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Zernitz M, Rizzello C, Rigoni M, Van de Winckel A. Case Report: Phantom limb pain relief after cognitive multisensory rehabilitation. FRONTIERS IN PAIN RESEARCH 2024; 5:1374141. [PMID: 38726352 PMCID: PMC11079144 DOI: 10.3389/fpain.2024.1374141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 04/15/2024] [Indexed: 05/12/2024] Open
Abstract
Introduction Relieving phantom limb pain (PLP) after amputation in patients resistant to conventional therapy remains a challenge. While the causes for PLP are unclear, one model suggests that maladaptive plasticity related to cortical remapping following amputation leads to altered mental body representations (MBR) and contributes to PLP. Cognitive Multisensory Rehabilitation (CMR) has led to reduced pain in other neurologic conditions by restoring MBR. This is the first study using CMR to relieve PLP. Methods A 26-year-old woman experienced excruciating PLP after amputation of the third proximal part of the leg, performed after several unsuccessful treatments (i.e., epidural stimulator, surgeries, analgesics) for debilitating neuropathic pain in the left foot for six years with foot deformities resulting from herniated discs. The PLP was resistant to pain medication and mirror therapy. PLP rendered donning a prosthesis impossible. The patient received 35 CMR sessions (2×/day during weekdays, October-December 2012). CMR provides multisensory discrimination exercises on the healthy side and multisensory motor imagery exercises of present and past actions in both limbs to restore MBR and reduce PLP. Results After CMR, PLP reduced from 6.5-9.5/10 to 0/10 for neuropathic pain with only 4-5.5/10 for muscular pain after exercising on the Numeric Pain Rating Scale. McGill Pain Questionnaire scores reduced from 39/78 to 5/78, and Identity (ID)-Pain scores reduced from 5/5 to 0/5. Her pain medication was reduced by at least 50% after discharge. At 10-month follow-up (9/2013), she no longer took Methadone or Fentanyl. After discharge, receiving CMR as outpatient, she learned to walk with a prosthesis, and gradually did not need crutches anymore to walk independently indoors and outdoors (9/2013). At present (3/2024), she no longer takes pain medication and walks independently with the prosthesis without assistive devices. PLP is under control. She addresses flare-ups with CMR exercises on her own, using multisensory motor imagery, bringing the pain down within 10-15 min. Conclusion The case study seems to support the hypothesis that CMR restores MBR which may lead to long-term (12-year) PLP reduction. MBR restoration may be linked to restoring accurate multisensory motor imagery of the remaining and amputated limb regarding present and past actions.
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Affiliation(s)
- Marina Zernitz
- Centro Studi di Riabilitazione Neurocognitiva, Villa Miari, Vicenza, Italy
| | - Carla Rizzello
- Centro Studi di Riabilitazione Neurocognitiva, Villa Miari, Vicenza, Italy
| | - Marco Rigoni
- Centro Studi di Riabilitazione Neurocognitiva, Villa Miari, Vicenza, Italy
| | - Ann Van de Winckel
- Division of Physical Therapy and Rehabilitation Science, Department of Family Medicine and Community Health, Medical School, University of Minnesota Twin Cities, Minneapolis, MN, United States
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Cohen SP, Caterina MJ, Yang SY, Socolovsky M, Sommer C. Pain in the Context of Sensory Deafferentation. Anesthesiology 2024; 140:824-848. [PMID: 38470115 DOI: 10.1097/aln.0000000000004881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
Pain that accompanies deafferentation is one of the most mysterious and misunderstood medical conditions. Prevalence rates for the assorted conditions vary considerably but the most reliable estimates are greater than 50% for strokes involving the somatosensory system, brachial plexus avulsions, spinal cord injury, and limb amputation, with controversy surrounding the mechanistic contributions of deafferentation to ensuing neuropathic pain syndromes. Deafferentation pain has also been described for loss of other body parts (e.g., eyes and breasts) and may contribute to between 10% and upwards of 30% of neuropathic symptoms in peripheral neuropathies. There is no pathognomonic test or sign to identify deafferentation pain, and part of the controversy surrounding it stems from the prodigious challenges in differentiating cause and effect. For example, it is unknown whether cortical reorganization causes pain or is a byproduct of pathoanatomical changes accompanying injury, including pain. Similarly, ascertaining whether deafferentation contributes to neuropathic pain, or whether concomitant injury to nerve fibers transmitting pain and touch sensation leads to a deafferentation-like phenotype can be clinically difficult, although a detailed neurologic examination, functional imaging, and psychophysical tests may provide clues. Due in part to the concurrent morbidities, the physical, psychologic, and by extension socioeconomic costs of disorders associated with deafferentation are higher than for other chronic pain conditions. Treatment is symptom-based, with evidence supporting first-line antineuropathic medications such as gabapentinoids and antidepressants. Studies examining noninvasive neuromodulation and virtual reality have yielded mixed results.
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Affiliation(s)
- Steven P Cohen
- Departments of Anesthesiology, Neurology, Physical Medicine and Rehabilitation, Psychiatry and Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Departments of Physical Medicine and Rehabilitation and Anesthesiology, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Michael J Caterina
- Neurosurgery Pain Research Institute and Department of Biological Chemistry, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Su-Yin Yang
- Psychology Service, Woodlands Health, and Adjunct Faculty, Lee Kong Chian School of Medicine, Singapore
| | - Mariano Socolovsky
- Department of Neurosurgery, University of Buenos Aires, Buenos Aires, Argentina
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Yang H, Yanagisawa T. Is Phantom Limb Awareness Necessary for the Treatment of Phantom Limb Pain? Neurol Med Chir (Tokyo) 2024; 64:101-107. [PMID: 38267056 PMCID: PMC10992984 DOI: 10.2176/jns-nmc.2023-0206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 10/31/2023] [Indexed: 01/26/2024] Open
Abstract
Phantom limb pain is attributed to abnormal sensorimotor cortical representations. Various feedback treatments have been applied to induce the reorganization of the sensorimotor cortical representations to reduce pain. We developed a training protocol using a brain-computer interface (BCI) to induce plastic changes in the sensorimotor cortical representation of phantom hand movements and demonstrated that BCI training effectively reduces phantom limb pain. By comparing the induced cortical representation and pain, the mechanisms worsening the pain have been attributed to the residual phantom hand representation. Based on our data obtained using neurofeedback training without explicit phantom hand movements and hand-like visual feedback, we suggest a direct relationship between cortical representation and pain. In this review, we summarize the results of our BCI training protocol and discuss the relationship between cortical representation and phantom limb pain. We propose a treatment for phantom limb pain based on real-time neuroimaging to induce appropriate cortical reorganization by monitoring cortical activities.
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Affiliation(s)
- Huixiang Yang
- Institute for Advanced Co-creation Studies, Osaka University
| | - Takufumi Yanagisawa
- Institute for Advanced Co-creation Studies, Osaka University
- Department of Neurosurgery, Graduate School of Medicine, Osaka University
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Salgues S, Plancher G, Michael GA. Is it really on your hand? Spontaneous sensations are not peripheral sensations - Evidence from able-bodied individuals and a phantom limb syndrome patient. Brain Cogn 2024; 175:106138. [PMID: 38335922 DOI: 10.1016/j.bandc.2024.106138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 01/26/2024] [Accepted: 01/29/2024] [Indexed: 02/12/2024]
Abstract
Among other bodily signals, the perception of sensations arising spontaneously on the skin with no external triggers contributes to body awareness. The topic of spontaneous sensations (SPS) being quite recent in the literature, there is still a debate whether this phenomenon is elicited by peripheral cutaneous units' activity underlying tactile perception or originates directly from central mechanisms. In a first experiment, we figured that, if SPS depended on peripheral afferents, their perception on the glabrous hand should relate to the hand tactile sensitivity. On the contrary, we found no relationship at all, which led us to envisage the scenario of SPS in the absence of cutaneous units. In a second experiment, we present the case of Julie, a right-hand amputee that could perceive and report SPS arising on her phantom limb syndrome. We found that SPS distribution on the phantom limb followed the same gradient as that observed in control participants, unlike SPS perceived on the intact left hand. Those findings are crucial to the understanding of neural factors determining body awareness through SPS perception and provide insights into the existence of a precise neural gradient underlying somesthesis.
