Thanks for your entry; it's a very compelling and strong one.
I suspect you're aware of the recent New Yorker piece (called "Muscle Memory" Http://www.newyorker.com/reporting/2007/07/30/070730fa_fact_mcgrath) devoted to the new initiatives being funded by DARPA to produce fully functioning humanlike replacement arms. Interestingly, it makes no reference at all to phantom pain and doesn't at all address a fact I spotted within the link you provided: that many amputees don't want to use prothetics because those prosthetics don't eliminate (or perhaps even worsen) the phantom pain... Does the work being done in the world of prothetics affect your own work and its prospects for impact, or are the questions of function and questions of pain pretty separate?
I think it's great that your statement on "potential demand" included some concrete numbers (eg numbers of existing amputees in the UK and the US). It's just a thought, but I wonder whether it's possible (or sensible) to also "gesture" toward the future too.... The NYorker article puts at 600 the number of (presumably American) "soldiers that have returned home without arms or legs, thanks, in part to modern body armor, which saves lives that in earlier wars would have been lost." Presumably there are a range of different kinds of injuries that bring the loss of limbs (instead of death) as a result of recent advances in emergency medicine, etc. I wonder: are there ways of making good projections about how those advances will affect the number of people your tool could help serve?
To answer your questions, I think the work being done in the prosthetic industry to make artificial limbs lighter and more intuitive to use will certainly encourage more people with amputations to use them - one benefit of this will be the reduction of pain which originates from the residual limb. Heavy, poor fitting limbs can cause physical pain and fatigue which impacts upon levels of phantom limb pain. Similarly, artificial limbs which are operated by, for example, using the shoulder muscles of the opposite intact limb, are difficult to learn to use effectively. Therefore I would expect that improvements in prosthetics which enable residual muscles which were associated with a lost limb to animate an artificial limb in a similar manner would help to reduce phantom limb pain in a similar manner to our system - and perhaps, with such advances in the future, these techniques could be used in tandem. However, such advances still seem to be some way in the future, and the cost of these would in all proabability remain prohibitively expensive and out of the reach of most people for a long time after (the best prothetic limbs at present are comparably primitive and costs tens of thousands of dollars). ( I am less optomistic about the prospects of movemment of prosthetic fingers - where upper-limb phantom pain tends to be concentrated - and toes enabled in the same manner - something which is possible using immersive virtual reality).
Undoubtedly advances in medicine have meant that many more people who would previously have died have life-saving amputations instead. Conflicts around the world (such as you refer to) have in recent years not only caused a significant number of amputations in serving soldiers, but have left whole populations at risk of amputation (e.g. through uncleared landmines) for years after conflicts have ceased. Similarly, the rise in smoking-related amputations in developing counties will continue to rise for the forseable future.
However, I think in thinking fully about the numbers of people our system could potentially help consideration should be given to people who have similar conditions, but are not amputees. For example, some people with a paralyzed limb (e.g. as the result of having nerves and muscles damaged in motorcycle accidents) will experience a supernumerary, phantom limb which is just as painful as that experinced by a person with an amputation. The system can be expected to help this population in the same manner. Other conditions for which this sytem could help include complex regional pain syndrome and painful, paralyzed limbs following stroke. Therefore, the potential of systems and the number of potential beneficiaries extends exponentially as we consider other health-related conditions which have similar underlying pain mechanisms.
I hope the above adresses the questions you raised. Please let me know if I can clarify any details.
Thanks for your comments, Craig. I'd wonder whether you might not want to include some of the details you provided me in the application itself; after all, they're future-looking, concrete, and point to a great range of GLOBAL communities whom your work could aid. (While you might have thought of those groups before, less-schooled readers (like me) might not have; these details help us appreciate the size of the community(ies) that are prospective beneficiaries of your work, and that only strengthens your application... )
As I have had great success with mirror therapy for relieving pain of complex regional pain syndrome, I know first hand how successful this VR technology will be. The limitations of mirror therapy, in that you can treat single sided pain, will be overcome with this new technology.
Just recently I discovered how effective mirror therapy is in treating tooth abscess pain. I was successfully stopping pain with a bifold double makeup mirror. However as soon as I stopped the pain returned. I eventually went to the dentist and lost the tooth. It pays to know that if pain returns that there is possibly pathology. I note that VR technology is used to redirect the brain's activity when very painful burn dressings are being removed.
I know when mirror therapy works for CRPS pain, it also stops the symptoms, muscle spasm, burning, inflammation, vascular changes etc. So the brain retraining has an effect on more than just pain. Is it possible that other brain messages could be changed using this technology. I think you are at the cutting edge of new science. It's very exciting.
Just as a last note. Someone in the US informed me that I could put a "button" for fund raising on my blogsite for charity. This is the perfect charity. Could you possibly look into having a donate button to support your work. Every little bit counts.
Comments
Dear "Phantom Limb" Team,
Thanks for your entry; it's a very compelling and strong one.
