Effectiveness of Electromyographic Biofeedback, Mirror Therapy, and Tactile Stimulation in Decreasing Chronic Residual Limb Pain and Phantom Limb Pain for a Patient with a Shoulder Disarticulation: A Case Report

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Background and Purpose: There are 1.3 million people in the United States living with limb loss, and most of these patients experience some form of residual limb pain and phantom limb pain (PLP). The purpose of this case study was to determine the effectiveness of mirror therapy, biofeedback, and tactile stimulation on decreasing chronic residual limb pain and PLP in a patient with an upper-limb traumatic amputation.

Case Description: The patient is a 48-year-old male who is employed as a construction worker. The patient was working on a conveyer belt transporting stones when the conveyer belt caught his arm resulting in a shoulder disarticulation. According to the International Classification of Functioning, Disability, and Health (ICF), the patient’s activity limitations included difficulty in sleeping, inability to write, or inability to perform heavy household chores, yard work, cook, or manage his own transportation needs. The patient’s participation limitations included decreased recreational activities with his 15-year-old son, maximum difficulty with sexual activities with his wife, and decreased confidence interfering with his normal social activities.

Intervention: Interventions include electromyographic (EMG) biofeedback training to infraspinatus and pectoralis major muscle in short/quick, sustained, and gradual contraction with decreasing sensitivity of electrodes. Treatment strategies also included mirror therapy, scapular proprioceptive neuromuscular facilitation (PNF), high-voltage electrical stimulation, retrograde massage, scar mobilizations, tactile cuing, and soft tissue mobilization.

Outcomes: The patient demonstrated a 30% decrease in Disability of the Arm, Shoulder, and Hand (DASH) score, decreased pain with Numeric Pain Rating (NPR) from 9/10 to 3/10, increased amplitude of contraction of infraspinatus and pectoral muscles, decreased sensitivity of myoelectric electrodes, and decreased edema. The patient also reported increased confidence in social interactions with friends and personal interactions with his wife. The patient was also able to participate in recreational activities with his teenage son.

Discussion: This case is clinically relevant to the field of physical therapy in terms of decreasing chronic residual limb pain, PLP, and improving muscular control with use of mirror therapy, biofeedback, and tactile stimulation.

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