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Affiliation(s)
- Sara Salgues
- Département de Sciences Cognitives, Psychologie Cognitive & Neuropsychologie, Institut de Psychologie, Unité de Recherche Étude des Mécanismes Cognitifs (EA 3082), Université Lumière Lyon 2, Lyon, France; Laboratoire Mémoire Cerveau et Cognition, Université Paris Cité, Paris, France.
| | - Gaën Plancher
- Département de Sciences Cognitives, Psychologie Cognitive & Neuropsychologie, Institut de Psychologie, Unité de Recherche Étude des Mécanismes Cognitifs (EA 3082), Université Lumière Lyon 2, Lyon, France; Institut Universitaire de France (IUF), France
| | - George A Michael
- Département de Sciences Cognitives, Psychologie Cognitive & Neuropsychologie, Institut de Psychologie, Unité de Recherche Étude des Mécanismes Cognitifs (EA 3082), Université Lumière Lyon 2, Lyon, France
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Wei HR, Tang L, Yang XL, Chen CM, Li LX, Mao Y, Wang D, Kang F, Qun S, Zhang Z, Cao P, Jin Y. A microglial activation cascade across cortical regions underlies secondary mechanical hypersensitivity to amputation. Cell Rep 2024; 43:113804. [PMID: 38368612 DOI: 10.1016/j.celrep.2024.113804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 08/03/2023] [Accepted: 01/31/2024] [Indexed: 02/20/2024] Open
Abstract
Neural mechanisms underlying amputation-related secondary pain are unclear. Using in vivo two-photon imaging, three-dimensional reconstruction, and fiber photometry recording, we show that a microglial activation cascade from the primary somatosensory cortex of forelimb (S1FL) to the primary somatosensory cortex of hindlimb (S1HL) mediates the disinhibition and subsequent hyperexcitation of glutamatergic neurons in the S1HL (S1HLGlu), which then drives secondary mechanical hypersensitivity development in ipsilateral hindpaws of mice with forepaw amputation. Forepaw amputation induces rapid S1FL microglial activation that further activates S1HL microglia via the CCL2-CCR2 signaling pathway. Increased engulfment of GABAergic presynapses by activated microglia stimulates S1HLGlu neuronal activity, ultimately leading to secondary mechanical hypersensitivity of hindpaws. It is widely believed direct neuronal projection drives interactions between distinct brain regions to prime specific behaviors. Our study reveals microglial interactions spanning different subregions of the somatosensory cortex to drive a maladaptive neuronal response underlying secondary mechanical hypersensitivity at non-injured sites.
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Affiliation(s)
- Hong-Rui Wei
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Hefei National Laboratory for Physical Sciences at the Microscale, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230026, China
| | - Lan Tang
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Hefei National Laboratory for Physical Sciences at the Microscale, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230026, China
| | - Xin-Lu Yang
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Hefei National Laboratory for Physical Sciences at the Microscale, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230026, China; Department of Anesthesiology, The First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui 241000, China
| | - Chang-Mao Chen
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Hefei National Laboratory for Physical Sciences at the Microscale, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230026, China
| | - Le-Xian Li
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Hefei National Laboratory for Physical Sciences at the Microscale, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230026, China
| | - Yu Mao
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - Di Wang
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Hefei National Laboratory for Physical Sciences at the Microscale, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230026, China
| | - Fang Kang
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Hefei National Laboratory for Physical Sciences at the Microscale, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230026, China
| | - Sen Qun
- Stroke Center and Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230026, China
| | - Zhi Zhang
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Hefei National Laboratory for Physical Sciences at the Microscale, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230026, China; Center for Advanced Interdisciplinary Science and Biomedicine, Institute of Health and Medicine, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230026, China.
| | - Peng Cao
- Stroke Center and Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230026, China.
| | - Yan Jin
- Stroke Center and Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230026, China.
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Limakatso K, Ndhlovu F, Usenbo A, Rayamajhi S, Kloppers C, Parker R. The prevalence and risk factors for phantom limb pain: a cross-sectional survey. BMC Neurol 2024; 24:57. [PMID: 38321380 PMCID: PMC10845739 DOI: 10.1186/s12883-024-03547-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 01/22/2024] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND We previously performed a systematic review and meta-analysis which revealed a Phantom Limb Pain (PLP) prevalence estimate of 64% [95% CI: 60.01-68.1]. The prevalence estimates varied significantly between developed and developing countries. Remarkably, there is limited evidence on the prevalence of PLP and associated risk factors in African populations. METHODS Adults who had undergone limb amputations between January 2018 and October 2022 were recruited from healthcare facilities in the Western and Eastern Cape Provinces. We excluded individuals with auditory or speech impairments that hindered clear communication via telephone. Data on the prevalence and risk factors for PLP were collected telephonically from consenting and eligible participants. The prevalence of PLP was expressed as a percentage with a 95% confidence interval. The associations between PLP and risk factors for PLP were tested using univariate and multivariable logistic regression analyses. The strength of association was calculated using the Odds Ratio where association was confirmed. RESULTS The overall PLP prevalence was 71.73% [95% CI: 65.45-77.46]. Persistent pre-operative pain, residual limb pain, and non-painful phantom limb sensations were identified as risk factors for PLP. CONCLUSION This study revealed a high prevalence of PLP. The use of effective treatments targeting pre-amputation pain may yield more effective and targeted pre-amputation care, leading to improved quality of life after amputation.
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Affiliation(s)
- Katleho Limakatso
- Pain Management Unit, Department of Anaesthesia and Perioperative Medicine, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
- Neural Prosthetics and Pain Research Unit, Bionics Institute, 384-388 Albert St, East Melbourne, East Melbourne, 3002, Australia
| | - F Ndhlovu
- Department of Anaesthesiology, Nelson Mandela Academic Hospital, Mthatha, South Africa
| | - A Usenbo
- Department of Anaesthesiology, Nelson Mandela Academic Hospital, Mthatha, South Africa
| | - S Rayamajhi
- Department of Acute Care Surgery, Groote Schuur Hospital, Cape Town, South Africa
| | - C Kloppers
- Department of Acute Care Surgery, Groote Schuur Hospital, Cape Town, South Africa
| | - R Parker
- Pain Management Unit, Department of Anaesthesia and Perioperative Medicine, D23 Groote Schuur Hospital, Faculty of Health Sciences, Anzio Rd, Observatory, Cape Town, 7925, South Africa.
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Tucciarelli R, Ejaz N, Wesselink DB, Kolli V, Hodgetts CJ, Diedrichsen J, Makin TR. Does Ipsilateral Remapping Following Hand Loss Impact Motor Control of the Intact Hand? J Neurosci 2024; 44:e0948232023. [PMID: 38050100 PMCID: PMC10860625 DOI: 10.1523/jneurosci.0948-23.2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 10/31/2023] [Accepted: 11/21/2023] [Indexed: 12/06/2023] Open
Abstract
What happens once a cortical territory becomes functionally redundant? We studied changes in brain function and behavior for the remaining hand in humans (male and female) with either a missing hand from birth (one-handers) or due to amputation. Previous studies reported that amputees, but not one-handers, show increased ipsilateral activity in the somatosensory territory of the missing hand (i.e., remapping). We used a complex finger task to explore whether this observed remapping in amputees involves recruiting more neural resources to support the intact hand to meet greater motor control demands. Using basic fMRI analysis, we found that only amputees had more ipsilateral activity when motor demand increased; however, this did not match any noticeable improvement in their behavioral task performance. More advanced multivariate fMRI analyses showed that amputees had stronger and more typical representation-relative to controls' contralateral hand representation-compared with one-handers. This suggests that in amputees, both hand areas work together more collaboratively, potentially reflecting the intact hand's efference copy. One-handers struggled to learn difficult finger configurations, but this did not translate to differences in univariate or multivariate activity relative to controls. Additional white matter analysis provided conclusive evidence that the structural connectivity between the two hand areas did not vary across groups. Together, our results suggest that enhanced activity in the missing hand territory may not reflect intact hand function. Instead, we suggest that plasticity is more restricted than generally assumed and may depend on the availability of homologous pathways acquired early in life.
