title: Observation of limb movements reduces phantom limb pain in bilateral amputees.
abstract: BACKGROUND
  Mirror therapy has been demonstrated to reduce phantom limb pain (PLP) experienced by unilateral limb amputees. Research suggests that the visual feedback of observing a limb moving in the mirror is critical for therapeutic efficacy.
  
  
  OBJECTIVE
  Since mirror therapy is not an option for bilateral lower limb amputees, the purpose of this study was to determine if direct observation of another person's limbs could be used to relieve PLP.
  
  
  METHODS
  We randomly assigned 20 bilateral lower limb amputees with PLP to visual observation (n = 11) or mental visualization (n = 9) treatment. Treatment consisted of seven discrete movements which were mimicked by the amputee's phantom limbs moving while visually observing the experimenter's limbs moving, or closing the eyes while visualizing and attempting the movements with their phantom limbs, respectively. Participants performed movements for 20 min daily for 1 month. Response to therapy was measured using a 100-mm visual analog scale (VAS) and the McGill Short-Form Pain Questionnaire (SF-MPQ).
  
  
  RESULTS
  Direct visual observation significantly reduced PLP in both legs (P < 0.05). Amputees assigned to the mental visualization condition did not show a significant reduction in PLP.
  
  
  CONCLUSIONS
  Direct visual observation therapy is an inexpensive and effective treatment for PLP that is accessible to bilateral lower limb amputees.
authors.affiliation: Walter Reed National Military Medical Center 8900 Wisconsin Avenue, Bethesda, Maryland, 20889.
authors.forename: Monica L
authors.initials: ML
authors.lastname: Tung
authors.affiliation: Walter Reed National Military Medical Center 8900 Wisconsin Avenue, Bethesda, Maryland, 20889.
authors.forename: Ian C
authors.initials: IC
authors.lastname: Murphy
authors.affiliation: Walter Reed National Military Medical Center 8900 Wisconsin Avenue, Bethesda, Maryland, 20889.
authors.forename: Sarah C
authors.initials: SC
authors.lastname: Griffin
authors.affiliation: Walter Reed National Military Medical Center 8900 Wisconsin Avenue, Bethesda, Maryland, 20889.
authors.forename: Aimee L
authors.initials: AL
authors.lastname: Alphonso
authors.affiliation: Walter Reed National Military Medical Center 8900 Wisconsin Avenue, Bethesda, Maryland, 20889.
authors.forename: Lindsey
authors.initials: L
authors.lastname: Hussey-Anderson
authors.affiliation: Walter Reed National Military Medical Center 8900 Wisconsin Avenue, Bethesda, Maryland, 20889.
authors.forename: Katie E
authors.initials: KE
authors.lastname: Hughes
authors.affiliation: Walter Reed National Military Medical Center 8900 Wisconsin Avenue, Bethesda, Maryland, 20889.
authors.forename: Sharon R
authors.initials: SR
authors.lastname: Weeks
authors.affiliation: Walter Reed National Military Medical Center 8900 Wisconsin Avenue, Bethesda, Maryland, 20889.
authors.forename: Victoria
authors.initials: V
authors.lastname: Merritt
authors.affiliation: Walter Reed National Military Medical Center 8900 Wisconsin Avenue, Bethesda, Maryland, 20889.
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Yetto
authors.affiliation: Walter Reed National Military Medical Center 8900 Wisconsin Avenue, Bethesda, Maryland, 20889 ; Department of Physical Medicine and Rehabilitation, Uniformed Services University of the Health Sciences 4301 Jones Bridge Road, Rm A1036, Bethesda, Maryland 20814.
authors.forename: Paul F
authors.initials: PF
authors.lastname: Pasquina
authors.affiliation: US Navy Bureau of Medicine and Surgery 7700 Arlington Blvd., Falls Church, Virginia, 22042 ; Department of Neurology, Uniformed Services University of the Health Sciences 4301 Jones Bridge Road, Rm A1036, Bethesda, Maryland, 20814.
authors.forename: Jack W
authors.initials: JW
authors.lastname: Tsao