KEEP CURRENT with END THE PAIN PROJECT

2012-01-29T10:54:00.001-08:00

Sin Chew Daily, the Malaysian Chinese-language newspaper, publishes article by Ng Yen Choo about Hoe the amputee calligrapher and ETPP on the front page of its Melaka, Malaysia edition in January, 2012.

HOE --AN INSPIRED AMPUTEE CALLIGRAPHER

2012-01-22T18:43:00.000-08:00

Meet Hoe, whom I met on my recent trip to SE Asia to teach mirror therapy ... one of the most amazing people on the face of the earth. --Moira Judith Mann

Hoe, a 42-year old double upper limb amputee is a self-taught calligrapher who started practicing the art twenty years ago after an industrial accident in China severed her left arm and her right hand.

Hoe straps a calligraphy brush to her right arm stub and then, as she reports, uses her phantom hand to guide her strokes.

Hoe produces calligraphy by donation from a street stand in Malaka, Malaysia, supporting two daughters going to university in China with her earnings.

Even twenty years after her accident, Hoe experiences phantom limb pain, particularly in the remaining stub of her left arm. End The Pain Project has taken steps to relieve this pain through various methods, including Farabloc and an EMF band.

Hoe has great dignity and focuses on perfecting her calligraphy style. She hopes to inspire other amputees through her efforts.

Hoe explaining her calligraphy at her street stand in Melaka, Malaysia.

Hoe and Moira Judith Mann, Co-Founder of End The Pain Project in December 2011, Melaka Malaysia.

In February, 2012, Shannon Nill, an upper arm amputee from Oregon, displays the calligraphy created for him by Hoe in gratitude for an EMF band donated by Nill that helps her sleep. Nill uses the EMF band for sounder sleep as well.

Mirror Therapy Training at Three (VIC) Veterans International Cambodia Physical Rehabilitation Centers - 12/2011 -01/2012

2012-01-22T15:43:00.000-08:00

This is an account of a recent mirror therapy training trip taken by Moira Judith Mann, Co-Founder of End the Pain Project to Cambodia. The results indicate that mirror therapy to alleviate phantom limb pain for the many amputees in Cambodia will be spread by the 29 physiotherapists who participated in the workshops. ETPP Workshops in other third world countries with large amputee populations can be made possible with your support.

Khuonh Barang, 24, lost his leg above the knee six months ago in a road accident. He suffers phantom limb pain which he feels in the toes and sole of his phantom leg and most of the time he feels heat at the same places.

Physiotherapists at the Veterans International Cambodia Physical Rehabilitation Center in Kratie, Cambodia, prepare Khuong Barang for a Mirror Therapy session. They explain the purpose and instruct to Barang.

Song Sit, PT Clinical Mentor instructs a Technical Coordinator at Kratie Physical Rehabilitation Center with initial assisted Mirror Therapy movements.

Song Sit explains the suggested schedule for Barang for self-administered Mirror Therapy. Barang was given an instruction print-out with his native language to follow each day.

Khuonh Barang reports that after 20 minutes of concentrating on the mirror image of his intact leg, he no longer feels hot in the sole of his phantom foot and that the pain was highly reduced.

The day after the initial Mirror Therapy, Khuonh Barang reported better sleep and seemed in higher spirits than the day before.

Physiotherapists at Kratie VIC Physical Rehabilitation Center studying Mirror Therapy. Song Sit, a PT clinical mentor for the three clinics of Veterans International Cambodia, is a regional member of IASP.

A diabetic who recently had her foot removed learns about movements to use in Mirror Therapy.

A positive response to Mirror Therapy was reported by the diabetic amputee to the clinical staff at Kratie Center.

Physiotherapists at the Kien Khleang Physical Rehabilitation Center for the Disabled, practicing Mirror Therapy. The object is to experience the sensations that come up when concentrating on the mirror image for twenty minutes. This will enable them to understand the process that their clients will undergo.

Ms. Um Naikim, a Prosthetist and Orthotist, uses ETPP Table Top Mirror Tent for practice at Kien Khleang National Rehabilitation Center for the Disabled,.

Mr. Wa Sarun, a bench technician at the Kien Khleang Physical Rehabilitation Center for the Disabled and an amputee, was sceptical about the benefits of Mirror Therapy prior to working with a mirror.

After one session, his experience convinced Mr. Wa that Mirror Therapy was effective in subduing an almost constant pain he has endured since stepping on a land mine.

Mr. Mao Sophan, a prosthetist and Orthotiest in Kien Khleang Physical Rehabilitation Center, is practising mirror therapy using an inflated glove for slow movements in front of a mirror.

Mr. Ull Meng Hour, Site Manager of the Prey Veng Physical Rehabiitation Center stepped on a land mine in 1984 and still suffers periodic bouts of phantom limb pain.

Mr. Ull had positive results from his first session of Mirror Therapy. He concentrates on the mirror image of his intact leg using a distortion-free unbreakable plastic donated by the non-profit charity, End The Pain Project.

Prey Veng Physical Rehabilitation Center. clinical staff concentrating on mirror images.

Physiotherapist, Prosthetist and Orthotist at Prey Veng concentrate on mirror images.

Other Physiotherapists at Prey Veng concentrate on mirror images.

Bouth Vorn, 53 years old, stepped on a land mine in Prey Veng Province seven years ago. He received a small grant from VIC to establish his motor and bicycle repair shop. At least two times a week his sleep is disrupted by severe tingling pain in his phantom large toe that spreads to his stump.

