Concept: Vilayanur S. Ramachandran
When placing one hand on each side of a mirror and making synchronous bimanual movements, the mirror-reflected hand feels like one’s own hand that is hidden behind the mirror. We developed a novel mirror box illusion to investigate whether motoric, but not spatial, visuomotor congruence is sufficient for inducing multisensory integration, and importantly, if biomechanical constraints encoded in the body schema influence multisensory integration. Participants placed their hands in a mirror box in opposite postures (palm up, palm down), creating a conflict between visual and proprioceptive feedback for the hand behind the mirror. After synchronous bimanual hand movements in which the viewed and felt movements were motorically congruent but spatially in the opposite direction, participants felt that the hand behind the mirror rotated or completely flipped towards matching the hand reflection (illusory displacement), indicating facilitation of multisensory integration by motoric visuomotor congruence alone. Some wrist rotations are more difficult due to biomechanical constraints. We predicted that these biomechanical constraints would influence illusion effectiveness, even though the illusion does not involve actual limb movement. As predicted, illusory displacement increased as biomechanical constraints and angular disparity decreased, providing evidence that biomechanical constraints are processed in multisensory integration.
Content Analyses of A Priori Qualitative Phantom Limb Pain Descriptions and Emerging Categories in Mid-Southerners with Limb Loss
- Rehabilitation nursing : the official journal of the Association of Rehabilitation Nurses
- Published over 4 years ago
PURPOSE: The purposes of this descriptive study were (a) to identify the relative frequencies of a priori categories of phantom limb pain (PLP) quality descriptors reported by Mid-Southerners with limb loss, (b) to analyze their descriptions for emerging categories of PLP, and © to identify the relative frequencies of the emerging categories. DESIGN: This cross-sectional descriptive verbal survey assessed PLP descriptors. A content analyses determined relative frequencies of a priori PLP descriptors as well as emerging categories that were identified. FINDINGS: The most common a priori PLP quality descriptors reported by 52 amputees with PLP were intermittent, tingling/needles/numb, sharp, cramping, burning, and stabbing. The most common emerging categories reported were pain compared to illness/injury, electrical cyclical, and manipulated/positional. CONCLUSION: The detailed descriptions of PLP provide insight into the vivid experiences of PLP. CLINICAL RELEVANCE: Rehabilitation nurses can use this information with PLP assessment, patient teaching, and counseling.
Development of a Clinical Framework for Mirror Therapy in Patients with Phantom Limb Pain: An Evidence-based Practice Approach
- Pain practice : the official journal of World Institute of Pain
- Published over 2 years ago
To describe the development and content of a clinical framework for mirror therapy (MT) in patients with phantom limb pain (PLP) following amputation.
- Cortex; a journal devoted to the study of the nervous system and behavior
- Published 10 months ago
Individuals with mirror-touch synesthesia (MTS) report feeling touch on their own body when seeing someone else being touched. We examined how the body schema - an on-line representation of body position in space - is involved in mapping touch from a viewed body to one’s own body. We showed 45 mirror-touch synesthetes videos of a hand being touched, varying the location of the viewed touch by hand (left, right), skin surface (palmar, dorsal) and finger (index, ring). Participant hand posture was either congruent or incongruent with the posture of the viewed hand. After seeing the video, participants were asked to report whether they felt touch on their own body and, if so, the intensity and location of their percepts. We found that participants reported more frequent and more veridical (i.e., felt at the same somatotopic location as the viewed touch) mirror-touch percepts on posturally congruent versus posturally incongruent trials. Furthermore, participant response patterns varied as a function of postural congruence. Some participants consistently felt sensations on the hand surface that was stimulated in the video - even if their hands were in the opposite posture. Other participants' responses were modulated based on their own hand position, such that percepts were more likely to be felt on the upright, plausible hand surface in the posturally incongruent condition. These results provide evidence that mapping viewed touch to one’s own body involves an on-line representation of body position in space.
Post amputation, the complication of phantom limb pain (PLP) is prevalent and difficult to manage. This study aimed to determine whether it was feasible and acceptable to undertake a definitive multicentred randomised controlled trial assessing the effectiveness of acupuncture for treating lower limb amputees with PLP.
While most people take identification with their body for granted, conditions such as phantom limb pain, alien hand syndrome, and xenomelia suggest that the feeling of bodily congruence is constructed and susceptible to alteration. Individuals with xenomelia typically experience one of their limbs as over-present and aversive, leading to a desire to amputate the limb. Similarly, many transgender individuals describe their untreated sexed body parts as incongruent and aversive, and many experience phantom body parts of the sex they identify with (Ramachandran, 2008). This experience may relate to differences in brain representation of the sexed body part, as suggested in xenomelia (McGeoch et al., 2011). We utilized magnetoencephalography imaging to record brain activity during somatosensory stimulation of the breast-a body part that feels incongruent to most presurgical female-to-male (FtM)-identified transgender individuals-and the hand, a body part that feels congruent. We measured the sensory evoked response in right hemisphere somatosensory and body-related brain areas and found significantly reduced activation in the supramarginal gyrus and secondary somatosensory cortex, but increased activation at the temporal pole for chest sensation in the FtM group (N = 8) relative to non-transgender females (N = 8). In addition, we found increased white matter coherence in the supramarginal gyrus and temporal pole and decreased white matter diffusivity in the anterior insula and temporal pole in the FtM group. These findings suggest that dysphoria related to gender-incongruent body parts in FtM individuals may be tied to differences in neural representation of the body and altered white matter connectivity.
Despite the multiple available pharmacological and behavioral therapies for the management of chronic phantom limb pain (PLP) in lower limb amputees, treatment for this condition is still a major challenge and the results are mixed. Given that PLP is associated with maladaptive brain plasticity, interventions that promote cortical reorganization such as non-invasive brain stimulation and behavioral methods including transcranial direct current stimulation (tDCS) and mirror therapy (MT), respectively, may prove to be beneficial to control pain in PLP. Due to its complementary effects, a combination of tDCS and MT may result in synergistic effects in PLP.
We developed a quantitative method to measure movement representations of a phantom upper limb using a bimanual circle-line coordination task (BCT). We investigated whether short-term neurorehabilitation with a virtual reality (VR) system would restore voluntary movement representations and alleviate phantom limb pain (PLP).
This article examines the material culture of neuroscientist Vilayanur S. Ramachandran’s research into phantom limbs. In the 1990s Ramachandran used a ‘mirror box’ to ‘resurrect’ phantom limbs and thus to treat the pain that often accompanied them. The experimental success of his mirror therapy led Ramachandran to see mirrors as a useful model of brain function, a tendency that explains his attraction to work on ‘mirror neurons’. I argue that Ramachandran’s fascination with and repeated appeal to the mirror can be explained by the way it allowed him to confront a perennial problem in the mind and brain sciences, that of the relationship between a supposedly immaterial mind and a material brain. By producing what Ramachandran called a ‘virtual reality’, relating in varied and complex ways to the material world, the mirror reproduced a form of psycho-physical parallelism and dualistic ontology, while conforming to the materialist norms of neuroscience today.
Phantom limb pain (PLP) is a common consequence of amputation and is difficult to treat. Mirror therapy (MT), a procedure utilizing the visual recreation of movement of a lost limb by moving the intact limb in front of a mirror, has been shown to be effective in reducing PLP. However, the neural correlates of this effect are not known.