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COMBINATION OF TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION AND VIRTUAL REALITY ENVIRONMENTS TO TREAT NEUROPATHIC PAIN
Virtual Reality (VR) allows to create immersive and motivating scenarios. Associated with somatosensory feedback through transcutaneous electrical nerve stimulation, VR could represent a rehabilitation therapy tool for amputees suffering from Phantom Limb Pain (PLP) and potentially other forms of ne
A major issue for amputees is that they feel sensations or pain arising from the original limb that has been amputated1. The pain symptoms are commonly known as Phantom Limb Pain (PLP). This pathology terribly affects the quality of life of people who suffer from it. The duration of the pain attacks ranges from seconds to being constant, and is usually described as knifelike, striking, pricking, shooting and burning. The causes for these sensations are not completely understood, but it is believed that several processes are responsible. Centrally, evidence of neural plasticity and sensitization in the spinal cord’s dorsal column have been reported. Similarly, thalamic plasticity and motor cortex reorganization are considered to have a big role in the induction and maintenance of PLP2. Peripherally, neuroma
formation at the stump site and ectopic firing of primary sensory neurons, including at dorsal root ganglia (DRG), have been implicated in PLP3.
Our team has recently shown the ability of intra-neural electrical stimulation to decrease or completely cure PLP in two transfemoral amputees4,5. We now want to test a non-invasive nerve stimulation approach in combination with VR to develop a treatment
for PLP. We are currently developing a primary pilot study, where amputees with PLP will be immersed in a relaxing scenario where visually presented stimuli will be synchronized with electrical stimulation through TENS over the stump.
TENS is an inexpensive, safe and simple technique, able to stimulate the nerves through electrodes placed over the skin of the user and represents a recommended substitute to drug therapy, which is the most common treatment today10. Fruthermore, TENS can be used to facilitate perceptual embodiment of the prosthetic limb into the body schema6 and in combination with VR this perceptual illusion may be further enhanced. By adopting this approach, the underlying idea is to target some of both central and peripheral mechanisms underlying the pain perceived by many amputees. Furthermore, we would like to expand the target population of our treatment also to other neuropathies, such as to patients suffering from painful diabetic neuropathy (PDN). Also for these subjects, our idea is to provide an entertaining and innovative rehabilitation treatment through VR, and to modulate the abnormal activity of the nerves thanks to TENS.
However, the evidence of the effectiveness of TENS for PLP treatment is still in debate, due to the lack of consistent results and the amount of variables to be controlled in studies using this technology (i.e., time of stimulation, stimulation frequency/pulse width/amplitude, placement of electrodes, number of stimulation sessions).
Therefore, in this project we want to explore the potential benefits of a VR + TENS approach to treat neuropathic conditions.
A major issue for amputees is that they feel sensations or pain arising from the original limb that has been amputated1. The pain symptoms are commonly known as Phantom Limb Pain (PLP). This pathology terribly affects the quality of life of people who suffer from it. The duration of the pain attacks ranges from seconds to being constant, and is usually described as knifelike, striking, pricking, shooting and burning. The causes for these sensations are not completely understood, but it is believed that several processes are responsible. Centrally, evidence of neural plasticity and sensitization in the spinal cord’s dorsal column have been reported. Similarly, thalamic plasticity and motor cortex reorganization are considered to have a big role in the induction and maintenance of PLP2. Peripherally, neuroma formation at the stump site and ectopic firing of primary sensory neurons, including at dorsal root ganglia (DRG), have been implicated in PLP3. Our team has recently shown the ability of intra-neural electrical stimulation to decrease or completely cure PLP in two transfemoral amputees4,5. We now want to test a non-invasive nerve stimulation approach in combination with VR to develop a treatment for PLP. We are currently developing a primary pilot study, where amputees with PLP will be immersed in a relaxing scenario where visually presented stimuli will be synchronized with electrical stimulation through TENS over the stump. TENS is an inexpensive, safe and simple technique, able to stimulate the nerves through electrodes placed over the skin of the user and represents a recommended substitute to drug therapy, which is the most common treatment today10. Fruthermore, TENS can be used to facilitate perceptual embodiment of the prosthetic limb into the body schema6 and in combination with VR this perceptual illusion may be further enhanced. By adopting this approach, the underlying idea is to target some of both central and peripheral mechanisms underlying the pain perceived by many amputees. Furthermore, we would like to expand the target population of our treatment also to other neuropathies, such as to patients suffering from painful diabetic neuropathy (PDN). Also for these subjects, our idea is to provide an entertaining and innovative rehabilitation treatment through VR, and to modulate the abnormal activity of the nerves thanks to TENS. However, the evidence of the effectiveness of TENS for PLP treatment is still in debate, due to the lack of consistent results and the amount of variables to be controlled in studies using this technology (i.e., time of stimulation, stimulation frequency/pulse width/amplitude, placement of electrodes, number of stimulation sessions). Therefore, in this project we want to explore the potential benefits of a VR + TENS approach to treat neuropathic conditions.
The goal of this project is to continue and refine our preliminary software and design an experimental protocol where amputees will undergo a VR +TENS treatment able to combine therapy and entertainment. The major targets (mandatory) for the students will be:
1. Implement a VR environment based on our previous one using Unity3D
2. Synchronize visual (VR) and electrical (TENS) stimulation
3. Design an experimental protocol for the developed system
4. Testing the system on volunteers
5. Analyze the data
Extra goal:
6. Use the system with amputees and analyze the results
Reccomandable skills
- Coding either C, Matlab, Python
- Familiar to VR
Time effort required
Master project full time; in case of a high specific expertise also a smaller time effort is accepted
The goal of this project is to continue and refine our preliminary software and design an experimental protocol where amputees will undergo a VR +TENS treatment able to combine therapy and entertainment. The major targets (mandatory) for the students will be: 1. Implement a VR environment based on our previous one using Unity3D 2. Synchronize visual (VR) and electrical (TENS) stimulation 3. Design an experimental protocol for the developed system 4. Testing the system on volunteers 5. Analyze the data
Extra goal: 6. Use the system with amputees and analyze the results
Reccomandable skills - Coding either C, Matlab, Python - Familiar to VR Time effort required Master project full time; in case of a high specific expertise also a smaller time effort is accepted
Dr. Stanisa Raspopovic, Assistant Professor Neuroengineering laboratory, Head ETH Zurich, Switzerland
Email: nesta.fale@gmail.com
Greta Preatoni, PhD Student at Neuroengineering laboratory, ETH Zurich, Switzerland
Email: greta.preatoni@hest.ethz.ch
Dr. Stanisa Raspopovic, Assistant Professor Neuroengineering laboratory, Head ETH Zurich, Switzerland Email: nesta.fale@gmail.com
Greta Preatoni, PhD Student at Neuroengineering laboratory, ETH Zurich, Switzerland Email: greta.preatoni@hest.ethz.ch