3. Phantom Pain &
Sensations
Continued sensations following
amputation of a body part
Common phantom pain/sensations
Phantom limb syndrome
Phantom bladder syndrome
3
4. Management of Phantom
Pain
Mirror Therapy
Virtual training
Not ideal for PBS
What alternatives do we have ?
4
5. Alternative Medicine
Guided imagery
a therapeutic and stress relaxation
technique
Endorphins
Chronic pain conditions, anxiety, cancer
pain, interstitial cystitis
5
https://www.youtube.com/watch?v=W
0i0KvHoSiM
6. Study Design
A randomized, double blind, parallel group
controlled trial
Sample size= 30
Control- relaxation CD, Intervention- Guided
Imagery twice a day for 8 weeks
Primary outcome
Pain (VAS)
Secondary outcome
Quality of life (SF-36)
6
7. Skills Acquired
Conducting comprehensive literature
review
HES database/ICD-10 and OPCS-4
coding
Research Design
IRB protocol
Patient recruitment
7
8. Objective Outcome
Evaluation
Outcome evaluation of an intervention
Outcomes related to quality of life and day to day
mobility are most evaluated through subjective
measures
Standard questionnaires
Self-reports
No objective measures under most scenarios
8
9. Why Go Objective
Example
Orthopedic surgery
Knee/Hip joint replacement
What impact does these interventions have on
everyday living and quality of life
Postural balance, walking, everyday living activities
Has the above been improved or at least regained
9
10. Postural Balance
Body sway
Previously assessed subjectively
Improved technology led to objective
measures
However, still not feasible for busy
clinics
Advent of Body-worn sensors
10
ML Sway, cm
APSway,cm
11. Walking Patterns
Motion Capture/ Mat Systems
Tedious
Confined to in lab measurements
Body-worn sensors
Out of lab
In clinic/home
Easy
11
12. Daily Spontaneous
Activities
Generally
Pedometers
Very basic measures (steps, calories,
distance)
Body worn sensors
Accurate
Easy
Valuable measures (steps, speed,
postural transitions, standing time,
walking time)
12
13. Stress Assessment
20 Diabetic patients with active
foot ulcers (57± 12 years)
Stress assessed during clinical visit
for wound dressing
Body worn sensor (Zephyr
BioHarness®)
Stress quantified by HRV
13
18%
35%
47%
Typical example of patient with
low stress (a) and high stress (b)
during would dressing
a
b
Duration of
different
levels of stress
experienced
by patients
during wound
dressing
14. Skills Acquired
IRB Protocols: CITI, HIPPA
Research Design and coordination
SCM/All scripts
Patient recruitment
Data collection
Body worn sensors
Grants writing
SPSS
14
16. Accomplishments
Grants Contributions
Urostomy Association: Grant awarded during research at
Bournemouth, England
NIH R21: A Tailored Stress-Management intervention to accelerate
wound healing in diabetes (Submitted)
Diabetes Research and Wellness Foundation Grant: Multifaceted
Patient Centric Approach to Improve Management of Diabetic Foot
Wounds (Submitted)
American Diabetes Association: An Innovative Game-Based Exercise to
Accelerate Diabetic Foot Wound Healing (Submitted)
Publications
Parvaneh S, Grewal GS, Grewal E, Menzies RA. Talal TK, Armstrong DG,
Sternberg E, and Najafi B. 2014 ‘Stressing the Dressing: Assessing Stress
during Wound Care in Real-Time Using Wearable Sensors’. Wound
Medicine, 4: 21-26.
Parvaneh S, Grewal GS, Grewal E, Talal TK, Armstrong DG and Najafi B.
2014 ‘Heart Rate Variability for assessment of physiological stress
response: validation of a personalized algorithm’. (Submitted).
Grewal E et al. Phantom Urinary Bladder Syndrome: A Systematic
Review (Drafting)
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