Mr. Bouth’s eight-year-old daughter, who might be of some limited assistance when Mr. Bouth, a widower, practices Mirror Therapy at home.

Mr. Bouth experienced some relief the first time practicing Mirror Therapy. Though he did not believe the method would work, at the end of the session he experienced some changes that convinced him to continue practising.

BBC NEWS MAGAZINE DECEMBER 5, 2011 CITES END THE PAIN PROJECT

2012-01-20T11:32:00.000-08:00

In the December 5, 2011 article "What Phantom Limbs and Mirrors Teach Us About The Brain" by Stephanie Hegarty of the BBC World Service, Hegerty cites the recent work of End The Pain Project in Vietnam in the BBC News Magazine.

The mirror therapy workshops were staged in Can Tho, Dong Ha and Hanoi in November and December 2011 for one hundred physicians and medical practitioners.

A comment from the article:

"The work of ETTP is also inspiring, especially because the equipment needed is not over-priced. The previous ad I read for mirror boxes had a starting price in excess of £100!"

Mirror Therapy Success Story at Amputee Resource Centre, Richmond BC

2011-04-21T12:20:00.000-07:00

The first ETPP success in eliminating Phantom Limb Pain with Mirror Therapy at our new Amputee Resource Centre in Richmond, B.C was recently achieved.

The amputee, Maria W., movingly recalls her experience in her own words:

"MY NAME IS MARIA AND I'M 57 YEARS OLD. IT'S BEEN SIX YEARS SINCE I HAVE HAD MY ABOVE KNEE LEG AMPUTATION DUE TO COMPLICATIONS FROM CANCER TREATMENTS.

I HAVE ENDURED PHANTOM PAIN FROM MY STUMP FOR YEARS. IT HAS BEEN A CONSTANT, CHRONIC IRRITATION. I WAS ALWAYS RUBBING MY STUMP TO THE POINT OF WEARING OUT MY PANT LEG. I DID SOMEWHAT GET SOME RELIEF FROM MY MICROFIBER BLANKET WHICH I USED WHEN GOING TO SLEEP, BUT I STILL AWAKENED MANY TIMES DURING THE NIGHT.

I WAS AT AN AMPUTEE SUPPORT GROUP MEETING WHEN MADELEINE ANDERSON ANNOUNCED TO THE GROUP THERE WAS GOING TO BE A TREATMENT FOR PHANTOM PAIN, WITHOUT THE USE OF DRUGS. I WAS UP TO TRYING ALMOST ANYTHING THAT MIGHT HELP ME.

IT WAS A 5-WEEK SESSION WITH MADELEINE AS MY COACH. THIS TREATMENT CONSISTED OF MIRRORING FOR 15 MINUTES TWICE A DAY BY PLACING A LONG MIRROR NEXT TO MY HEALTHY LEG AND VISUALIZING THAT IT WAS MY LEG I HAD REMOVED.

THE FIRST TIME I DID IT, IT WAS SO OVERWHELMING. I DIDN'T REALIZE HOW MUCH I MISSED MY LEG. IT WAS LIKE A BIRTH OF A CHILD! I WAS IN AWE AND DISBELIEF. WOW, IT MADE ME FEEL SO GOOD!

IT WASN'T TILL MY 3RD WEEK THAT I REALIZED I WASN'T RUBBING MY LEG AS OFTEN AS I WAS USED TO DOING. BY THE 5TH WEEK, I WASN'T EVEN RUBBING MY STUMP AT ALL, UNTIL SOMEONE WOULD ASK ME HOW MY TREATMENTS WERE GOING.

I STILL DO MY MIRRORING EVERYDAY AS I REALLY LOOK FORWARD TO SEEING TWO LEGS IN THE MIRROR. I'M TAKING MUCH BETTER CARE OF MY GOOD LEG TOO. I'M MOISTERIZING AND POLISHING MY TOES MORE OFTEN.

I KNOW THIS MAY SOUND A LITTLE NUTTY, BUT UNTIL YOU EXPERIENCE THIS TREATMENT YOU WOULDN'T KNOW HOW TO RELATE TO MY EXPERIENCE.

I'M SO VERY THANKFUL TO MADELEINE WHO KEPT ME FOCUSED AND GAVE ME SUPPORT. THERE IS NOTHING TO LOOSE, BUT EVERYTHING TO GAIN. BY TRYING THIS TREATMENT.

MY SINCERE THANKS TO MOIRA AND MADELEINE, CO-FOUNDERS OF THE END THE PAIN PROJECT FOR THIS MUCH NEEDED AND MOST WELCOME THERAPY."

--MARIA W.

NOTE:If you have your own Mirror Therapy success story to share, please forward it to info@endthepainproject.org and we will post your story on this blog.

NPR's Brain Candy Interview: V.S. Ramachandran's 'Tales Of The 'Tell-Tale Brain'

2011-02-14T14:00:00.000-08:00

Listen and read NPR's Brain Candy Interview: V.S. Ramachandran's 'Tales Of The 'Tell-Tale Brain' given on Valentine's Day, 2011.

Donate To End The Pain Project Through The Giving Effect

2011-02-14T13:36:00.000-08:00

Hey, please consider donating something. You'll get an online thank-you which can be shared to inspire more people to give:

List Your Items on eBay Giving Works for End The Pain Project

2011-02-08T10:14:00.000-08:00

End The Pain Project is now listed on eBay Giving Works. Turn your eBay listings into a force for good.

With each listing you can pledge to donate from 10% to 100% of an item's final sale price to End The Pain Project and get a pro-rated fee credit on your Insertion fee and Final Value fees when your listing sells.

