tasks for the patient to undergo with the normal limb resulting in simulated motion of the missing limb. Of course, the unit may also display motion by both limbs using motion transmitting sensors on both the normal and missing limbs. In other embodiments, the unit is in electronic communication with a game console so that the sensor input data is used by the game console to display visual simulations using the missing limb or both the normal and missing limb.
Referring now to
Referring now to
Referring now to
A second sensor Remote 2 will be placed in a normal limb. The Remote 2 will allow the patient to activate the particular function of the game they are playing, e.g., throwing a bowling ball, while playing bowling. Such interactive games then can be played by the patient displaying the patient having and using the missing limb supplying need visual feedback to treat PLP and reducing PLP symptoms. Suppose the patient had the right forearm amputated. This patient will use the of bowling. The Remote 1 can be placed on the elbow of the amputated arm. The Remote 2 will be placed in the left or normal hand. When the patient is ready to discharge the bowling bowl, the signal sensor will sense the motion and display a generated image of the right arm, where the generated image may be generated from a mirror image of the left hand that is stored in the VREST computer and the patient sees it as the right hand (phantom) motion on the television screen. The patient will trigger the activity of discharging the bowling bowl with the Remote 2 in the left hand. The television monitor will show the patient throwing a bowling bowl with his right hand. This then will provide the visual feedback from the phantom hand to the brain. Such a device will be interactive, fun provide a continuous visual feedback to the brain.
All references cited herein are incorporated by reference. Although the invention has been disclosed with reference to its preferred embodiments, from reading this description those of skill in the art may appreciate changes and modification that may be made which do not depart from the scope and spirit of the invention as described above and claimed hereafter.
This application claims the benefit of and priority to U.S. Provisional Application Ser. No. 61/237,481, filed 27 Aug. 2009 (Aug. 27, 2009).
| Number | Date | Country | |
|---|---|---|---|
| 61237481 | Aug 2009 | US |