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Affiliation(s)
- Raffaele Tucciarelli
- MRC Cognition & Brain Sciences Unit, University of Cambridge, Cambridge CB2 7EF, United Kingdom
- Institute of Cognitive Neuroscience, University College London, London WC1N 3AZ, United Kingdom
| | - Naveed Ejaz
- Departments of Statistical and Actuarial Sciences and Computer Science, Western University, London, Ontario N6A 5B7, Canada
| | - Daan B Wesselink
- WIN Centre, Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford OX3 9DU, United Kingdom
- Department of Neurobiology, Harvard Medical School, Boston, Massachusetts 02115
| | - Vijay Kolli
- Queen Mary's Hospital, London SW15 5PN, United Kingdom
| | - Carl J Hodgetts
- CUBRIC, School of Psychology, Cardiff University, Cardiff CF24 4HQ, United Kingdom
- Royal Holloway, University of London, Egham TW20 0EX, United Kingdom
| | - Jörn Diedrichsen
- Departments of Statistical and Actuarial Sciences and Computer Science, Western University, London, Ontario N6A 5B7, Canada
- Brain and Mind Institute, Western University, London, Ontario N6A 3K7, Canada
| | - Tamar R Makin
- MRC Cognition & Brain Sciences Unit, University of Cambridge, Cambridge CB2 7EF, United Kingdom
- Institute of Cognitive Neuroscience, University College London, London WC1N 3AZ, United Kingdom
- WIN Centre, Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford OX3 9DU, United Kingdom
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Sparling T, Iyer L, Pasquina P, Petrus E. Cortical Reorganization after Limb Loss: Bridging the Gap between Basic Science and Clinical Recovery. J Neurosci 2024; 44:e1051232024. [PMID: 38171645 PMCID: PMC10851691 DOI: 10.1523/jneurosci.1051-23.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 08/28/2023] [Accepted: 09/29/2023] [Indexed: 01/05/2024] Open
Abstract
Despite the increasing incidence and prevalence of amputation across the globe, individuals with acquired limb loss continue to struggle with functional recovery and chronic pain. A more complete understanding of the motor and sensory remodeling of the peripheral and central nervous system that occurs postamputation may help advance clinical interventions to improve the quality of life for individuals with acquired limb loss. The purpose of this article is to first provide background clinical context on individuals with acquired limb loss and then to provide a comprehensive review of the known motor and sensory neural adaptations from both animal models and human clinical trials. Finally, the article bridges the gap between basic science researchers and clinicians that treat individuals with limb loss by explaining how current clinical treatments may restore function and modulate phantom limb pain using the underlying neural adaptations described above. This review should encourage the further development of novel treatments with known neurological targets to improve the recovery of individuals postamputation.Significance Statement In the United States, 1.6 million people live with limb loss; this number is expected to more than double by 2050. Improved surgical procedures enhance recovery, and new prosthetics and neural interfaces can replace missing limbs with those that communicate bidirectionally with the brain. These advances have been fairly successful, but still most patients experience persistent problems like phantom limb pain, and others discontinue prostheses instead of learning to use them daily. These problematic patient outcomes may be due in part to the lack of consensus among basic and clinical researchers regarding the plasticity mechanisms that occur in the brain after amputation injuries. Here we review results from clinical and animal model studies to bridge this clinical-basic science gap.
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Affiliation(s)
- Tawnee Sparling
- Department of Physical Medicine and Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, Maryland 20814
| | - Laxmi Iyer
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland 20817
| | - Paul Pasquina
- Department of Physical Medicine and Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, Maryland 20814
| | - Emily Petrus
- Department of Anatomy, Physiology and Genetics, Uniformed Services University, Bethesda, Maryland 20814
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Zhu J, Gu R, Shi L, Su Y. Altered intrinsic brain activity in patients with neuropathic pain after brachial plexus avulsion. Brain Res Bull 2024; 206:110831. [PMID: 38056510 DOI: 10.1016/j.brainresbull.2023.110831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 09/08/2023] [Accepted: 11/28/2023] [Indexed: 12/08/2023]
Abstract
OBJECTIVE This study aimed to investigate brain activity changes in patients suffering from neuropathic pain (NP) following brachial plexus avulsion (BPA). METHODS Fifteen patients with NP following BPA and eight healthy participants (HP) were recruited for this study. All participants underwent examination using resting-state functional MRI. The amplitude of low-frequency fluctuation (ALFF) and regional homogeneity (ReHo) were calculated and compared between the BPA group, left-BPA subgroup, right-BPA subgroup, and the HP group using independent samples t-tests. RESULTS In the BPA group, there were notable increases in ALFF/ReHo observed in the left rolandic operculum, insula, and supramarginal gyrus, while decreases were observed in the left paracentral lobule, fusiform gyrus, calcarine fissure and surrounding cortex, lingual gyrus, precuneus, as well as the bilateral anterior/median cingulate and paracingulate gyri, supplementary motor area, and cerebellum. In the left-BPA subgroup, elevated ALFF/ReHo levels were identified in the left middle/inferior frontal gyri, rolandic operculum, and supramarginal gyrus, with corresponding decreases in the left calcarine fissure and surrounding cortex, inferior occipital gyrus, fusiform gyrus, lingual gyrus, as well as the bilateral anterior/median cingulate and paracingulate gyri, postcentral gyri, supplementary motor area, paracentral lobules, and cerebellum. The right-BPA subgroup displayed increased ALFF/ReHo in the left frontal lobe, rolandic operculum, insula, fusiform gyrus, and lingual gyrus, as well as the right cerebellum. Conversely, decreases in ALFF/ReHo were observed in the bilateral anterior/median cingulate and paracingulate gyri, calcarine fissure and surrounding cortex, cuneus, and occipital lobes. CONCLUSIONS The NP after BPA caused spontaneous activity changes in brain regions associated with linguistic, visual, somatosensory, and motor coordination and processing function. The majority of these abnormal areas were situated in the left cerebral hemisphere, while the effect of cingulate gyri and cerebellum seemed to be bilateral.
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Affiliation(s)
- Jin Zhu
- Department of Neurosurgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100035, China
| | - Rui Gu
- Department of Functional Neurosurgery, Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Liang Shi
- Department of Neurosurgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100035, China.
| | - Yibing Su
- Department of Neurosurgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100035, China.
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Guekos A, Cole DM, Dörig M, Stämpfli P, Schibli L, Schuetz P, Schweinhardt P, Meier ML. BackWards - Unveiling the brain's topographic organization of paraspinal sensory input. Neuroimage 2023; 283:120431. [PMID: 37914091 DOI: 10.1016/j.neuroimage.2023.120431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 10/24/2023] [Accepted: 10/27/2023] [Indexed: 11/03/2023] Open
Abstract
Cortical reorganization and its potential pathological significance are being increasingly studied in musculoskeletal disorders such as chronic low back pain (CLBP) patients. However, detailed sensory-topographic maps of the human back are lacking, and a baseline characterization of such representations, reflecting the somatosensory organization of the healthy back, is needed before exploring potential sensory map reorganization. To this end, a novel pneumatic vibrotactile stimulation method was used to stimulate paraspinal sensory afferents, while studying their cortical representations in unprecedented detail. In 41 young healthy participants, vibrotactile stimulations at 20 Hz and 80 Hz were applied bilaterally at nine locations along the thoracolumbar axis while functional magnetic resonance imaging (fMRI) was performed. Model-based whole-brain searchlight representational similarity analysis (RSA) was used to investigate the organizational structure of brain activity patterns evoked by thoracolumbar sensory inputs. A model based on segmental distances best explained the similarity structure of brain activity patterns that were located in different areas of sensorimotor cortices, including the primary somatosensory and motor cortices and parts of the superior parietal cortex, suggesting that these brain areas process sensory input from the back in a "dermatomal" manner. The current findings provide a sound basis for testing the "cortical map reorganization theory" and its pathological relevance in CLBP.