If you're ready to dive right in and create your first eBay Giving Works listing, eBay will walk you through the steps you'll need to follow. Before long, you'll be an expert!

Shop, sell, and donate for a good cause. Thanks for your generosity!

Amputee Support Centre of Richmond BC

2010-12-20T17:50:00.000-08:00

Hand Prosthesis Eases Phantom Pain

2010-10-27T21:41:00.000-07:00

"Phantom pain is very difficult to treat," says Professor Dr Thomas Weiss from the Friedrich Schiller University, Jena, Germany.

"In many cases the symptoms persist, in spite of high dosages of painkillers. This puts patients at a high risk of medication addiction" the professor at the Department for Biological and Clinical Psychology says.

But now scientists of the University of Jena give cause for hope to the affected patients. Together with the trauma surgeons of the Jena University Hospital, business partners and support by the German Social Accident Insurance (Deutsche Gesetzliche Unfallversicherung, DGVU), Professor Weiss´s team modified conventional hand prostheses in order to reduce phantom pain after an underarm amputation.

A stimulation unit connected to the remaining part of the upper arm by a cuff plays a crucial part in the newly developed medical device.

"There are pressure sensors between thumb and index finger as well as on the thumb of the hand prosthesis," Professor/ Dr Gunther Hofmann, Director of the Jena Department for Trauma, Hand and Reconstructive Surgery explains.

Originally they were only meant to regulate the strength of grip of the artificial hand -- depending on what the patient wanted to pick up -- a raw egg or a hammer.

"Our system is now able to transmit this sensory information from the hand to the upper arm," says trauma surgeon Hofmann.

"The brain picks up the feedback from the prosthesis as if it was one´s own hand," Professor Weiss adds, explaining the cause for phantom pain: The brain structures that were originally responsible for the stimulus processing of the arm are suddenly "out of work" after the loss of the limb. This induces a functional re-organization of these brain regions.

"These areas take over the processing of sensory stimuli from other body parts, especially the arm stump and the face," says the Jena psychologist. As a result, intensified and sometimes painful sensations occur -- the phantom pain.

By means of the feedback between the artificial hand and the brain, provided by the Jena system, the re-organization of the brain is supposed to be prevented or to be reversed. "The first patients who have tested the system were very positive about it," Professor Hofmann was delighted to report. It is important now to test the feedback system on as many patients as possible, he added.

"We would like to know if the transmission of sensory information from the hand is helpful to only a few people or if it is a therapeutic for all wearers of artificial limbs," says Professor Weiss.

--ScienceNews 08/09/10

The Homunculus and Remapping Video Clip

2010-10-27T18:35:00.000-07:00

ANDREW T. AUSTIN EXPLAINS BRAIN REMAPPING AND AN

ALTERNATIVE METHOD TO RELIEVE UPPER LIMB PHANTOM

PAIN

Phantom Limb Contractures Chart & Video Clip

2010-10-25T19:38:00.000-07:00

These are eight of a number of different phantom limb contractures. The missing limb may feel as if it is in a
distorted and painful position. Ramachandran and Blakeslee describe that some people's representations of
their limbs do not actually match what they should be,
for example, one amputee reported that her phantom arm
was about "6 inches too short". (Ramachandran & Blakeslee 1998).

ANDREW T. AUSTIN DEMONSTRATES A PHANTOM LIMB
CONTRACTURE AND A METHOD TO UNCURL IT.

ETPP Partners with The Amputee Coalition of British Columbia

2010-10-08T13:05:00.000-07:00

A unique partnership has been struck by End The Pain Project and The Amputee Coalition of British Columbia, both serving the needs of amputees.

The mission of The Amputee Coalition of BC is to support and empower amputees through education, advocacy, physical activity and mentoring. Its vision to ensure that every amputee in British Columbia has the tools, guidance and support that will enable them to lead full and productive lives to the extent of their ability is in line with the mission and vision of End The Pain Project.

Plans are in the works for the two organizations to jointly operate an Amputee Re-Entry Centre in Richmond, B.C. starting in January, under the auspices of Dr. Don Nixdorf, a widely esteemed BC chiropractor and advocate for amputees. 

Keep watching this blog for the actual opening date and the services that will be provided to amputees.

Table-Top Mirror now available from ETPP for hand/arm amputees suffering Phantom Limb Pain

2010-10-04T15:29:00.000-07:00

ETPP Table-Top Mirror in use

A Table-Top Mirror for Mirror Therapy use by hand/arm amputees suffering Phantom Limb Pain, has been designed and developed by Marty Moser, an End The Pain Project associate. The easy-to-setup, portable Table-Top Mirror which measures 10"x13" when folded for storage, is constructed of sturdy but lightweight white cardboard and unbreakable acrylic mirror.

Priced at $20 + $6 postage, the Table-Top Mirror can be ordered through End The Pain Project. Net proceeds fund mirrors for amputees in third world countries.

Cross Border Affair Wine Tasting Saturday, Oct 23, 3 pm Fundraiser for ETPP

2010-09-28T20:02:00.000-07:00

A fun way to spend an afternoon: Like Washington wine? Or is it all BC for you? Tried the fruits of our local wine regions side by side? Neighbors, Okanagan Valley and the Columbia Valley are both evolving extensive fruit growing into a complex, comprehensive wine culture.

We're fierce local supporters on both sides - but what does your palate say? The wine tasting goal is to compare 5 BC and 5 Washington wines in an informative and entertaining setting. No pressure to swirl, sniff, spit or swill a certain way. Learn a little, try a lot and hopefully, find new favourite wines!

