Playing Virtual Games to Treat Phantom Limb Pain

Apr 11, 2019

Paula Youngblood has struggled with phantom limb pain since losing her hand in a car crash in 2017, but she may have found a treatment that works -- virtual reality gaming.  She’s been working with a grad student at James Madison University studying alternative therapy methods.  WMRA’s Calvin Pynn reports.

[Paula Youngblood strapping controller to arm]

Paula Youngblood is preparing for an afternoon of virtual reality gaming with an HTC Vive as she activates a pair of ray gun-like controllers and adjusts a large headset that recalls the retro-futurism of 80s science fiction. But as she straps a controller in place of her now amputated left hand, she notices an unexpected sign of progress as the strap feels tighter than before.

PAULA YOUNGBLOOD: It’s atrophied really bad because it doesn’t get any use so the muscle tone has gone out of it, it happens pretty fast too…

That’s one side effect Youngblood has experienced since losing her left hand – a symptom second only to the phantom limb pain.  It’s why she and JMU grad student Stuart Landis are in the Virtual Reality -- or "VR" Room -- in Carrier Library's Makery, testing out the gaming software as a way to ease her pain.

[Youngblood starting up game]

Phantom limb is the sensation that a missing limb is still attached, and according to the International Association for the Study of Pain, it affects 60 to 80 percent of amputees. Those sensations can be intermittent depending on factors such as mood, stress and weather, but they can often be painful.

Landis and research partner Jasper Coleman are students in JMU's Occupational Therapy graduate program with a specialized interest in hand therapy. They decided to focus on phantom limb because treatment options are limited.

STUART LANDIS: Phantom limb sensation is a bizarre one because it's neurological, it's unique enough there’s a niche we wanted to try to pursue it more.

Mirror box therapy has been the primary treatment method for amputees suffering from phantom limb pain. It involves a two-sided box divided by a mirror, in which a patient places their unaffected limb on one side, and their residual limb on the other. When viewing from an angle, two complete symmetrical hands are visible.

That treatment has its limitations though, as only 60 percent of those who try mirror box therapy report benefitting from it. It had been the only therapy available to Youngblood, and as she tried it, it only reminded her of what she had lost.

YOUNGBLOOD: No bashing to mirror therapy, but that's what it’s kind of like. It’s like 'yep, my hand’s still not there.'

Virtual reality gaming has been explored as an alternative treatment for phantom limb in past studies. While it has been proven effective, Landis said they wanted to explore the less clinical aspects of that treatment.

LANDIS: There’s definitely a precedent to say that this works, so we thought we’d just actually try doing it and add the motivation piece.

In other words, for the treatment to work, the patient has to want to use it in the first place.  So motivation became the key focus of the study.

[Youngblood playing Diner Duo, seen here in a sample video on YouTube]

YOUNGBLOOD: Oh, we’ve got two…

LANDIS: Two doubles!

YOUNGBLOOD: Hot diggity! Alright, we can do this.

Youngblood is playing Diner Duo, grilling hamburgers in a simulated busy lunch rush. She can only use one controller in her right hand while the other is strapped to her affected left arm, but through the visor strapped to her head, she sees herself controlling two hands working the virtual grill.

After about twenty minutes playing Diner Duo, they decide to switch over to Beat Saber, which has become a favorite during the sessions. This game has Youngblood using two lightsaber-like blades to fend off energy blasts flying at her to the beat of electronic dance music.

Watch a video of Youngblood playing Beat Saber

Unlike Diner Duo, Youngblood is using both of her limbs to their full potential. She gets so into it at one point that the controller strapped to her left arm almost flies off.

YOUNGBLOOD: Whoa! Dude! Did you see that?

This has been the routine for all of their sessions over the past month. At the end, Youngblood fills out a questionnaire to gauge her experience and her motivation. Even from their earliest session, Youngblood says she has felt a morale boost.

YOUNGBLOOD: Right now I feel like I just kicked that game’s butt. And I don’t walk out of there feeling like, 'woe is me, I don’t have a hand.' I’m gonna be amped up for the rest of the day, my heart is just now starting to slow down and recover.

Youngblood says she has felt the positive rush from the VR sessions up to a few days after. That effect has even crossed over to help in her career at Brian Mayes’ Karate, where Youngblood works as a martial arts instructor.

YOUNGBLOOD: So is everybody feeling like a black belt today?

Class: Yeah!

Youngblood’s martial arts career aided in her recovery after losing her hand, and she even managed to earn her Third Degree Blackbelt as an amputee. But unlike her therapy options, VR games such as Beat Saber have helped her retain the muscle memory used in her life’s passion.

YOUNGBLOOD: You forget about your aches and pains when you’re doing that, it’s just exciting and it’s fun. Doing mirror box therapy versus: “whoa look at the sword in my hand!” It’s a no brainer.  

The study concluded on April 4. With their research done, Landis is finalizing the results. As for Youngblood, the VR sessions are far from over, and she even plans to bring another amputee she befriended in to share the experience.

[Youngblood advancing to the next level of Diner Duo]