PMC10251437_01
Assessments of the patient's condition, VAS and ADLs. (A) The patient's condition upon admission. (B) Assessment of the VAS shows scores of 4 cm before treatment and 2 cm after 1-month treatment of mirror therapy and magnetic stimulation. (C) Evaluation of the Barthel index for ADLs demonstrates the ability in fundamental skills pre-treatment and after 1-month treatment.
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F1
Upon admission, we checked the residual limb, and found it in good condition, without swelling or fever (Figure 1A). The pre-treatment score of the patient was 4 cm (Figure 1B). The pre-treatment score of ADLs was 55 points, with 0 points for bathing, toilet use, and stair climbing, and with decreased points for dressing, transfers, and mobility on level surfaces (Figure 1C). The VAS was reduced to 2 cm from 4 cm, indicating a reduction in pain intensity (Figure 1B). The Barthel index for ADLs was increased to 85 points, with improved ability in bathing, toilet use, transfers, mobility on level surfaces, and stair climbing (Figure 1C).
Timeline showing the relevant events in the case.
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F2
The timeline (Figure 2) shows the relevant events in this case from amputation to the follow-up.
Interventions of mirror therapy and magnetic stimulation. (A) The image shows the patient who is receiving mirror therapy. (B) The graph demonstrates the program of magnetic stimulation at 1 Hz frequency for a total of 20 min, with 2 s rest between each 20 s stimulation.
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F3
The left intact lower limb of the patient was positioned on one side of the mirror, with the affected right side hidden on the other side, such that the patient could view the reflection of the left lower limb as if it were the right one (Figure 3A). Sacrum 3 because the sacral plexus receives sensory information from the lower extremities (Neufeld et al.,). Stimulation at a low frequency of 1 Hz, which was supposed to have inhibitory effects, was applied for a total of 20 min, with 2-s rest between each 20-s pulse (Figure 3B).
High-resolution 3D T1-weighted BRAVO images. (A) 3D BRAVO images before treatments (T1) and at the end of 2-month treatments (T3) of mirror therapy and sacral plexus magnetic stimulation. Different colors demonstrate different thicknesses, as shown with the color bar. The black arrows indicate regions with changed thickness. (B) Analysis of 3D T1-weighted BRAVO images obtained before treatment (T1) in July, at the end of 1-month treatment (T2) in August, and at the end of 2-month treatment (T3) in September 2022.
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F4
T1-weighted BRAVO images (Figure 4A) were acquired with the following parameters: matrix size = 256 x 256 x 184, voxel size = 1 x 1 x 1 mm3, repetition time (TR) = 7.1 ms, echo time (TE) = 2.7 ms, flip angle (FA) = 12 . The raw images were processed with the Computational Furthermore, analysis of BRAVO images showed that the thicknesses of the frontal pole, caudal anterior cingulate cortex (cACC), lateral occipital lobe, lateral orbitofrontal cortex, pars opercularis, pericalcarine gyrus on the right side and bilateral middle temporal gyrus were increased more than 0.1 mm at the end of 2-month interventions (T3), compared to that pre-treatment (T1) (Figure 4B). On the contrary, thicknesses of the temporal pole, insula and entorhinal cortex on the left side were reduced after 1- and 2-month treatments (Figure 4B).