And the #1 Cross Border Wine Tasting door prize is fabulous! 2 tix to the Vancouver Playhouse Wine Fest 2011. $190 value! And opportunities to win other great door prizes!

All proceeds go to End The Pain Project - a non-profit helping amputees at home and abroad whose lives are impacted by phantom limb pain.

Tix $35: RSVP Samantha
Where: Point Roberts Marina 713 Simundson Drive -Upstairs Club

P.S. Don't forget your passport!

Beth Darnall, PhD, develops self-treatment tool for phantom pain

2010-09-11T10:38:00.000-07:00

Beth Darnall, PhD, Assistant Professor, Department of Anesthesiology and Perioperative Medicine, has developed an instructional DVD to enable amputees to self-treat their phantom pain. Do It Yourself Mirror Therapy teaches patients how to use this evidence-based treatment at home, making it a cost-effective non-pharmacologic treatment for phantom pain.

“When mirror therapy is practiced, the brain is exposed to the image of the intact limb repeatedly and receives the message that both limbs are intact and functioning,” said Dr. Darnall. “When mirror therapy is used consistently over the course of one month, phantom pain may lessen or even resolve.”

Functional MRI studies show that positive results from mirror therapy are related to cortical restructuring in the brain. It is thought that a remapping of the body map in the brain reduces or eliminates any distortion that may have been created when the brain tried to reconcile the amputation.

“Our study findings are promising, and self-treatment is especially important where access to pain care is severely limited,” said Dr. Darnall. She is currently working with a global non-profit organization called End the Pain Project to bring mirror therapy tool kits to amputees in Vietnam and Cambodia. HealthSaas has made it possible to evaluate their progress from Portland.

Dr. Darnall recently presented an instructional session on mirror therapy to amputees and caregivers at the national conference of the Amputee Coalition of America. In October, an OHSU N.L. Tartar Trust Fellowship will fund her travel to the annual conference of the Egyptian Society for the Management of Pain where she will present her findings on self-delivered mirror therapy. While she is in Cairo, Dr. Darnall will also meet with researchers at Al-Ahzar University to discuss a collaborative comparative effectiveness study of phantom pain treatments that will include mirror therapy.

From OHSU School of Medicine News 9/9/10

HealthSaaS launches custom version of PainPHR 'Personal Health Record' a secure interactive online treatment tracking service for End The Pain Project

2010-07-10T19:01:00.000-07:00

HealthSaaS, Inc specializing in web-based Sofware as a Service (SaaS) solutions with the cooperation of OHSU Department of Anesthesiology & Perioperative Medicine, has built a web-based Personal Health Record (PHR) Portal for End The Pain Project to specifically track the use of Mirror Therapy to reduce or eliminate Phantom Limb Pain in amputees.

End The Pain Project will offer the PainPHR to practitioners, rehabilitation centers, hospitals and NGO's in developing countries as a free secure online service. These registered users and their clients will have access to individual Pain Diaries 7 days a week, 24 hours a day anywhere in the world, providing there is an internet connection.

The PainPHR facilitates better communication between amputees and their healthcare providers. Patient-driven report data will help providers identify both effective and ineffective treatment. The providers may then make treatment modifications to improve efficacy and provide their clients with a more consistent and improved quality of life.

Portable Collapsible Mirror Therapy Box

2010-06-20T18:39:00.000-07:00

An invaluable upper limb recovery tool, a portable, collapsible and lightweight Mirror Box is offered by Reflex Pain Management Ltd., allowing rehabilitation exercises for amputees suffering Phantom Limb Pain, wherever and whenever. To avoid distortion, the unaffected limb should be held as close as possible near the mirror.
A lower-limb collapsible mirror box is under development and available in the near future.

Uncurling a Phantom Limb Contracture

2010-06-20T17:59:00.000-07:00

Andrew T. Austin, respected NLP Master Practitioner, has found a way to uncurl or retract an upper phantom limb to enable effective mirror therapy.

Fundraiser Screening of 'Phantom Pain' for End The Pain Project June 10 Vancouver BC

2010-04-28T23:14:00.001-07:00

PR: n/a

I: 0

L: 2

LD: 76,789,619

I: 0

Rank: 7

Age: Oct 12, 1999

I: 0

whois

source

Robo: yes

Sitemap: no

Rank: n/a

Price: n/a

Info

PR: n/a

I: 0

L: 2

LD: 76,789,619

I: 0

Rank: 7

Age: Oct 12, 1999

I: 0

whois

source

Robo: yes

Sitemap: no

Rank: n/a

Price: n/a

Links: 11|3

Density

Event registration powered by Eventbrite

ETPP Co-Founder transfers flame in 2010 Paralympic Torch Relay

2010-04-25T09:45:00.000-07:00

Madeleine Anderson, End The Pain Project co-founder and an atk amputee, participated in the 2010 Paralympic Torch Relay held in Downtown Vancouver B.C. on March 12, 2010, successfully part of the transfer of the flame to the Opening Ceremony of the Paralympic Games at BC Place. Way to go, Madeleine!

ETPP Co-Founder Selected as a Paralympic Torchbearer for the Vancouver 2010 Paralympic Games

2010-02-12T13:29:00.000-08:00

Madeleine Anderson, ETPP Co-Founder, has been invited to be an ambassador for her community and country by carrying and sharing an important symbol of the Paralympic Games — the Paralympic Flame.

Madeleine, an atk amputee, will participate in the 2010 Paralympic Torch Relay to be held in Downtown Vancouver B.C. on March 12, 2010, transferring the flame to the Opening Ceremony of the Paralympic Games at BC Place.