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Affiliation(s)
- Alexandros Guekos
- Integrative Spinal Research, Department of Chiropractic Medicine, Balgrist University Hospital, University of Zurich, Zurich, Switzerland; Decision Neuroscience Lab, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland; Neuroscience Center Zurich (ZNZ), Zurich, Switzerland.
| | - David M Cole
- Integrative Spinal Research, Department of Chiropractic Medicine, Balgrist University Hospital, University of Zurich, Zurich, Switzerland; Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital, University of Zurich, Switzerland
| | - Monika Dörig
- Integrative Spinal Research, Department of Chiropractic Medicine, Balgrist University Hospital, University of Zurich, Zurich, Switzerland; School of Engineering and Architecture, Lucerne University of Applied Sciences and Arts, Horw, Switzerland
| | - Philipp Stämpfli
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital, University of Zurich, Switzerland; MR-Center of the Psychiatric University Hospital, Department of Child and Adolescent Psychiatry, University of Zurich, Zurich, Switzerland
| | - Louis Schibli
- Competence Center Thermal Energy Storage, Lucerne University of Applied Sciences and Art, Horw, Switzerland
| | - Philipp Schuetz
- Competence Center Thermal Energy Storage, Lucerne University of Applied Sciences and Art, Horw, Switzerland
| | - Petra Schweinhardt
- Integrative Spinal Research, Department of Chiropractic Medicine, Balgrist University Hospital, University of Zurich, Zurich, Switzerland; Neuroscience Center Zurich (ZNZ), Zurich, Switzerland
| | - Michael L Meier
- Integrative Spinal Research, Department of Chiropractic Medicine, Balgrist University Hospital, University of Zurich, Zurich, Switzerland; Neuroscience Center Zurich (ZNZ), Zurich, Switzerland
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Zhu J, Shi L, Su Y. A rs-fMRI study of functional connectivity changes between thalamus and postcentral gyrus in patients with neuropathic pain after brachial plexus avulsion. Clin Neurol Neurosurg 2023; 235:108021. [PMID: 37898030 DOI: 10.1016/j.clineuro.2023.108021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 10/21/2023] [Accepted: 10/23/2023] [Indexed: 10/30/2023]
Abstract
BACKGROUND The neuropathic pain (NPP) after brachial plexus avulsion (BPA) is common and difficult to cure, and thalamus and postcentral gyrus have been accepted to be the key nodes of mechanisms and pathways for pain. However, little attention has been paid on the thalamus-postcentral gyrus functional connectivity changes in NP patients after BPA. METHODS Eighteen patients with NPP after BPA and twenty age and gender matched healthy controls were enrolled and underwent resting-state functional MRI (rs-fMRI) scans in this study. The Pearson's r-value of functional connection (bilateral thalamus and postcentral gyrus as regions of interest) was generated and examined using two sample t-test. The linear regression analysis was used to select possible related factors, and multiple linear regression of the possible predictors was used to identify the variables that significantly predicted Visual Analogue Score (VAS). RESULTS The standardized Pearson r-values of the left thalamus-right thalamus, left thalamus-left postcentral gyrus, left thalamus-right postcentral gyrus, right thalamus-left postcentral gyrus and right thalamus-right postcentral gyrus in the control group were 0.759 ± 0.242, 0.358 ± 0.297, 0.383 ± 0.270, 0.317 ± 0.295 and 0.333 ± 0.304, respectively. And the corresponding standardized Pearson r-values in patients group were 0.510 ± 0.224,0.305 ± 0.212,0.281 ± 0.225,0.333 ± 0.193 and 0.333 ± 0.210, respectively. The functional connectivity strength of the left thalamus-right thalamus in control group was significantly higher than that in the patients group (P < 0.05). Linear regression analysis showed that the functional connectivity strength of the left thalamus-right thalamus was negatively correlated with the patients' VAS score (P < 0.05). CONCLUSIONS NPP patients after BPA had a significant pain-related bilateral thalamus functional connection reorganization, with the purpose to limit the pain signal inputs within the unilateral cerebral hemisphere.
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Affiliation(s)
- Jin Zhu
- Department of Neurosurgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100035, China
| | - Liang Shi
- Department of Neurosurgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100035, China
| | - Yibing Su
- Department of Neurosurgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100035, China.
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12
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Weiss T, Koehler H, Croy I. Pain and Reorganization after Amputation: Is Interoceptive Prediction a Key? Neuroscientist 2023; 29:665-675. [PMID: 35950521 PMCID: PMC10623598 DOI: 10.1177/10738584221112591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
There is an ongoing discussion on the relevance of brain reorganization following amputation for phantom limb pain. Recent attempts to provide explanations for seemingly controversial findings-specifically, maladaptive plasticity versus persistent functional representation as a complementary process-acknowledged that reorganization in the primary somatosensory cortex is not sufficient to explain phantom limb pain satisfactorily. Here we provide theoretical considerations that might help integrate the data reviewed and suppose a possible additional driver of the development of phantom limb pain-namely, an error in interoceptive predictions to somatosensory sensations and movements of the missing limb. Finally, we derive empirically testable consequences based on our considerations to guide future research.
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Affiliation(s)
- Thomas Weiss
- Department of Psychology, Clinical Psychology, Friedrich Schiller University Jena, Jena, Germany
| | - Hanna Koehler
- Department of Psychology, Clinical Psychology, Friedrich Schiller University Jena, Jena, Germany
- Biomagnetic Center, Jena University Hospital, Jena, Germany
| | - Ilona Croy
- Department of Psychology, Clinical Psychology, Friedrich Schiller University Jena, Jena, Germany
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13
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Huo X, Huang P, Di H, Ma T, Jiang S, Yao J, Huang L. Risk Factors Analysis of Phantom Limb Pain in Amputees with Malignant Tumors. J Pain Res 2023; 16:3979-3992. [PMID: 38026454 PMCID: PMC10676115 DOI: 10.2147/jpr.s433996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 11/14/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose Postamputation neuropathic pain is a common disease in patients with malignant tumor amputation, seriously affecting amputees' quality of life and mental health. The objective of this study was to identify independent risk factors for phantom limb pain in patients with tumor amputation and to construct a risk prediction model. Methods Patients who underwent amputation due to malignant tumors from 2013 to 2023 were retrospectively analyzed and divided into phantom limb pain group and non-phantom limb pain group. To determine which preoperative factors would affect the occurrence of phantom limb pain, we searched for candidate factors by univariate analysis and used multivariate logistic regression analysis to identify independent factors and construct a predictive model. The receiver operating characteristic curve (ROC) was drawn to further evaluate the accuracy of the prediction model in evaluating the phantom limb pain after amputation of bone and soft tissue tumors. Results Multivariate analysis showed that age (OR, 1.054; 95% CI, 1.027 to 1.080), preoperative pain (OR, 5.773; 95% CI, 2.362 to 14.104), number of surgeries (OR, 3.425; 95% CI, 1.505 to 7.795), amputation site (OR, 5.848; 95% CI, 1.837 to 18.620), amputation level (OR, 8.031; 95% CI, 2.491 to 25.888) were independent risk factors for phantom limb pain for bone and soft tissue tumors. The the area under the curve (AUC) of this model was 0.834. Conclusion Risk factors for postoperative phantom limb pain were the site of amputation, proximal amputation, preoperative pain, multiple amputations, and older age. These factors will help surgeons to individualize and stratify phantom limb pain and help patients with risk counseling. In particular, an informed clinical decision targeting those modifiable factors can be considered when needed.
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Affiliation(s)
- Xiulin Huo
- Department of Anesthesiology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, People’s Republic of China
- Department of Anesthesiology, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People’s Republic of China
| | - Peiying Huang
- Department of Anesthesiology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, People’s Republic of China
| | - Hexuan Di
- Department of Orthopaedic Surgery, The Key Laboratory of Orthopedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People’s Republic of China
| | - Tianxiao Ma
- Department of Orthopaedic Surgery, The Key Laboratory of Orthopedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People’s Republic of China
| | - Sufang Jiang
- Department of Anesthesiology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, People’s Republic of China
| | - Jie Yao
- Department of Anesthesiology, The First Affiliated Hospital of Hebei North University, Zhangjiakou, Hebei, People’s Republic of China
| | - Lining Huang
- Department of Anesthesiology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, People’s Republic of China
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14
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Moro V, Beccherle M, Scandola M, Aglioti SM. Massive body-brain disconnection consequent to spinal cord injuries drives profound changes in higher-order cognitive and emotional functions: A PRISMA scoping review. Neurosci Biobehav Rev 2023; 154:105395. [PMID: 37734697 DOI: 10.1016/j.neubiorev.2023.105395] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 09/01/2023] [Accepted: 09/17/2023] [Indexed: 09/23/2023]
Abstract
Spinal cord injury (SCI) leads to a massive disconnection between the brain and the body parts below the lesion level representing a unique opportunity to explore how the body influences a person's mental life. We performed a systematic scoping review of 59 studies on higher-order cognitive and emotional changes after SCI. The results suggest that fluid abilities (e.g. attention, executive functions) and emotional regulation (e.g. emotional reactivity and discrimination) are impaired in people with SCI, with progressive deterioration over time. Although not systematically explored, the factors that are directly (e.g. the severity and level of the lesion) and indirectly associated (e.g. blood pressure, sleeping disorders, medication) with the damage may play a role in these deficits. The inconsistency which was found in the results may derive from the various methods used and the heterogeneity of samples (i.e. the lesion completeness, the time interval since lesion onset). Future studies which are specifically controlled for methods, clinical and socio-cultural dimensions are needed to better understand the role of the body in cognition.
