Towards the implementation of home-based phantom limb pain training facilitated by a textile-electrode system: lessons learned from a pilot study

Phantom limb pain (PLP) affects many individuals with limb loss and often requires long-term treatment. Phantom motor execution (PME), which involves decoding phantom movements through myoelectric pattern recognition and real-time feedback, often delivered via extended reality (XR), has shown promise in reducing PLP. However, its use in home settings is limited by usability and the cost of traditional disposable (Ag/AgCl) electrodes. Textile-electrode systems may offer a more user-friendly and sustainable alternative, improving the practicality of home-based PLP training. This pilot study aimed to explore the potential of using a textile-electrode system for self-administered, home-based PME interventions, focusing on user perceptions and experiences through qualitative data. Five participants with lower and one with upper limb amputations were provided with a textile-electrode system (Textrode-band, a study-specific prototype developed at the University of Borås) connected to a PME system (Neuromotus, Integrum AB, Sweden). Participants used the system at home for 24 weeks: 12 weeks of guided training (video sessions and mobile reminders), followed by 12 weeks of unsupervised training with only a weekly emailed training plan. The primary outcome was user acceptance and usability of the system, assessed through semi-structured interviews. Secondary outcomes included training frequency and continuity over two intervention periods. Self-reported PLP and quality of life data were collected to support interpretation but are not reported here. Participants generally found the textile-electrode system comfortable, easy to use, and feasible for independent use at home. Two participants reported reductions in PLP intensity or frequency, and one described improved sleep quality and several reported that the system allowed them to integrate the training into daily routines, improving their sense of control and self-management. However, some challenges with motivation and consistency, especially during the unsupervised phase, indicating the need for ongoing support. The textile-electrode system shows potential to support self-administered, home-based PME offering a user-friendly and practical alternative to traditional electrodes. Future research should focus on improving system robustness, integrating engaging training strategies, and developing support frameworks that balance user independence with necessary guidance. The findings also provide insights into advancing home-based rehabilitation for other neuromuscular conditions requiring long-term rehabilitation.