ETPP Co-Founder brings Mirror Therapy techniques to Vietnam and Cambodia

2010-02-11T15:48:00.000-08:00

The focus of a December 2009 trip to Vietnam and Cambodia for Moira Judith Mann, ETPP Co-Founder, was to present mirror therapy techniques, prototype unbreakable plastic mirror systems, ETPP ToolKits translated into Vietnamese and Khmer and PrismGlasses to the Vietnamese Training Centre for Orthopaedic Technologists (VIETCOT) in Hanoi, PeaceTrees Vietnam, an NGO based in Dong Ha that services over 600 landmine victims, The Cambodian School of Prosthetics & Orthotics (CSPO), Kien Khleang National Rehabilitation Center in Phnom Penh, CHA, an NGO in Phnom Penh, as well as two designated ETPP representatives who will bring mirror therapy to hill tribe villages in the former DMZ, Quang Tri Province.

The mirror therapy information and the use of non-breakable plastic mirrors were enthusiastically accepted and will be incorporated into the VIETCOT curriculum, as well as becoming part of the treatment offered at the Kien Khieang National Rehabilitation Center and CHA. In addition, an outreach connection was made with Catholic Charities of Sri Lanka.

Mirror Therapy performed prior to amputation may prevent Phantom Limb Pain from developing

2010-02-02T17:32:00.000-08:00

Phantom limb pains are a common and difficult problem after amputations—even though the injured limb is removed, the pain continues. "The pain pathways in the spinal cord and brain 'remember' the painful injury," says Dr. Shafer. "Because of this memory, the missing arm or leg continues to ache, sometimes severely so, long after the limb itself has been amputated."

Dr. Hanling and colleagues used mirror therapy in an attempt to prevent phantom pain in four soldiers requiring leg amputation because of combat injuries. In each case, amputation was necessary after extensive efforts to save the leg.

Before amputation surgery, the patients performed several sessions of mirror therapy. "In this form of therapy, patients sit with a mirror placed vertically between the legs and arms so that they are reflected in it," Dr. Shafer explains. The reflection in the mirror makes it look like the injured arm or leg is healthy and normal.

"Patients then observe and control their injured arm or leg in the mirror—but they are actually observing and controlling the reflected uninjured arm or leg," says Dr. Shafer. "The brain and spinal cord are visually tricked into believing that all of the arms and legs are intact and without pain."

None of the four soldiers had major problems with phantom pain after amputation. Any episodes of phantom limb pain were brief and mild. Importantly, all patients were able to fully participate in their postoperative physical therapy program.

Mirror therapy appears to re-program the brain's pain circuits into thinking that the painful injury is no longer present, according to Dr. Shafer. "Removing the source of the pain may not let the brain forget this memory, but by controlling, seeing, and reacting to a healthy limb, the brain can be tricked into believing the limb has healed, reducing the risk of phantom limb pain when the injured limb is eventually amputated."

Previous studies have reported the use of mirror therapy in patients with phantom pain that does not respond to other treatments. Although more research is needed, the new results suggest that mirror therapy performed before amputation may prevent disabling phantom limb pain from developing in the first place.

Read the full study in Anesthesia & Analgesia

End The Pain Project Ventures Into Vietnam

2009-12-12T21:04:00.000-08:00

Friday, December 18, marks the beginning of End The Pain Project activity in Vietnam. Co-Founder, Moira-Judith Mann arrives on that date to bring information about Mirror Therapy for amputees suffering Phantom Limb Pain to several Vietnamese organizations serving amputees in various capacities. First stop -Hanoi. Mid-January, she will visit Phnom Penh, Cambodia to establish connections.

Mann will present the ETPP ToolKit; a newly developed unbreakable mirror system prototype and portable PrismGlasses, recently invented by Dr. Jonathan Bannister and Dr. Glyn Walsh of Scotland and marketed by Scottish Health Innovations Ltd., all as non-invasive interventions to reduce or end Phantom Limb Pain.

OHSU Clinical Trial: Home-based Self-delivered Mirror Therapy for Phantom Limb Pain

2009-12-08T17:10:00.000-08:00

Beth D. Darnall, PhD, a psychologist at Oregon Health & Science University is conducting a pilot study of self-delivered home-based Mirror Therapy for Phantom Limb Pain. The clinical trial started January 2009 and will continue through December 2010, and is currently recruiting participants.

In The Oregonian, December 2, 2009 article, participant Gail Hillyer describes experiencing phantom limb pain soon after surgeons removed most of her right leg, a delayed consequence of damage caused by radiation therapy she underwent for bone cancer as a child.

"It was like someone taking my leg and shoving it on a bed of coals and holding it there," Hillyer says. Pain medications have helped minimize the pain, but she still experiences joint aches, shooting pains, itching and muscle cramps from the leg that is no longer there.

Hillyer decided to volunteer in a clinical trial at Oregon Health & Science University testing a treatment called Mirror Therapy. The technique is simple: She holds a mirror vertically alongside her left leg so that it hides the missing right leg, and what she sees is an image of two intact legs. She spends 25 minutes a day moving the intact limb in the mirror, exposing her brain to views of a functioning, pain-free limb.

The first time she sat down with the mirror, Hillyer experienced startling sensations from her phantom leg.

"When I pointed my toe, I felt a distinct sensation that my other heel was dragging across the bed covers," she says. While rotating her left foot in circles, her big toe accidentally touched the mirror. But instead of feeling cool glass, "it felt as if my two toes were touching," she says. "At some level, I know that didn't happen, but I would vouch for that sensation as being real."