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Affiliation(s)
- Valentina Moro
- NPSY.Lab-VR, Department of Human Sciences, University of Verona, Lungadige Porta Vittoria, 17, 37129 Verona, Italy.
| | - Maddalena Beccherle
- NPSY.Lab-VR, Department of Human Sciences, University of Verona, Lungadige Porta Vittoria, 17, 37129 Verona, Italy; Department of Psychology, Sapienza University of Rome and cln2s@sapienza Istituto Italiano di Tecnologia, Italy.
| | - Michele Scandola
- NPSY.Lab-VR, Department of Human Sciences, University of Verona, Lungadige Porta Vittoria, 17, 37129 Verona, Italy
| | - Salvatore Maria Aglioti
- Department of Psychology, Sapienza University of Rome and cln2s@sapienza Istituto Italiano di Tecnologia, Italy; Fondazione Santa Lucia IRCCS, Roma, Italy
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15
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Segas E, Mick S, Leconte V, Dubois O, Klotz R, Cattaert D, de Rugy A. Intuitive movement-based prosthesis control enables arm amputees to reach naturally in virtual reality. eLife 2023; 12:RP87317. [PMID: 37847150 PMCID: PMC10581689 DOI: 10.7554/elife.87317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2023] Open
Abstract
Impressive progress is being made in bionic limbs design and control. Yet, controlling the numerous joints of a prosthetic arm necessary to place the hand at a correct position and orientation to grasp objects remains challenging. Here, we designed an intuitive, movement-based prosthesis control that leverages natural arm coordination to predict distal joints missing in people with transhumeral limb loss based on proximal residual limb motion and knowledge of the movement goal. This control was validated on 29 participants, including seven with above-elbow limb loss, who picked and placed bottles in a wide range of locations in virtual reality, with median success rates over 99% and movement times identical to those of natural movements. This control also enabled 15 participants, including three with limb differences, to reach and grasp real objects with a robotic arm operated according to the same principle. Remarkably, this was achieved without any prior training, indicating that this control is intuitive and instantaneously usable. It could be used for phantom limb pain management in virtual reality, or to augment the reaching capabilities of invasive neural interfaces usually more focused on hand and grasp control.
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Affiliation(s)
- Effie Segas
- Univ. Bordeaux, CNRS, INCIA, UMR 5287BordeauxFrance
| | - Sébastien Mick
- Univ. Bordeaux, CNRS, INCIA, UMR 5287BordeauxFrance
- ISIR UMR 7222, Sorbonne Université, CNRS, InsermParisFrance
| | | | - Océane Dubois
- Univ. Bordeaux, CNRS, INCIA, UMR 5287BordeauxFrance
- ISIR UMR 7222, Sorbonne Université, CNRS, InsermParisFrance
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16
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Bao B, Sun Y, Lin J, Gao T, Shen J, Hu W, Zhu H, Zhu T, Li J, Wang Z, Wei H, Zheng X. Altered cortical thickness and structural covariance networks in upper limb amputees: A graph theoretical analysis. CNS Neurosci Ther 2023; 29:2901-2911. [PMID: 37122148 PMCID: PMC10493660 DOI: 10.1111/cns.14226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 04/03/2023] [Accepted: 04/09/2023] [Indexed: 05/02/2023] Open
Abstract
BACKGROUND The extensive functional and structural remodeling that occurs in the brain after amputation often results in phantom limb pain (PLP). These closely related phenomena are still not fully understood. METHODS Using magnetic resonance imaging (MRI) and graph theoretical analysis (GTA), we explored how alterations in brain cortical thickness (CTh) and structural covariance networks (SCNs) in upper limb amputees (ULAs) relate to PLP. In all, 45 ULAs and 45 healthy controls (HCs) underwent structural MRI. Regional network properties, including nodal degree, betweenness centrality (BC), and node efficiency, were analyzed with GTA. Similarly, global network properties, including global efficiency (Eglob), local efficiency (Eloc), clustering coefficient (Cp), characteristic path length (Lp), and the small-worldness index, were evaluated. RESULTS Compared with HCs, ULAs had reduced CThs in the postcentral and precentral gyri contralateral to the amputated limb; this decrease in CTh was negatively correlated with PLP intensity in ULAs. ULAs showed varying degrees of change in node efficiency in regional network properties compared to HCs (p < 0.005). There were no group differences in Eglob, Eloc, Cp, and Lp properties (all p > 0.05). The real-worldness SCN of ULAs showed a small-world topology ranging from 2% to 34%, and the area under the curve of the small-worldness index in ULAs was significantly different compared to HCs (p < 0.001). CONCLUSION These results suggest that the topological organization of human CNS functional networks is altered after amputation of the upper limb, providing further support for the cortical remapping theory of PLP.
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Affiliation(s)
- Bingbo Bao
- Department of Orthopedic SurgeryShanghai Jiao Tong University Affiliated Sixth People's HospitalShanghaiChina
| | - Yi Sun
- Department of Orthopedic SurgeryShanghai Jiao Tong University Affiliated Sixth People's HospitalShanghaiChina
| | - Junqing Lin
- Department of Orthopedic SurgeryShanghai Jiao Tong University Affiliated Sixth People's HospitalShanghaiChina
| | - Tao Gao
- Department of Orthopedic SurgeryShanghai Jiao Tong University Affiliated Sixth People's HospitalShanghaiChina
| | - Junjie Shen
- Department of Orthopedic SurgeryShanghai Jiao Tong University Affiliated Sixth People's HospitalShanghaiChina
| | - Wencheng Hu
- Department of Orthopedic SurgeryShanghai Jiao Tong University Affiliated Sixth People's HospitalShanghaiChina
| | - Hongyi Zhu
- Department of Orthopedic SurgeryShanghai Jiao Tong University Affiliated Sixth People's HospitalShanghaiChina
| | - Tianhao Zhu
- Department of Orthopedic SurgeryShanghai Jiao Tong University Affiliated Sixth People's HospitalShanghaiChina
| | - Jing Li
- Institute of Diagnostic and Interventional RadiologyShanghai Jiao Tong University Affiliated Sixth People's HospitalShanghaiChina
| | - Zhibin Wang
- Institute of Diagnostic and Interventional RadiologyShanghai Jiao Tong University Affiliated Sixth People's HospitalShanghaiChina
| | - Haifeng Wei
- Department of Orthopedic SurgeryShanghai Jiao Tong University Affiliated Sixth People's HospitalShanghaiChina
| | - Xianyou Zheng
- Department of Orthopedic SurgeryShanghai Jiao Tong University Affiliated Sixth People's HospitalShanghaiChina
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17
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Castro F, Lenggenhager B, Zeller D, Pellegrino G, D'Alonzo M, Di Pino G. From rubber hands to neuroprosthetics: Neural correlates of embodiment. Neurosci Biobehav Rev 2023; 153:105351. [PMID: 37544389 PMCID: PMC10582798 DOI: 10.1016/j.neubiorev.2023.105351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 07/10/2023] [Accepted: 08/03/2023] [Indexed: 08/08/2023]
Abstract
Our interaction with the world rests on the knowledge that we are a body in space and time, which can interact with the environment. This awareness is usually referred to as sense of embodiment. For the good part of the past 30 years, the rubber hand illusion (RHI) has been a prime tool to study embodiment in healthy and people with a variety of clinical conditions. In this paper, we provide a critical overview of this research with a focus on the RHI paradigm as a tool to study prothesis embodiment in individuals with amputation. The RHI relies on well-documented multisensory integration mechanisms based on sensory precision, where parietal areas are involved in resolving the visuo-tactile conflict, and premotor areas in updating the conscious bodily representation. This mechanism may be transferable to prosthesis ownership in amputees. We discuss how these results might transfer to technological development of sensorised prostheses, which in turn might progress the acceptability by users.
