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Phantom limb pain case study
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Amputation often causes patients to experience sensory illusions that the limb is still present. This is often called a phantom limb. This sense of having a phantom limb is a natural and frequent development during the recovery of an amputation. (1) (2) It is reported that at first, the phantom limb feels normal in size and shape, but in time this illusion of the size of the phantom limb usually becomes smaller.(1)
Phantom limb pain is a painful sensation experienced in a body part which is no longer part of the body, often due to amputation.(3) Individuals also reported that tingling as well as various types of pain have occurred, and these sensations may eventually disappear or may persist as cramping, shooting, burning or crushing sensations.(1) (4) Various studies report that phantom limb pain occurs in between 0,4-90 percent of cases.(1) (2) (4) (5) (6) Recently it was found that phantom limb pain occurs in approximately 50-85% of patients several months or years after the amputation, rather than immediately after the amputation.(1) (4)
Studies have found that phantom limb pain is closely connected with the somatosensory cortex.(2) (4) There is evidence that amputation of a limb leads to cortical reorganization and that phantom limb pain may be related to incongruency between motor intention, somatosensation and visual feedback. (4) The cortical contributions towards phantom limb pain come from various studies that show neuroplastic changes in the primary somatosensory and motor cortices after amputation. (4)
Treatment of phantom limb pain is difficult and no specific method of treatment has been confirmed.(1) (4) (5) The treatment of phantom limb pain includes medication, various forms of physical treatment, nerve blocki...
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...antom limb pain. While mirror therapy makes use of visuomotor stimulation and is found to beneficial dependent on the type of pain experienced, illusory touch makes use of visuotactile stimulation and is said to be effective in those patients who generally experience pain on movement and it is suggested that the point of stimulation is imported in the effectiveness of the sensations experienced in the phantom limb. It is also evident that more extensive research needs to be done on both mechanisms of treatment and that the role of occupational therapy in the use of these treatment modalities is not well documented despite their being a clear role for occupational therapy in the treatment of phantom limb pain. Most studies document the use of mirror therapy in occupational therapy with regard to movement of a limb rather than its use in the treatment of sensation.
His aim was to in-crease amputees’ confidence in the use of their prosthetics and their mental attitude. He recruited 100 volunteer amputees and put them through the programme. The results sug-gested that he achieved his aim he noted improvements in the physical and mental well-being of the volunteers. They also gained confidence in using their prosthetic which aided their recovery. Their mental well-being was particularly important as it was noted that a positive mental attitude and acceptance of the prosthetic resulted in a quicker recovery time (Dillingham, T.R., 1998).
“Amputees by Choice” written by Bayne and Levy, conists of an unusual topic. Bayne and Levy examine and discuss two basic questions. The first question they look into is the motivations people to have a perfectly healthy limb amputated? The other question concerns what circumstances would a doctor comply with a patients’ wish to get a limb amputated. Along with the other two questions, Levy and Bayne discuss other erratic cases involving the amputation of one’s limbs. More specifically, Levy and Bayne attempt to define and analyze Body Dysmorphic Disorder (BDD). This disorder occurs when people think incorrectly about their healthy limbs. In addition to BDD, Apotemnophiles are sexually attracted to amputees, and are sexually excited by the fact that maybe becoming an amputee as well.
Two ideas about the nervous system that can be better understood from these observations are the concepts of having and locating the I-function. It seems that the I-function here is very often affected in terms of voluntary movement. A person with Arnold-Chiari malformation who has lost the feeling in and control of his arm for example will not be able to move it even upon someone's request and his or her own desire to do so. Some use of the I-function is definitely impaired. However, these observations do not seem to necessarily imply that some part of the I-function was damaged, because it may very well be located elsewhere- connections may have simply been lost. A person with Arnold-Chiari can still think and have a sense of self, but somehow can not connect with the various body parts that can be affected. Some uses and pathways of the I-function can be understood, but the exact location of it remains vague.
Strange as that this may sound, when a Wannabee person lose a limb they are actually gaining so much more of who they felt they are. As one Amputee said to his doctor “you have made me the happiest of all men by taking away from me a limb which put an invincible obstacle to my
Have you ever wondered why when you stub your toe on the chair in the living room, it helps tremendously to yell out an expletive or two and vigorously rub the area? I may not be able to discuss the basis for such language in this paper, but we will explore the analgesic response to rubbing that toe, in addition to the mechanism of pain and alternative treatments such as acupuncture and transcutaneous electrical nerve stimulation.
Amputation and Surgery in the 19th Century Surgery and Amputation During this period a deep cut could lead to infection, and the only treatment for infections was amputation and catheterization. However, hospitals and medical instruments were hardly ever sanitized, so one could often come out of the hospital worse than when one went in (Bloodwiki). It is not uncommon for a person to survive a surgery only to be set upon by diseases such as hospital gangrene and septicaemia (Youngson 29). Youngson describes hospitals as “dark and overcrowded, ill-run and insanitary”. It was not uncommon to see in the same ward, at the same time, cases of, (let us say) typhoid fever, erysipelas, pneumonia, rickets, dysentery; nor was it uncommon to see two patients in the same bed” (Youngson 24).