In the OHSU trial, Darnall hopes to show that amputees can use mirror therapy to treat themselves at home without the expense and inconvenience of having to visit a therapist for each session.

How it works remains "a great mystery," says University of Oregon neuroscientist Scott Frey. His group used functional MRI to scan brain activity in people with amputations as they viewed mirror images that appeared to restore the missing limb.

"When you give this visual feedback with the mirror, you tend to see a boost in activity in the brain that would have been used in moving the hand that the person no longer has," Frey says.

Targeted Muscle Reinnervation

2009-12-06T13:08:00.000-08:00

Excerpted from The New York Times article, 2/11/09, New Artificial Arm Listens to the Brain.

Man controlled robotic hand with thoughts

2009-12-02T08:45:00.000-08:00

AP reported from Rome on December 2, that a group of European scientists say they have successfully connected a robotic hand to a man who had lost an arm, allowing him to feel sensations in the artificial hand and control it with his thoughts.

The experiment lasted a month. Scientists say it was the first time an amputee has been able to make complex movements using his mind to control a biomechanic hand connected to his nervous system.
The Italian-led team said at a news conference Wednesday in Rome that last year they implanted electrodes into the arm of the patient, who had lost his left hand and forearm in a car accident.

The electrodes were removed after a month, during which the man learned to wiggle the robotic fingers and make other movements.

Virtual massage could relieve phantom limb pain for amputees

2009-12-01T18:51:00.000-08:00

The Daily Mail of London, England, reported that amputees who experience phantom limb pain could find relief in a surprisingly simple way - by watching someone else rub their hands together.

The treatment seems to fool the brain that it is their missing hand being massaged, according to the American researchers, who worked with combat veterans. Phantom limbs occur when an amputee feels the often painful sensation of touch arising from a limb that is no longer present.

Lead researcher Vilayanur Ramachandran from the Centre for Brain and Cognition at the University of California, used newly discovered properties of mirror neurons to soothe the ache. Mirror neurons fire when a person performs an intentional action - such as waving - and also when they observe someone else performing the same action. They are thought to help us predict the intentions of others by creating a "virtual reality" simulation of the action in our minds.

"You also find cells like this for touch," says Ramachandran. "They fire when you touch yourself and when you watch someone else being touched in the same location."

Ramachandran and his colleague and wife Diane Rogers-Ramachandran used a "mirror box" - a tool that creates the visual illusion of two hands for people who actually only have one. By placing an amputee's arms either side of a mirror - with the missing limb on the non-reflective side, the amputee sees the reflection of their normal hand superimposed on the location of their missing hand.

Two amputees watched their normal hand being prodded, and both felt the remarkable sensation of "being prodded" in their missing hand. In another experiment, when the amputees watched a volunteer's hand being stroked, they too began to experience a stroking sensation arising from their missing limb.
The amputees "felt" the actions of others because their missing limb provided no feedback to partially inhibit their mirror neurons, no longer telling them that they were not "literally" being touched, says Ramachandran.

One woman reported that watching a volunteer rubbing her hand caused the cramping sensation within the phantom limb to cease for 10 to 15 minutes. "If you do it often enough perhaps this pain will go away for good," suggests Ramachandran. "If an amputee experiences pain in their missing limb, they could watch a friend or partner rub their hand to get rid of it."

Massaging the skin helps relieve a painful sensation by restoring blood flow and activating sensory fibres, which inhibit pain messages to the brain. By watching another person rubbing their hand, these amputees are apparently tapping into this latter mechanism, says Ramachandran.

"If performed early enough, this type of therapy may also be used to help stroke patients regain movements by watching others perform their lost actions," he concluded.

New Study Shows Amputees Can Mentally Move Missing Limbs In Impossible Ways

2009-11-30T22:40:00.000-08:00

Excerpted from the Science News article: An experiment explores the connections between brain and body By Stephen Ornes, Web edition : Thursday, November 19th, 2009

“Phantom” pain is like a ghost in the body — but it’s anything but imaginary. People who have had an arm or leg amputated can often still feel sensations of the missing limb, even though it’s no longer there. These sensations can be painful, and scientists are always looking for new ways to help relieve this phantom pain for amputees. Treatment often involves using mirrors to visually trick the person’s brain. The thinking is that, if a person can “see” his own body in a new way, his brain may stop sending pain messages.
In a new study, a team of neuroscientists have made another surprising discovery about amputees: They can be taught to mentally move their missing limbs in ways that are impossible in the real, physical world. It’s impossible for a person to bend his wrist down and then twist his hand around in a full circle.
Seven people who had had their arms amputated above the elbow participated in the experiment. After extensive mental training, four of the seven were able to feel the sensation of this impossible act, and describe it in detail.
“It is very surprising that anybody — amputees or not — can learn impossible movements just by thinking about it,” Henrik Ehrsson of the Karolinska Institutet in Stockholm, told Science News. Ehrsson is a neuroscientist, which is a scientist who studies the brain and nervous system.

Preventing Phantom Limb Pain with Immediate Post-Operative Prostheses (IPOP) Procedure

2009-11-18T15:49:00.000-08:00

Though the Immediate Post-Operative Prostheses (IPOP) Procedure offers the highest rate of healing of any of the post operative modality treatments for lower limb amputation, it is not widely in use.