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Affiliation(s)
- Fabio Castro
- Neurophysiology and Neuroengineering of Human-Technology Interaction Research Unit, Campus Bio-Medico University, via Alvaro del Portillo 5, 00128 Rome, Italy; Institute of Sport, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom
| | - Bigna Lenggenhager
- Department of Psychology, Cognitive Psychology, University of Konstanz, Universitätsstraße 10, 78464 Konstanz, Germany; Department of Psychology, University of Zurich, Binzmuehlestrasse 14, 8050 Zurich, Switzerland
| | - Daniel Zeller
- Department of Neurology, University Hospital Würzburg, Josef-Schneider-Str. 11, 97080 Würzburg, Germany
| | - Giovanni Pellegrino
- Epilepsy program, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Marco D'Alonzo
- Neurophysiology and Neuroengineering of Human-Technology Interaction Research Unit, Campus Bio-Medico University, via Alvaro del Portillo 5, 00128 Rome, Italy.
| | - Giovanni Di Pino
- Neurophysiology and Neuroengineering of Human-Technology Interaction Research Unit, Campus Bio-Medico University, via Alvaro del Portillo 5, 00128 Rome, Italy
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18
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Apelian C, Terhune DB, De Vignemont F. Hypnotic suggestion versus sensory modulation of bodily awareness. PLoS One 2023; 18:e0291493. [PMID: 37699046 PMCID: PMC10497174 DOI: 10.1371/journal.pone.0291493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 08/30/2023] [Indexed: 09/14/2023] Open
Abstract
Bodily awareness arises from somatosensory, vestibular, and visual inputs but cannot be reduced to these incoming sensory signals. Cognitive factors are known to also impact bodily awareness, though their specific influence is poorly understood. Here we systematically compared the effects of sensory (bottom-up) and cognitive (top-down) manipulations on the estimated size of body parts. Toward this end, in a repeated-measures design, we sought to induce the illusion that the right index finger was elongating by vibrating the biceps tendon of the left arm whilst participants grasped the tip of their right index finger (Lackner illusion; bottom-up) and separately by hypnotic suggestion (top-down), with a sham version of the Lackner illusion as an active control condition. The effects of these manipulations were assessed with perceptual and motor tasks to capture different components of the representation of body size. We found that hypnotic suggestion significantly induced the illusion in both tasks relative to the sham condition. The magnitudes of these effects were stronger than those in the Lackner illusion condition, which only produced a significantly stronger illusion than the sham condition in the perceptual task. We further observed that illusion magnitude significantly correlated across tasks and conditions, suggesting partly shared mechanisms. These results are in line with theories of separate but interacting representational processes for perception and action and highlight the influence of cognitive factors on low-level body representations.
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Affiliation(s)
- C. Apelian
- Département d’études Cognitives, Institut Jean Nicod, ENS, EHESS, CNRS, PSL University, Paris, France
- ARCHE, Formation, Paris, France
| | - D. B. Terhune
- Department of Psychology, Goldsmiths, University of London, London, United Kingdom
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - F. De Vignemont
- Département d’études Cognitives, Institut Jean Nicod, ENS, EHESS, CNRS, PSL University, Paris, France
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19
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Ritter C, Geisler M, Blume KR, Nehrdich S, Hofmann GO, Koehler H, Miltner WHR, Weiss T. Stimulation of peroneal nerves reveals maintained somatosensory representation in transtibial amputees. Front Hum Neurosci 2023; 17:1240937. [PMID: 37746055 PMCID: PMC10512738 DOI: 10.3389/fnhum.2023.1240937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 08/18/2023] [Indexed: 09/26/2023] Open
Abstract
Introduction Several studies have found changes in the organization of the primary somatosensory cortex (SI) after amputation. This SI reorganization was mainly investigated by stimulating neighboring areas to amputation. Unexpectedly, the somatosensory representation of the deafferented limb has rarely been directly tested. Methods We stimulated the truncated peroneal nerve in 24 unilateral transtibial amputees and 15 healthy controls. The stimulation intensity was adjusted to make the elicited percept comparable between both stimulation sides. Neural sources of the somatosensory-evoked magnetic fields (SEFs) to peroneal stimulation were localized in the contralateral foot/leg areas of SI in 19 patients and 14 healthy controls. Results We demonstrated the activation of functionally preserved cortical representations of amputated lower limbs. None of the patients reported evoked phantom limb pain (PLP) during stimulation. Stimulation that evoked perceptions in the foot required stronger intensities on the amputated side than on the intact side. In addition to this, stronger stimulation intensities were required for amputees than for healthy controls. Exploratorily, PLP intensity was neither associated with stimulation intensity nor dipole strength nor with differences in Euclidean distances (between SEF sources of the healthy peroneus and mirrored SEF sources of the truncated peroneus). Discussion Our results provide hope that the truncated nerve may be used to establish both motor control and somatosensory feedback via the nerve trunk when a permanently functional connection between the nerve trunk and the prosthesis becomes available.
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Affiliation(s)
- Caroline Ritter
- Department of Clinical Psychology, Institute of Psychology, Friedrich Schiller University Jena, Jena, Germany
- Clinic for Psychosomatics and Psychotherapy, Jena University Hospital, Jena, Germany
| | - Maria Geisler
- Department of Clinical Psychology, Institute of Psychology, Friedrich Schiller University Jena, Jena, Germany
- Clinic for Psychosomatics and Psychotherapy, Jena University Hospital, Jena, Germany
| | - Kathrin R. Blume
- Department of Clinical Psychology, Institute of Psychology, Friedrich Schiller University Jena, Jena, Germany
- Institute of Psychosocial Medicine, Psychotherapy and Psychooncology, Jena University Hospital, Jena, Germany
| | - Sandra Nehrdich
- Department of Clinical Psychology, Institute of Psychology, Friedrich Schiller University Jena, Jena, Germany
- Clinic for Psychosomatics and Psychotherapy, Jena University Hospital, Jena, Germany
| | - Gunther O. Hofmann
- Berufsgenossenschaftliche Kliniken Bergmannstrost Halle/Saale, Halle, Germany
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Jena, Jena, Germany
| | - Hanna Koehler
- Department of Clinical Psychology, Institute of Psychology, Friedrich Schiller University Jena, Jena, Germany
- Biomagnetic Center, Department of Neurology, University Hospital Jena, Jena, Germany
| | - Wolfgang H. R. Miltner
- Department of Clinical Psychology, Institute of Psychology, Friedrich Schiller University Jena, Jena, Germany
| | - Thomas Weiss
- Department of Clinical Psychology, Institute of Psychology, Friedrich Schiller University Jena, Jena, Germany
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Torres FDF, Ramalho BL, Rodrigues MR, Schmaedeke AC, Moraes VH, Reilly KT, Carvalho RDP, Vargas CD. Plasticity of face-hand sensorimotor circuits after a traumatic brachial plexus injury. Front Neurosci 2023; 17:1221777. [PMID: 37609451 PMCID: PMC10440702 DOI: 10.3389/fnins.2023.1221777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 07/17/2023] [Indexed: 08/24/2023] Open
Abstract
Background Interactions between the somatosensory and motor cortices are of fundamental importance for motor control. Although physically distant, face and hand representations are side by side in the sensorimotor cortex and interact functionally. Traumatic brachial plexus injury (TBPI) interferes with upper limb sensorimotor function, causes bilateral cortical reorganization, and is associated with chronic pain. Thus, TBPI may affect sensorimotor interactions between face and hand representations. Objective The aim of this study was to investigate changes in hand-hand and face-hand sensorimotor integration in TBPI patients using an afferent inhibition (AI) paradigm. Method The experimental design consisted of electrical stimulation (ES) applied to the hand or face followed by transcranial magnetic stimulation (TMS) to the primary motor cortex to activate a hand muscle representation. In the AI paradigm, the motor evoked potential (MEP) in a target muscle is significantly reduced when preceded by an ES at short-latency (SAI) or long-latency (LAI) interstimulus intervals. We tested 18 healthy adults (control group, CG), evaluated on the dominant upper limb, and nine TBPI patients, evaluated on the injured or the uninjured limb. A detailed clinical evaluation complemented the physiological investigation. Results Although hand-hand SAI was present in both the CG and the TBPI groups, hand-hand LAI was present in the CG only. Moreover, less AI was observed in TBPI patients than the CG both for face-hand SAI and LAI. Conclusion Our results indicate that sensorimotor integration involving both hand and face sensorimotor representations is affected by TBPI.