This article discusses the basic understanding of what occupational therapy is and what it the Occupation is defined as “activites of everyday life, names, organized and given meaning by individuals and a culture” (Association, 2006). This article also discusses the historical aspects of occupational therapy. Occupational therapy was founded by many different professionals with different backgrounds, that came together to share the same idea about how occupational therapy should be and the importance of activites for a person. This article also talks about different types of services that occupational therapy offers. Occupational therapists and assistances can work in many different settings.
A hypothesis that can be made from the patient’s report is that she is suffering from cervical radiculopathy, or a nerve root lesion. Symptoms that describe cervical radiculopathy include: arm pain in a dermatome distribution, pain increased by extension, rotation, and/or side flexion, possible relief of pain from arm positioned overhead, affected sensation, altered hand function, no spasticity, and no change to gait or bowel and bladder function (Magee, 2008, p. 142). These symptoms correlate to what the patient reported as a result of her injury. She stated that her pain is in the posterolateral upper and lower arm with aching and paresthesia in the thumb and index finger, which is in the dermatome pattern of cervical root 5 and 6 (C5, C6) (Magee, 2008, p. 25). She also reports lancinating pain with extension or rotation to the right of her head.
Another researcher has stated that instead of there being additional connections, the synaesthesia might be a result from disinhibited feedback in neural pat...
The two controversial topics discussed below share a single goal: to enhance the quality of life of a human individual. The first topic, transhumanism, is a largely theoretical movement that involves the advancement of the human body through scientific augmentations of existing human systems. This includes a wide variety of applications, such as neuropharmacology to enhance the function of the human brain, biomechanical interfaces to allow the human muscles to vastly out-perform their unmodified colleagues, and numerous attempts to greatly extend, perhaps indefinitely, the human lifespan. While transhumanist discussion is predominantly a thinking exercise, it brings up many important ethical dilemmas that may face human society much sooner than the advancements transhumanism desires to bring into reality. The second topic, elective removal of healthy limbs at the request of the patient, carries much more immediate gravity. Sufferers of a mental condition known as Body Integrity Identity Disorder seek to put to rest the disturbing disconnect between their internal body image and their external body composition. This issue is often clouded by sensationalism and controversy in the media, and is therefore rarely discussed in a productive manner (Bridy). This lack of discussion halts progress and potentially limits citizens' rights, as legislation is enacted without sufficient research. The primary arguments against each topic are surprisingly similar; an expansion on both transhumanism and elective amputation follows, along with a discussion of the merit of those arguments. The reader will see how limits placed on both transhumanism and elective amputation cause more harm to whole of human society than good.
Occupational therapy was based off of psychology; we evolved from treating mentally ill patients with isolation as an efficient treatment plan. We must never forget we are known to be “the art and science of helping people do the day-to-day activities that are important and meaningful to their health and well being through engagement in valued occupations” (Crepeau, Cohn, & Schell, 2008). To other professional disciplines this article explains the difference between each of us, yet can also express our relation to one another. The basic goal of all therapeutic disciplines is to better our clients life, through physical, speech or occupational therapy. Every discipline targets different goals, may it be body mechanics, reducing a stutter or buttoning a shirt, at the end of the day our clients well being may it be through science, art or both is all that matters. To the occupational therapy field this article means progress for what we do. Reading this article today in the year 2015 did not seem like old information to me, it is still relevant, I am proud that our field is not only evolving with contemporary time but it is also maintaining its
Phantom pain refers to the phenomenal experience of pain in a body part that has been amputated or deafferented (Flor, Nikolajsen & Jensen, 2006). The characteristics of phantom pain have been described to occur in quick and sudden attacks of pain shooting up and down the amputated limb as well as cases of constant, excruciating pain whilst intensely perceiving the amputated limb to be cramped or postured abnormally (Katz, 1992). Approximately eighty percent of amputees report suffering from or at least experiencing some level of phantom pain post amputation; therefore it is a prominent issue (Flor, Nikolajsen & Jensen, 2006). Phantom pain is neuropathic pain that has no individual trigger but instead a plethora of psychobiological aspects of neuroplasticity that contribute to the cause of phantom pain (Grusser, Diers & Flor, 2003). The following will: outline the role of the peripheral and central factors associated with phantom pain and discuss the cortical reorganisation of the somatosensory cortex in relation to phantom pain.
In diabetes, pain that is located in the upper and lower extremities is referred to as Painful Diabetic Neuropathy (PDN) (Stein et al., 2013). Other names, such as Painful Diabetic Peripheral Neuropathy (PDPN) and Diabetic Peripheral Neuropathy (DPN) are also used to describe this symptom (Zelman, Brandenburg, & Gore, 2006). For continuity of this paper, the term PDN will be used. PDN is considered a chronic pain, and a common complaint is increased peripheral pain at night that disrupts sleep (Zelman et al., 2006). This exacerbated nighttime pain and disruption in sleep can affect the overall health and quality of life for the diabetic person (Zelman et al., 2006).
The previous insert from William Lee Adams’ article, Amputee Wannabes, describes a 33-year-old man’s wish for amputation of his foot. There was nothing physically or medically wrong with this limb; John only stated that he did not feel comfortable with his own body and felt as though his foot was not a part of him. John’s leg was amputated above the knee, and he went on to describe that the operation resolved his anxiety and allowed him to be at ease in his own body (Adams, 2007).
The Principles of Psychology. Toronto, Ontario: York University. L. R. Hochberg, M. D. (2006). Neuronal ensemble control of prosthetic devices in a human with tetraplegia. Nature, 164-71.