The primary reasons for its modest use include the fact that the process itself is slightly more time consuming in the O.R.(approx. 20 min); requires more monitoring of the wound itself; possible payment issues for the prosthetist for the procedure, including the frequency of subsequent visits and lack of familiarity with the treatment itself. Many surgeons performing the amputation are not trained in IPOP principles nor have knowledge of the benefits in the rehabilitation aspect. Many do not have a working relationship with a prosthetist who will be performing this procedure in the O.R. immediately after they are finished. And, the prosthetist needs to be available for this critical time period to apply the rigid dressing & the associated components.

These, and any other objections, are greatly offset by the benefits to the patient/client, when used immediately after lower limb amputation:

Accelerates recovery – Early use of a prosthesis often results in shorter hospital stays and a faster transition to a temporary prosthesis as patients begin to develop a tolerance to weight bearing.

Controls swelling – In applying gentle pressure to the patient’s residual limb, an IPOP will minimize swelling. This helps the healing process, shaping the limb, making the final custom-made prosthesis easier to fit and in a more timely manner.

Reduces pain – In controlling the swelling, pain is often reduced. This reduces the use of drugs, decreasing costs and may even eliminate drug dependency. Research also indicates that early prosthetic use made possible with the IPOP Procedure, may reduce (or eliminate) the occurrence and severity of phantom limb pain and sensations.

Protection and Safety – Especially in patients who are in a weakened condition, elderly or have other medical considerations, IPOP practice shows a dramatic reduction in the number of falls and can help prevent additional injury to the wound.

Prevents knee flexion contractures and loss of muscle strength – By allowing amputees to stand almost in very short order and to gradually begin using their legs, an IPOP can significantly improve rehabilitation – again, reducing hospital stays & costs.

Greater stability - An IPOP, which is a rigid locked knee above a "weightless" prosthesis, gives the patient more stability than prior to the surgery, when they undoubtedly had a painful or weak leg. It is usual practice to mobilize patients within 24 hours post-surgically. At a minimum to have the patient stand and transfer to the toilet or wheelchair using a limb. The importance of minimal ambulation in therapy from the second day onwards cannot be emphasized enough. The minor risk of harm involved with minimal weight bearing and the brief stance phase on the amputated leg is outweighed by all the general advantages to the patient for ultimate survival.

Psychological benefits – Patients learn immediately what it feels like to wear a prosthesis and thereby can focus more on their rehabilitation than on their missing limb. This is usually very positive as long as it does not delay the process of accepting the loss of their limb. Having an IPOP can help them return to their homes, or workplaces, sooner especially if wheelchair accessibility is a problem. The new amputee generally has a more positive outlook on their future.

The risks and side effects of an IPOP also need to be considered. Not every patient is an ideal candidate for an IPOP. It should be a decision reached by the patient, the physician(s) and any others in the rehab team to determine if the benefits outweigh the risks.

Side effects can be avoided or minimized with attentive care by a well-trained rehab team. Damage to the wound can occur from excessive weight bearing too soon after amputation. To use an IPOP correctly, the patient must be able to limit the amount of weight he or she applies to it.

Pre-existing disease issues can complicate matters – diabetes and other circulatory problems should be taken into consideration along with general health, age and strength factors. Although rare, in some cases a patient may develop an infection or non-healing surgical wounds. In this situation, the use of the IPOP is discontinued while the problem is being addressed. It can be reinstituted at the soonest appropriate time after the ‘problem’ has been eliminated or determined. Sometimes a slight elevation in temperature has worried hospital staff to the point that the IPOP is removed - only to find out that the wound was perfectly fine. The IPOP/rigid dressing then has to be re-done.

Other issues would include cognitive dysfunction and delirium, poor nutrition and the presence of a stroke. They sould be strongly taken in to consideration in the determination to use or not use an IPOP. .

Open-Source Colaborative Approach To Better Prosthetics

2009-11-11T15:58:00.000-08:00

A recent NPR article and webcast features Jonathan Kuniholm, who, after a tour of duty in Iraq, was missing part of his right arm — which he lost when his Marine patrol was ambushed near Haditha.

When Kuniholm returned to his design shop, Tackle Design, he brought along three prosthetic arms given to him at Walter Reed Medical Center — the same body-operated hook many veterans have used since World War I, a shorter utility prosthetic, and a new, state-of-the-art myoelectric arm. Each one had its drawbacks — and when Kuniholm and his Tackle Design colleagues disassembled them, they quickly concluded that they could improve on the designs.

They founded the Open Prosthetics Project, an open-source collaboration that makes its innovations available to anyone. And Kuniholm signed on with Revolutionizing Prosthetics, an initiative of the Defense Advanced Research Projects Agency, or DARPA.

Self-Hypnosis for Relief of Phantom Limb Pain

2009-11-03T16:35:00.000-08:00

Self-hypnosis can be used to relieve phantom limb pain prior or during Mirror Therapy treatment.

Michael F. Garner, a British-certified hypnotherapist, developed effective self-hypnosis scripts for amputees suffering Phantom Limb Pain, focused specifically on arm/hand or leg/foot amputations.

Soothing narratives by Joseph Weisnewski combined with healing musical excerpts by Iqbal Ishani from SleepWell Journey encourage deep relaxation which promotes pain reduction. End The Pain Project offers the self-hypnosis as mp3 downloads or CDs .

100% of the proceeds from the sale of a CD or mp3s help support the behind-the-scenes running of ETPP, such as office costs, staff, project costs. Your purchase supports needed non-invasive interventions for amputees suffering Phantom Limb Pain in developing countries.

Conway-Bike eBay Auction for End The Pain Project

2009-11-03T14:59:00.000-08:00

It's with deep gratitude that The End The Pain Project's staff has accepted the proceeds from a recent eBay auction for a ConwayQ-RT 1100 Titan Bicycle by Hartje Bicycles of Germany. This fantastic titanium bike has its seat autographed by the Canadian actor, Stephen Sumner of Battleship Galectica fame.