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Affiliation(s)
- Fernanda de Figueiredo Torres
- Laboratory of Neurobiology of Movement, Institute of Biophysics Carlos Chagas Filho, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Laboratory of Neuroscience and Rehabilitation, Institute of Neurology Deolindo Couto, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Bia Lima Ramalho
- Laboratory of Neurobiology of Movement, Institute of Biophysics Carlos Chagas Filho, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Laboratory of Neuroscience and Rehabilitation, Institute of Neurology Deolindo Couto, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Research, Innovation and Dissemination Center for Neuromathematics, Institute of Mathematics and Statistics, University of São Paulo, São Paulo, Brazil
| | - Marcelle Ribeiro Rodrigues
- Laboratory of Neurobiology of Movement, Institute of Biophysics Carlos Chagas Filho, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Laboratory of Neuroscience and Rehabilitation, Institute of Neurology Deolindo Couto, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ana Carolina Schmaedeke
- Laboratory of Neurobiology of Movement, Institute of Biophysics Carlos Chagas Filho, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Laboratory of Neuroscience and Rehabilitation, Institute of Neurology Deolindo Couto, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Victor Hugo Moraes
- Laboratory of Neurobiology of Movement, Institute of Biophysics Carlos Chagas Filho, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Laboratory of Neuroscience and Rehabilitation, Institute of Neurology Deolindo Couto, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Karen T. Reilly
- Trajectoires Team, Lyon Neuroscience Research Center, Lyon, France
- University UCBL Lyon 1, University of Lyon, Lyon, France
| | - Raquel de Paula Carvalho
- Laboratory of Neuroscience and Rehabilitation, Institute of Neurology Deolindo Couto, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Research, Innovation and Dissemination Center for Neuromathematics, Institute of Mathematics and Statistics, University of São Paulo, São Paulo, Brazil
- Laboratory of Child Development and Motricity, Department of Human Movement Science, Institute of Health and Society, Universidade Federal de São Paulo, Santos, Brazil
| | - Claudia D. Vargas
- Laboratory of Neurobiology of Movement, Institute of Biophysics Carlos Chagas Filho, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Laboratory of Neuroscience and Rehabilitation, Institute of Neurology Deolindo Couto, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Research, Innovation and Dissemination Center for Neuromathematics, Institute of Mathematics and Statistics, University of São Paulo, São Paulo, Brazil
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21
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Jadidi AF, Jensen W, Zarei AA, Lontis ER, Atashzar SF. From pulse width modulated TENS to cortical modulation: based on EEG functional connectivity analysis. Front Neurosci 2023; 17:1239068. [PMID: 37600002 PMCID: PMC10433172 DOI: 10.3389/fnins.2023.1239068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 07/18/2023] [Indexed: 08/22/2023] Open
Abstract
Modulation in the temporal pattern of transcutaneous electrical nerve stimulation (TENS), such as Pulse width modulated (PWM), has been considered a new dimension in pain and neurorehabilitation therapy. Recently, the potentials of PWM TENS have been studied on sensory profiles and corticospinal activity. However, the underlying mechanism of PWM TENS on cortical network which might lead to pain alleviation is not yet investigated. Therefore, we recorded cortical activity using electroencephalography (EEG) from 12 healthy subjects and assessed the alternation of the functional connectivity at the cortex level up to an hour following the PWM TENS and compared that with the effect of conventional TENS. The connectivity between eight brain regions involved in sensory and pain processing was calculated based on phase lag index and spearman correlation. The alteration in segregation and integration of information in the network were investigated using graph theory. The proposed analysis discovered several statistically significant network changes between PWM TENS and conventional TENS, such as increased local strength and efficiency of the network in high gamma-band in primary and secondary somatosensory sources one hour following stimulation. Our findings regarding the long-lasting desired effects of PWM TENS support its potential as a therapeutic intervention in clinical research.
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Affiliation(s)
- Armita Faghani Jadidi
- Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Aalborg University, Aalborg East, Denmark
| | - Winnie Jensen
- Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Aalborg University, Aalborg East, Denmark
| | - Ali Asghar Zarei
- Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Aalborg University, Aalborg East, Denmark
| | - Eugen Romulus Lontis
- Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Aalborg University, Aalborg East, Denmark
| | - S. Farokh Atashzar
- Department of Electrical and Computer Engineering, New York University, New York, NY, United States
- Department of Mechanical and Aerospace Engineering, New York University, New York, NY, United States
- Department of Biomedical Engineering, New York University, New York, NY, United States
- NYU WIRELESS, New York University (NYU), New York, NY, United States
- NYU Center for Urban Science and Progress (CUSP), New York University (NYU), New York, NY, United States
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22
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Pinto CB, Pacheco-Barrios K, Saleh Velez FG, Gunduz ME, Münger M, Fregni F. Detangling the Structural Neural Correlates Associated with Resting versus Dynamic Phantom Limb Pain Intensity Using a Voxel-based Morphometry Analysis. PAIN MEDICINE (MALDEN, MASS.) 2023; 24:528-537. [PMID: 36583548 PMCID: PMC10406160 DOI: 10.1093/pm/pnac205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 09/23/2022] [Accepted: 10/20/2022] [Indexed: 12/31/2022]
Abstract
The management of phantom limb pain (PLP) is still challenging due to a partial understanding of its neurophysiological mechanisms. Structural neuroimaging features are potential biomarkers. However, only a few studies assessed their correlations with clinical severity and treatment response. This study aims to explore the association between brain gray matter volume (GMV) with phantom limb manifestations severity and PLP improvement after neuromodulatory treatments (transcranial direct current stimulation and mirror therapy). Voxel-based morphometry analyses and functional decoding using a reverse inference term-based meta-analytic approach were used. We included 24 lower limb traumatic amputees with moderate to severe PLP. We found that alterations of cortical GMV were correlated with PLP severity but not with other clinical manifestations. Less PLP severity was associated with larger brain clusters GMV in the non-affected prefrontal, insula (non-affected mid-anterior region), and bilateral thalamus. However, only the insula cluster survived adjustments. Moreover, the reverse inference meta-analytic approach revealed that the found insula cluster is highly functionally connected to the contralateral insula and premotor cortices, and the decoded psychological processes related to this cluster were "rating," "sustained attention," "impulsivity, " and "suffering." Moreover, we found that responders to neuromodulatory treatment have higher GMV in somatosensory areas (total volume of S1 and S2) in the affected hemisphere at baseline, compared to non-responders, even after adjustments.
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Affiliation(s)
| | | | - Faddi G Saleh Velez
- Department of Neurology, University of Chicago Medical Center, University of Chicago, Chicago, IL 60637, United States
| | - Muhammed E Gunduz
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA 02129, United States
| | - Marionna Münger
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA 02129, United States
| | - Felipe Fregni
- Corresponding author: Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, 96 13th Street, Charlestown, Boston, MA 02129, USA.
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23
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Kral A, Sharma A. Crossmodal plasticity in hearing loss. Trends Neurosci 2023; 46:377-393. [PMID: 36990952 PMCID: PMC10121905 DOI: 10.1016/j.tins.2023.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 01/27/2023] [Accepted: 02/21/2023] [Indexed: 03/29/2023]
Abstract
Crossmodal plasticity is a textbook example of the ability of the brain to reorganize based on use. We review evidence from the auditory system showing that such reorganization has significant limits, is dependent on pre-existing circuitry and top-down interactions, and that extensive reorganization is often absent. We argue that the evidence does not support the hypothesis that crossmodal reorganization is responsible for closing critical periods in deafness, and crossmodal plasticity instead represents a neuronal process that is dynamically adaptable. We evaluate the evidence for crossmodal changes in both developmental and adult-onset deafness, which start as early as mild-moderate hearing loss and show reversibility when hearing is restored. Finally, crossmodal plasticity does not appear to affect the neuronal preconditions for successful hearing restoration. Given its dynamic and versatile nature, we describe how this plasticity can be exploited for improving clinical outcomes after neurosensory restoration.
