Functional rehabilitation of a person with transfemoral amputation through guided motor imagery: A case study
Background & Purpose: Motor imagery (MI) is a mental technique absent of physical movement employed to foster movement patterns and relieve pain via a top-down model enacting the brain before engaging the body. This method has been helpful in rehabilitating many functional limitations, such as those found in persons with stroke, Parkinson’s disease, and orthopedic injuries. The current case study assessed MI’s efficacy in decreasing phantom limb pain and attaining functional gait and balance with a prosthesis after a lower extremity amputation.
Case Description: The participant was a 71 year old, African American female with a transfemoral amputation occurring 7 years prior to the study due to peripheral arterial disease. She required a standard walker to walk with a prosthesis despite receiving physical therapy in the past. She lived independently but reported mobility limitations of phantom pain, arthritis, and a fear of falling. During this ABA design case study, the participant underwent baseline testing (PRE), followed by 3 sessions per week for 4 weeks of MI intervention, with an immediate post-test (POST) and one-week post-intervention retention (RET) test. Intervention sessions involved quiet sitting with eyes closed while listening to the experimenter read a MI script focusing on gait and balance performance. Progress was assessed via the Timed Up and Go (TUG), Short-Form Berg Balance Scale (Berg), Tinetti Performance Oriented Mobility Assessment (POMA), Activities-Specific Balance Confidence scale (ABC), and Short Form-12 (SF-12) survey. The 2-SD band method was used to determine significant changes.
Outcomes: TUG improved from PRE (29.5±4.8s) to POST (26.5s) and RET (22.5s). Berg improved significantly from PRE (17.7/56 ±4.7) to POST (26/56) and RET (26/56). POMA improved significantly from PRE (15.3/28±2.9) to POST (22/28) and RET (22/28). ABC improved significantly from PRE (44±0.7%) to POST (45%) and RET (45.6%). SF-12 Physical Component Scale improved from PRE (41.1±5.3) to POST (42.4) and RET (43). SF-12 Mental Component Scale improved from PRE (46.9±7.7) to POST (50.9) and RET (50.2). Post-intervention, the participant reported decreased phantom pain frequency and duration, and walked with her prosthesis without an assistive device.
Discussion: MI is a simple, time- and cost-effective, low-risk treatment option that decreased phantom pain and improved balance and functional gait in an individual with a lower extremity amputation and prosthesis. Though the participant’s results did not deem her low fall-risk, her Berg, POMA, and ABC scores showed significant, retainable improvement that allowed her to walk a short distance independently for the first time in 7 years. This individual may benefit from a longer duration of MI training to further decrease fall-risk. Use of MI as a stand-alone and/or adjunct treatment with physical therapy for amputation rehabilitation must be further examined.