Re: Combining the Absence of Electromagnetic Fields and Mirror Therapy to Improve Outcome for Persons with Lower-Limb Vascular Amputation: Letter to the Editor : JPO: Journal of Prosthetics and Orthotics

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Re: Combining the Absence of Electromagnetic Fields and Mirror Therapy to Improve Outcome for Persons with Lower-Limb Vascular Amputation: Letter to the Editor

Fillmore, Shannon BS

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Journal of Prosthetics and Orthotics 29(3):p 98-99, July 2017. | DOI: 10.1097/JPO.0000000000000133
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The recent article, “Combining the Absence of Electromagnetic Fields and Mirror Therapy to Improve Outcome for Persons with Lower-Limb Vascular Amputation” (JPO Volume 28, Number 4, October 2016) sought to explore an important topic that can greatly impact the world of amputation and prosthetic use.1 As 1.7 million people in America are currently living with an amputation and 51% to 81% of them experience phantom limb pain (PLP), determining the most effective treatment protocol to reduce PLP can have a lasting impact on the mobility and quality of life among all current sufferers.2 Houston et al.1 suggested the effectiveness of combining Farabloc technology and mirror therapy to reduce PLP and improve wound healing.

According to Foell et al.,2 the development and symptoms of phantom limb pain can vary among individuals, making it very difficult to understand and treat. However, these authors discovered that the combined treatment of mirror therapy and the use of Farabloc technology to eliminate electromagnetic fields “reduces PLP to the extent to which persons with amputation can increase participation in their activities of daily life and subsequently improve their quality of life.”1 I applaud them for making this connection, because it can have a lasting impact on the treatment protocol prescribed by physical therapists for treating PLP.

However, a 2015 literature review concluded that the evidence regarding mirror therapy is weak because of the discrepancies of methodology within the treatment given and overall recruitment biases seen within many studies.3 This article discusses the limitations within this study thoroughly and highlights the need for a larger sample size, a control group, and the need for treatment to be administered within the same setting to reduce external influences. However, I believe further expansion of this topic is needed in three important ways. First, it would be beneficial for future prosthetists to study the effect of incorporating the Farabloc fabric into the sockets of prostheses and determining the effect this would have on PLP. Second, it would be beneficial to study the long-term effects this combined treatment can have toward the development and persistence of PLP. I commend this study for the promising results that exemplify the use of mirror therapy and Farabloc technology for the short-term treatment of PLP. However, I believe that to evaluate the overall effectiveness of this treatment protocol, a long-term trial must be conducted with a large enough sample to generalize the entire population. Third, I believe that the comparison between this combined treatment and more common treatment regimens such as pharmacological interventions and transcutaneous electrical nerve stimulation should be made.

Further exploration into this topic is crucial for physical therapists and prosthetists. Expanding the treatment options for PLP is imperative, given that PLP is a major issue seen within people with an amputation. As a future physical therapist, I would be interested in learning more about the benefits of these treatments through more clinical trials and further exploration on the long-term effects.

Shannon Fillmore, BS
Health Studies Student – Physical Therapy Track
Utica College
Utica, New York


1. Houston H, Dickerson A, Wu Q. Combining the absence of electromagnetic fields and mirror therapy to improve outcomes for persons with lower-limb vascular amputation. J Prosthet Orthot 2016;28:154–164.
2. Foell J, Bekrater-Bodmann R, Flor H, Cole J. Phantom limb pain after lower limb trauma: origins and treatments. Int J Low Extrem Wounds 2011;10:224–235.
3. Timms J, Carus C. Mirror therapy for the alleviation of phantom limb pain following amputation: a literature review. Int J Ther Rehabil 2015;22:135–145.
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