Mr. Sumner, an ETPP Board member and an above-knee amputee, successfully rode this lightweight unisex bike at the Berlin Velothon, June, 2009. The new German feature film, Phantomschmerz/ Phantom Pain, which premiered at the 2009 Toronto Film Festival, is based upon his experiences.

Hartje Bicycle's generous donation will fund a pilot project in mid-December. End The Pain Project hopes to partner with several organizations in Vietnam to deliver Mirror Therapy to land mine amputees utilizing nonbreakable mirror kits for both arm/hand and leg/foot, along with self-hypnosis CDs to be translated into Vietnamese.

Mirror Box Therapy from "Phantoms in the Brain" by Blakeslee & Ramachandran

2009-11-01T18:19:00.000-08:00

Excerpted from The NY Review of Books Volume 55, Number 11 · June 26, 2008: How the Mind Works: Revelations by Israel Rosenfield & Edward Ziff

The problem of representation, meaning, and memory is also illustrated by the case of a patient who has lost his arm in an accident. As is often the case, the brain creates a "phantom" limb in an apparent attempt to preserve a unified sense of self. For the patient, the phantom limb is painful. The brain knows there is no limb; pain is the consequence of the incoherence between what the brain "sees" (no arm) and the brain's "feeling" the presence of a phantom that it has created in its attempt to maintain a unified sense of self in continuity with the past. Such pain is not created by an external stimulus and cannot be eliminated by painkillers.

One famous case is that of a young man who had lost his hand in a motorcycle accident. In a therapeutic procedure devised by V.S. Ramachandran, and described in his book with Sandra Blakeslee, Phantoms in the Brain, the patient put his intact hand in one side of a box and "inserted" his phantom hand in the other side. As the illustration on this page shows, one section of the box had a vertical mirror, which showed a reflection of his intact hand. The patient observed in the mirror the image of his real hand, and was then asked to make similar movements with both "hands," which suggested to the brain real movement from the lost hand. Suddenly the pain disappeared. Though the young man was perfectly aware of the trick being played on him—the stump of his amputated arm was lying in one section of the box—the visual image overcame his sense of being tricked. Seeing is believing! Pain—the consequence of the incoherence between the brain's creation of a phantom limb and the visual realization that the limb does not exist—disappeared; what was seen (a hand in the mirror) matched what was felt (a phantom).

According to the Italian neurologist Angela Sirigu, who used videos instead of mirrors to perform a similar experiment,

It is the dissonance between the image of oneself and the damaged body, that is at the origin of the phantom pain. Seeing the damaged hand once again functioning, reduces the dissonance even though the patient is aware of being tricked.

At one moment the patient experiences a painful phantom limb; at another he sees a mirror image of his intact hand and the pain disappears. This is only one of many neurological examples of what we might call the Dr. Jekyll and Mr. Hyde Syndrome: the patient in the experiment sees and remembers one world at certain times and a completely different world at other times.[4] The phantom limb is the brain's way of preserving a body image—a sense of self that is essential to all coherent brain activity. And as in the case of colors, the phantom limb suggests that what we see, hear, and feel are inventions of the brain—an integration of the past (the loss of the limb) and the present (a phantom that is essential for the brain's continuing to function "normally").

In general, every recollection refers not only to the remembered event or person or object but to the person who is remembering. The very essence of memory is subjective, not mechanical, reproduction; and essential to that subjective psychology is that every remembered image of a person, place, idea, or object inevitably contains, whether explicitly or implicitly, a basic reference to the person who is remembering.

Our conscious life is a constant flow, or integration, of an immediate past and the present—what Henri Bergson called le souvenir du présent (1908) and Edelman more recently called the remembered present (1989). Consciousness, in this view, is neither recalled representations nor the immediate present, but something different in kind (as colors are different in kind from the lightness and darkness of different reflected wavelengths).

The importance of body image and motor activity for perception, physical movement, and thought is suggested by the recent discovery of "mirror neurons" by Giacomo Rizzolatti and his colleagues. They observed that the neurons that fired when a monkey grasped an object also fired when the monkey watched a scientist grasp the same object. The monkey apparently understood the action of the experimenter because the activity within its brain was similar when the monkey was observing the experimenter and when the monkey was grasping the object. What was surprising was that the same neurons that produced "motor actions," i.e., actions involving muscular movement, were active when the monkey was perceiving those actions performed by others.

Phantoms in the Brain: Probing the Mysteries of the Human Mind

by V.S. Ramachandran and Sandra Blakeslee, with a foreword by Oliver Sacks
Quill, 328 pp., $16.00 (paper)

Mirrors in the Brain: How Our Minds Share Actions and and Emotions
by Giacomo Rizzolatti and Corrado Sinigaglia, translated from the Italian by Frances Anderson
Oxford University Press,242 pp., $49.95

A Universe of Consciousness: How Matter Becomes Imagination

by Gerald M. Edelman and Giulio Tononi
Basic Books, 274 pp., $18.00 (paper)

Welcome to the End The Pain Project blog

2009-10-30T21:57:00.000-07:00

This blog is where you can learn of the latest developments in Phantom Pain relief for amputees, current treatments Prosthetists and Orthotists are considering for Phantom Limb Pain, experiences of amputees and updates on End The Pain Project programs as well other amputee-related topics.

We welcome your accounts of coping with phantom pain as well as your comments. Thanks for your input!