A while back I realized how the term prosthetic applies to so many of our add-on items. Since then we have also seen the rise to stardom of Amber Case. It now seems to be also terribly undefined and unclear exactly how an interface between stump and phantom replacement is supposed to look like.

One way to replace a phantom hand with a visual appearance is using a prosthetic arm. That has the disadvantage of being different and stiff, mostly unintuitive and clumsy, heavy, at times even smelly, some of the practical but most somewhat if not outright ugly – at least, comparing it with a more embedded experience.

Another way to replace a phantom hand is by using a mirror box. However, mirror therapy is a rather strenuous mental exercise. It also is not good for just anybody – my phantom pains, for example, got quite a bit worse with the mirror box.

And then, there is Microsoft XBOX 360 with KINECT.

For a person with disability such as me, game consoles usually are a bit of a problem. On one hand [p] these offer great distraction and entertainment, on the other hand [p], the control interface usually sucks.

These controllers usually are hard or impossible to really use with a hand and a forearm stump. So playing games if at all usually worked best using a computer mouse.

But now, check out this interface.

For better understanding: behind these front buttons containing different avatar images, my phantom body complete with a mirror image of my left (L) and right (R) hand, my head (H) and my body (B) is shown. When I move my hands, I see my hands!

The thing is, I can play this with the extended motion of my left hand and my right stump – and what I get to see, is the full bodied me!

Ahh : ) first of all, this is a great relief. To see yourself like that is an enormous relief. Secondly, for the time I now played some relatively harmless motion games, I did not have the burning and stabbing sensation of phantom pains. As I type this, phantom sensations and pains are back. Placebo, retail therapy effect, acute sensory distraction – whatever it is, it was a new and great experience. I will try with different virtual experiences though.

But now you know. Maybe you want to try it out too. If anything, self respecting neurologists should use these Microsoft XBOX 360 with KINECT to study various aspects of phantom pain because, really, this is the glorified and animated virtual version of their mirror box.

Update 2014.

It took some  researchers 3 years to catch up with this idea here.

Lo and behold, they actually published some research, but mind you – only in form of a case report [1]! No control group, no study group, no sizable numbers such as 150 amputees or anything like it. Just a case.

And they did not cite my first report of this effect (here), obviously – but that aside, this does appear like academia trying to play catch-up with amputee related experiences. That cannot all be bad, even though they still may want to work on their plagiarism and fairness bits a bit more. Just a minute little bit.

After all, they write that “To the best of our knowledge, this is the first time that AR, gaming, and the prediction of motion intent using myoelectric pattern recognition have been used together as a treatment for PLP”. Sounds interesting. But then, there are not so many pioneers writing their guts out in the field around, are there. In fact, the general truth is that “whatever it is, as long as it is some type of prosthetic related activity, the arm amputee is likely to experience a degree of diminished phantom pain”. Neurological and psychological processes then are assumed to intertwine although neither I nor the authors of that study really know why. So in terms of “do something to feel better” we are not one inch more advanced after this study. Unless of course you sell 8 channel myoelectric game setups, but then you need controls (and not just a 1 case thingy such as here). Reading his comment [link], the author seems to be blissfully oblivious to this, as disregarding my reference to phantom pain, he sees Kinect and his toy as “fundamentally different”.

To explain what I meant: use an iron bar, and a hammer, of the same shape to hit against a porcelain cup. It will break in both instances, in a similar way. I look at the broken porcelain cup and say “same difference” and Doctor Ortiz-Catalan tells us that a hammer and an iron bar are “fundamentally different”.

For their next publication that heavily leans on stuff they found elsewhere, I suggest they word their “Roald Amundsen”-statement like this: “To the best of our knowledge, this is the first time that (idea goes here) was investigated using this Swedish team north of (put Latitude here)”.

[p] pun intended.

[1] M. Ortiz-Catalan, N. Sander, M. B. Kristoffersen, B. Håkansson, and R. Brånemark, “Treatment of phantom limb pain (PLP) based on augmented reality and gaming controlled by myoelectric pattern recognition: a case study of a chronic PLP patient,” Frontiers in Neuroscience, vol. 8, iss. 24, 2014.
[Bibtex]

@ARTICLE{ortiz2014,
 AUTHOR={Ortiz-Catalan, Max  and  Sander, Nichlas  and  Kristoffersen, Morten B.  and  Håkansson, Bo  and  Brånemark, Rickard},     
TITLE={Treatment of phantom limb pain (PLP) based on augmented reality and gaming controlled by myoelectric pattern recognition: a case study of a chronic PLP patient},       
JOURNAL={Frontiers in Neuroscience},        
VOLUME={8},        
YEAR={2014},        
NUMBER={24},         
URL={http://www.frontiersin.org/neuroprosthetics/10.3389/fnins.2014.00024/abstract},         
DOI={10.3389/fnins.2014.00024},        
ISSN={1662-453X},        
ABSTRACT={A variety of treatments have been historically used to alleviate phantom limb pain (PLP) with varying efficacy. Recently, virtual reality (VR) has been employed as a more sophisticated mirror therapy. Despite the advantages of VR over a conventional mirror, this approach has retained the use of the contralateral limb and is therefore restricted to unilateral amputees. Moreover, this strategy disregards the actual effort made by the patient to produce phantom motions. In this work, we investigate a treatment in which the virtual limb responds directly to myoelectric activity at the stump, while the illusion of a restored limb is enhanced through augmented reality (AR). Further, phantom motions are facilitated and encouraged through gaming.The proposed set of technologies was administered to a chronic PLP patient who has shown resistance to a variety of treatments (including mirror therapy) for 48 years. Individual and simultaneous phantom movements were predicted using myoelectric pattern recognition and were then used as input for VR and AR environments, as well as for a racing game.The sustained level of pain reported by the patient was gradually reduced to complete pain-free periods. The phantom posture initially reported as a strongly closed fist was gradually relaxed, interestingly resembling the neutral posture displayed by the virtual limb. The patient acquired the ability to freely move his phantom limb and a telescopic effect was observed where the position of the phantom hand was restored to the anatomically correct distance. More importantly, the effect of the interventions was positively and noticeably perceived by the patient and his relatives.Despite the limitation of a single case study, the successful results of the proposed system in a patient for whom other medical and non-medical treatments have been ineffective justifies and motivates further investigation in a wider study.}}