A virtual reality (VR) programme for phantom limb pain, called Targeted Brain Rehabilitation (TBR), is reporting early pain reductions in upper-limb amputees, according to Amputee Store (7 November 2026). The figures come from the developers’ own clinical reports, not from a published controlled trial.
VR therapy for phantom limb pain: who built it
TBR was developed by hand and upper-limb surgeons Dr Glenn Gaston and Dr Bryan Loeffler at OrthoCarolina’s Reconstructive Center for Lost Limbs in Charlotte, North Carolina, with engineers at the University of Georgia’s VR lab. The surgeons co-founded Axolo Health to commercialise it, and the university licenses the software to the company. Healio reported in February 2026 that the FDA has registered TBR as a Class II software medical device. Axolo is offering it for in-clinic use first.
The four phases
- Laterality recognition: the patient identifies whether an on-screen hand is left or right.
- Guided motor imagery: in a calm virtual setting, the patient imagines moving the missing hand.
- Immersive mirror therapy: the patient moves the intact limb and the headset mirrors it, so the movement appears to come from the missing side.
- Motor execution: a virtual limb appears where the missing one would be, and the patient practises moving it.
Patients steer the programme with their gaze rather than handheld controllers, which matters for people with upper-limb loss.
What results are reported?
Amputee Store reports that 60 to 70 upper-limb patients have used the programme. Those treated soon after surgery saw average pain scores fall from 9 to about 2, and people with chronic pain reported reductions of more than half. Gaston told Spectrum News that long-term amputees reported about 50% less pain after 10 weeks. A single session is said to give around six to eight hours of relief, and the team is studying a six-week home protocol. None of these figures has yet been published as peer-reviewed trial data.
A lower-limb version is in development
In March 2026 the Lulu Strong Foundation awarded Axolo Health a US$100,000 grant to build a version for lower-limb amputees, according to a PRWeb release.
IMEA CPO Perspective
Phantom limb pain is one of the most common reasons upper-limb users struggle with, or abandon, a prosthesis. Mirror therapy and graded motor imagery already sit in many rehabilitation programmes across the Middle East, Africa and South Asia, often with nothing more than a mirror box. TBR packages those same steps into a structured, hands-free headset routine that a clinic can run consistently.
For CPOs in IMEA, two questions remain open: whether the results hold up in independent, controlled studies, and whether the system will be priced and registered for markets outside the US. Until then, the practical takeaway is that phantom pain is worth assessing and treating before and during prosthetic fitting, and that low-cost mirror therapy remains available today. Readers may also want to see our look at neural interfaces and upper-limb prosthetics and more in upper limb news.
FAQ
What is Targeted Brain Rehabilitation? A four-phase VR software programme for phantom limb pain, combining laterality recognition, motor imagery, mirror therapy and virtual limb movement.
Is it FDA-cleared? It is registered with the FDA as a Class II software medical device, according to Healio.
Does it work for leg amputees? Not yet. Reported use so far is in upper-limb amputees; a lower-limb version is in development.
Suggested hyperlinks / sources
- Amputee Store: VR therapy for phantom limb pain, a four-phase program (7 November 2026)
- Healio: Targeted Brain Rehabilitation uses virtual reality to address phantom limb pain (2 February 2026)
- Spectrum News Charlotte: Targeted Brain Rehabilitation (21 April 2026)
- PRWeb: Lulu Strong Foundation grant to Axolo Health
- Axolo Health