Phantom limb related phenomena and their rehabilitation after lower limb amputation.

This paper reviewed the various hypotheses on phantom limb and phantom limb pain as well as all the related rehabilitation techniques to control these symptoms. The uncertainty in their pathophysiology strongly affects all the rehabilitation approaches so far used, as no single parameter has been found to predict or control phantom limb pain as well as no single factor can be quoted as an indicator of rehabilitation success for lower limb amputation. Within a comprehensive rehabilitation plan, behavioral interventions, stimulation techniques, feedback, physical therapies designed to possibly reverse the maladaptive memory traces and enhance its extinction have been described. Although substantially not clinically useful, pharmacological and surgical interventions also have been briefly considered. A reassessment of the actual strategies used is suggested with a role for rehabilitation not only after the amputation but also in the pre-emptive control of the pre-existing painful condition. In this process, rehabilitation should take into account many parameters, not always related to the traditional role of rehabilitation. Pain assessment before and after amputation, its natural history and clinical picture such as its quality, variations, level of the amputation, dominance, time interval between amputation and rehabilitation, as well as all the other phantom limb related phenomena should be considered and treated.