THE EFFECT OF NEUROPSYCHOLOGICAL MOTOR PHYSICAL THERAPY ON THE INTENSITY OF PHANTOM PAIN IN AMPUTATED LIMBS

Abstract

Limb amputation is a surgical procedure to remove part or all of a limb, performed for life-saving reasons (gangrene, infection, tumor) or as a result of severe trauma (traumatic amputation). Amputation is aimed at saving the patient's life, eliminating the source of infection or non-viable tissue, followed by the formation of a stump for subsequent prosthetics. Limb amputation is a complex physical and psychological problem for the patient, radically changing their life, relationships in the family, at work, and in society. The problem is accompanied by loss of mobility, depression, phantom pain, and social isolation. Unfortunately, to date, there is no complete understanding of the causes, mechanisms, and ways to overcome phantom pain, and therefore research on this problem continues. The aim of the study is to determine the effectiveness of overcoming phantom pain through the combined use of neuropsychological methods of physical therapy (phantom-ideomotor gymnastics and mirror therapy) with the aim of overcoming phantom pain. Materials and methods. Twenty-two patients with moderate to severe phantom pain, rated on a 6-point verbal rating scale, after amputation of the limbs at the hip and lower leg participated in the experimental study. Patients were randomly divided into two groups – control (n=11) and main (n=11). During the experimental study, patients in both groups were treated and rehabilitated using the same method – the program adopted by the medical facility. Patients in the main group additionally underwent treatment using the experimental method. The experimental treatment lasted 1.5 months. In the first half of the day, under the guidance of an instructor, patients performed 15-minute courses of ideomotor exercises on the amputated limb, and in the second half of the day, they underwent 15-minute sessions of mirror visual feedback (mirror therapy). This mutually reinforcing effect of both types of neuropsychological motor physical activity contributed to the formation and restoration of various connections in the cerebral cortex, which led to a reduction in the intensity of phantom pain. Results. As a result of the experimental study, which lasted for 6 weeks, the following results were obtained: in patients in the main group, phantom pain sensations significantly decreased compared to the control group, namely: the intensity of phantom pain decreased from 7.18 to 4.05 points, a difference of 3.13 points, which in percentage terms amounted to 45.03%; phantom pain in patients in the control group decreased from 7.16 to 6.10 points, i.e., the difference was 1.06 points, or 13.56%. Thus, the difference in the dynamics of phantom pain intensity between patients in the main and control groups is 31.47%. Conclusion. Methods of neuropsychological motor physical therapy, namely phantom-ideomotor exercises combined with mirror gymnastics with visual feedback (mirror therapy), are simple and accessible means of overcoming phantom pain, which allows this technique to be widely practiced in the practical work of physical therapists.