Department of Clinical Neurophysiology, Foundation S. Maugeri IRCCS, Scientific Institute of Montescano, Montescano, Italy.
Eur J Phys Rehabil Med. 2009 Dec;45(4):559-66. Epub 2009 Feb 26.
This paper reviewed the various hypotheses on phantom limb and phantom limb pain as well as all the related rehabilitation techniques to control these symptoms. The uncertainty in their pathophysiology strongly affects all the rehabilitation approaches so far used, as no single parameter has been found to predict or control phantom limb pain as well as no single factor can be quoted as an indicator of rehabilitation success for lower limb amputation. Within a comprehensive rehabilitation plan, behavioral interventions, stimulation techniques, feedback, physical therapies designed to possibly reverse the maladaptive memory traces and enhance its extinction have been described. Although substantially not clinically useful, pharmacological and surgical interventions also have been briefly considered. A reassessment of the actual strategies used is suggested with a role for rehabilitation not only after the amputation but also in the pre-emptive control of the pre-existing painful condition. In this process, rehabilitation should take into account many parameters, not always related to the traditional role of rehabilitation. Pain assessment before and after amputation, its natural history and clinical picture such as its quality, variations, level of the amputation, dominance, time interval between amputation and rehabilitation, as well as all the other phantom limb related phenomena should be considered and treated.
本文回顾了各种关于幻肢和幻肢痛的假说，以及所有相关的康复技术来控制这些症状。它们的病理生理学的不确定性强烈影响到迄今为止使用的所有康复方法，因为没有找到单一的参数可以预测或控制幻肢痛，也没有单一的因素可以作为下肢截肢康复成功的指标。在全面的康复计划中，描述了行为干预、刺激技术、反馈、旨在可能逆转适应不良的记忆痕迹并增强其消除的物理疗法。尽管在临床上基本没有用处，但也简要考虑了药物和手术干预。建议重新评估实际使用的策略，康复不仅应在截肢后进行，而且还应在预防性控制预先存在的疼痛状况方面发挥作用。在这个过程中，康复应该考虑到许多参数，而这些参数并不总是与康复的传统作用有关。应该考虑和治疗截肢前后的疼痛评估、其自然病史和临床特征，如疼痛的质量、变化、截肢的水平、优势、截肢和康复之间的时间间隔，以及所有其他与幻肢相关的现象。