I suspect you're aware of the recent New Yorker piece (called "Muscle Memory" Http://www.newyorker.com/reporting/2007/07/30/070730fa_fact_mcgrath) devoted to the new initiatives being funded by DARPA to produce fully functioning humanlike replacement arms. Interestingly, it makes no reference at all to phantom pain and doesn't at all address a fact I spotted within the link you provided: that many amputees don't want to use prothetics because those prosthetics don't eliminate (or perhaps even worsen) the phantom pain... Does the work being done in the world of prothetics affect your own work and its prospects for impact, or are the questions of function and questions of pain pretty separate?
I think it's great that your statement on "potential demand" included some concrete numbers (eg numbers of existing amputees in the UK and the US). It's just a thought, but I wonder whether it's possible (or sensible) to also "gesture" toward the future too.... The NYorker article puts at 600 the number of (presumably American) "soldiers that have returned home without arms or legs, thanks, in part to modern body armor, which saves lives that in earlier wars would have been lost." Presumably there are a range of different kinds of injuries that bring the loss of limbs (instead of death) as a result of recent advances in emergency medicine, etc. I wonder: are there ways of making good projections about how those advances will affect the number of people your tool could help serve?
I'm interested in hearing your thoughts.
Best,
Diane
The Changemakers Team
Hello Diane. Thank you for your welcoming words!
To answer your questions, I think the work being done in the prosthetic industry to make artificial limbs lighter and more intuitive to use will certainly encourage more people with amputations to use them - one benefit of this will be the reduction of pain which originates from the residual limb. Heavy, poor fitting limbs can cause physical pain and fatigue which impacts upon levels of phantom limb pain. Similarly, artificial limbs which are operated by, for example, using the shoulder muscles of the opposite intact limb, are difficult to learn to use effectively. Therefore I would expect that improvements in prosthetics which enable residual muscles which were associated with a lost limb to animate an artificial limb in a similar manner would help to reduce phantom limb pain in a similar manner to our system - and perhaps, with such advances in the future, these techniques could be used in tandem. However, such advances still seem to be some way in the future, and the cost of these would in all proabability remain prohibitively expensive and out of the reach of most people for a long time after (the best prothetic limbs at present are comparably primitive and costs tens of thousands of dollars). ( I am less optomistic about the prospects of movemment of prosthetic fingers - where upper-limb phantom pain tends to be concentrated - and toes enabled in the same manner - something which is possible using immersive virtual reality).
Undoubtedly advances in medicine have meant that many more people who would previously have died have life-saving amputations instead. Conflicts around the world (such as you refer to) have in recent years not only caused a significant number of amputations in serving soldiers, but have left whole populations at risk of amputation (e.g. through uncleared landmines) for years after conflicts have ceased. Similarly, the rise in smoking-related amputations in developing counties will continue to rise for the forseable future.
However, I think in thinking fully about the numbers of people our system could potentially help consideration should be given to people who have similar conditions, but are not amputees. For example, some people with a paralyzed limb (e.g. as the result of having nerves and muscles damaged in motorcycle accidents) will experience a supernumerary, phantom limb which is just as painful as that experinced by a person with an amputation. The system can be expected to help this population in the same manner. Other conditions for which this sytem could help include complex regional pain syndrome and painful, paralyzed limbs following stroke. Therefore, the potential of systems and the number of potential beneficiaries extends exponentially as we consider other health-related conditions which have similar underlying pain mechanisms.
I hope the above adresses the questions you raised. Please let me know if I can clarify any details.
Best wishes
Craig
Thanks for your comments, Craig. I'd wonder whether you might not want to include some of the details you provided me in the application itself; after all, they're future-looking, concrete, and point to a great range of GLOBAL communities whom your work could aid. (While you might have thought of those groups before, less-schooled readers (like me) might not have; these details help us appreciate the size of the community(ies) that are prospective beneficiaries of your work, and that only strengthens your application... )
Best,
Diane
The Changemakers Team
Thanks Diane. I've now updated the application to include these points. Best wishes, Craig
As I have had great success with mirror therapy for relieving pain of complex regional pain syndrome, I know first hand how successful this VR technology will be. The limitations of mirror therapy, in that you can treat single sided pain, will be overcome with this new technology.
Just recently I discovered how effective mirror therapy is in treating tooth abscess pain. I was successfully stopping pain with a bifold double makeup mirror. However as soon as I stopped the pain returned. I eventually went to the dentist and lost the tooth. It pays to know that if pain returns that there is possibly pathology. I note that VR technology is used to redirect the brain's activity when very painful burn dressings are being removed.
I know when mirror therapy works for CRPS pain, it also stops the symptoms, muscle spasm, burning, inflammation, vascular changes etc. So the brain retraining has an effect on more than just pain. Is it possible that other brain messages could be changed using this technology. I think you are at the cutting edge of new science. It's very exciting.
Just as a last note. Someone in the US informed me that I could put a "button" for fund raising on my blogsite for charity. This is the perfect charity. Could you possibly look into having a donate button to support your work. Every little bit counts.
jeisea
http://crps-rsd-a-better-life.blogspot.com/
crps/rsd a better life
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