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Affiliation(s)
- Andrej Kral
- Institute of AudioNeuroTechnology and Department of Experimental Otology, Otolaryngology Clinics, Hannover Medical School, Hannover, Germany; Australian Hearing Hub, School of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - Anu Sharma
- Department of Speech Language and Hearing Science, Center for Neuroscience, Institute of Cognitive Science, University of Colorado Boulder, Boulder, CO, USA.
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24
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Kuffler DP. Evolving techniques for reducing phantom limb pain. Exp Biol Med (Maywood) 2023; 248:561-572. [PMID: 37158119 PMCID: PMC10350801 DOI: 10.1177/15353702231168150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Abstract
At least two million people in the United States of America live with lost limbs, and the number is expected to double by 2050, although the incidence of amputations is significantly greater in other parts of the world. Within days to weeks of the amputation, up to 90% of these individuals develop neuropathic pain, presenting as phantom limb pain (PLP). The pain level increases significantly within one year and remains chronic and severe for about 10%. Amputation-induced changes are considered to underlie the causation of PLP. Techniques applied to the central nervous system (CNS) and peripheral nervous system (PNS) are designed to reverse amputation-induced changes, thereby reducing/eliminating PLP. The primary treatment for PLP is the administration of pharmacological agents, some of which are considered but provide no more than short-term pain relief. Alternative techniques are also discussed, which provide only short-term pain relief. Changes induced by various cells and the factors they release are required to change neurons and their environment to reduce/eliminate PLP. It is concluded that novel techniques that utilize autologous platelet-rich plasma (PRP) may provide long-term PLP reduction/elimination.
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Affiliation(s)
- Damien P Kuffler
- Institute of Neurobiology, Medical Sciences Campus, University of Puerto Rico, San Juan 00901, Puerto Rico
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25
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Bottemanne H, Joly L. [Mother brain: Bayesian theory of maternal interoception during pregnancy and postpartum]. L'ENCEPHALE 2023; 49:185-195. [PMID: 36243551 DOI: 10.1016/j.encep.2022.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 05/28/2022] [Accepted: 05/30/2022] [Indexed: 11/05/2022]
Abstract
The perinatal period, including pregnancy and postpartum, causes major morphological, endocrinal, and thermal transitions in women. As the fetus grows, abdominal muscle fibers stretch, internal organs such as the bladder or colon move, and the uterine anatomy changes. Many of these changes involve interoception, the perception of internal body signals such as muscle and visceral sensations. Despite the importance of these interoceptive signals, few studies have explored perinatal interoception. We propose an innovative theory of maternal interoception based on recent findings in neuroscience. We show that interoceptive signals processing during pregnancy is crucial for understanding perinatal phenomenology and psychopathology, such as maternal perception of fetal movements, maternal-infant bonding, denial of pregnancy, phantom fetal movements after childbirth, pseudocyesis or even puerperal delusion. Knowing the importance of these interoceptive mechanisms, clinicians in obstetrics, gynecology and mental health should be particularly vigilant to maternal interoception during the perinatal period.
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Affiliation(s)
- Hugo Bottemanne
- Department of Psychiatry, Sorbonne University, Pitié-Salpêtrière Hospital, DMU Neuroscience, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France; Paris Brain Institute - Institut du Cerveau (ICM), Department of Neuroscience, UMR 7225/UMRS 1127, Sorbonne University/CNRS/INSERM, Paris, France; Sorbonne University, Department of Philosophy, SND Research Unit, UMR 8011, CNRS, Paris, France.
| | - Lucie Joly
- Department of Psychiatry, Sorbonne University, Pitié-Salpêtrière Hospital, DMU Neuroscience, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France; Paris Brain Institute - Institut du Cerveau (ICM), Department of Neuroscience, UMR 7225/UMRS 1127, Sorbonne University/CNRS/INSERM, Paris, France
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26
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Bagheri Z, Khosrowabadi R, Hatami J, Armani Kian AR, Fatemi MJ, Khatibi A. Differential Cortical Oscillatory Patterns in Amputees With and Without Phantom Limb Pain. Basic Clin Neurosci 2023; 14:171-184. [PMID: 38107525 PMCID: PMC10719972 DOI: 10.32598/bcn.2021.261.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 04/11/2021] [Accepted: 09/20/2021] [Indexed: 12/19/2023] Open
Abstract
Introduction Phantom limb pain (PLP) as neuropathic pain affects the life of amputees. It is believed an efficient PLP treatment should consider the underlying neurological mechanisms. Hereby, we investigated brain activity in PLP and its relationships to the psychological and cognitive dimensions of chronic pain. We investigate differences in resting brain activities between amputees with and without pain. We hypothesize significant differences in the motor cortex and parietal cortex activity that are related to pain perception. Also, we hypothesize two groups have significant differences in cognitive and psychological components. Methods Behavioral assessment (psychological status, life satisfaction, and pain level) and EEG signals of 19 amputees (12 without pain and 7 with pain) were recorded. Data were statistically compared between the two groups. Also, the association between behavioral and neurophysiological data was computed. Results The results showed a significant decrease in the pain group for the beta and gamma waves, as well as, for the theta and delta waves in the posterior temporal on both sides, during the eye-open condition. The eyes-closed condition showed that the delta waves were decreased on the right side of the cortex. Also, data showed a significant difference in the correlation of pain features with brain waves between the two groups. Conclusion Significant differences were mostly observed in regions related to pain perception rather than the motor cortex. This can be due to the learned strategies to deal with pain and the degree of pain. Results showed maladaptive cognitive processes had a relationship with brain wave activities. According to the result of brain wave activities, it seems that cognitive factors have a role in the experience of PLP rather than neuroplasticity through amputation. Highlights Differences found in the parietal and temporal regions of phantom limb pain's (PLP's) suggests cognition's role in the persistence of PLP.Decreased delta power at the posterior temporal cortex in PLP's could be the focus of treatments.Increased activity of the parietal cortex could be helpful in the treatment of PLP's. Plain Language Summary PLP is an annoying neurologic pain. A wide range of treatments have focused on this type of pain but couldn't be effective. Recently, researchers suggest BCI-based treatments for better treatment. For this type of treatment, we should know the neurological aspect of PLP. In most studies to investigate or treatment of neurological aspects of PLP, researchers induced pain experimentally or studied acute phantom limb pain. We believed for a better understanding of PLP, should investigate it in a natural and stabilized position. Therefore we studied brain activities in amputees with and without PLP in a resting state to find out differences. Trends in this field express the alpha band differences in the motor cortex. On the contrary, our results showed the most significant difference in high-frequency bandpasses such as beta and gamma. Also, in our study, it seems the parietal and temporal cortex that are related to pain perception is the more relevant to PLP. This study showed a psycho-cognitive aspect of pain such as pain exaggeration has a relation with PLP's brain wave activities. So, we can suggest rather than neuroplasticity through amputation, cognitive factors have a role in the experience of PLP.
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Affiliation(s)
- Zahra Bagheri
- Department of Cognitive Psychology, Institute of Cognitive Science Studies, Pardis, Iran
| | - Reza Khosrowabadi
- Department of Cognitive Modeling, Institute for Cognitive and Brain Sciences, Shahid Beheshti University, Tehran, Iran
| | - Javad Hatami
- Department of Cognitive Psychology, Institute of Cognitive Science Studies, Pardis, Iran
- Department of Psychology, Faculty of Psychology and Education, Tehran University, Tehran, Iran
| | - Ali Reza Armani Kian
- Department of Psychiatry, Shahid Beheshti Hospital, Zanjan University of Medical Science, Zanjan, Iran
| | - Mohamad Javad Fatemi
- Department of Plastic Surgery, Hazrat Fatemeh Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Khatibi
- Centre of Precision Rehabilitation for Spinal Pain, University of Birmingham, Birmingham, United Kingdom
- Centre for Human Brain Health, University of Birmingham, Birmingham, United Kingdom
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27
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de Jongh Curry AL, Hunt ME, Pasquina PF, Waters RS, Tsao JW. Non-surgical Management of Phantom Limb Pain: Current and Emerging Clinical Approaches. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2023. [DOI: 10.1007/s40141-023-00377-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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28
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Lustenhouwer R, Cameron IG, van Alfen N, Toni I, Geurts AC, van Engelen BG, Groothuis JT, Helmich RC. Cerebral Adaptation Associated with Peripheral Nerve Recovery in Neuralgic Amyotrophy: A Randomized Controlled Trial. Neurorehabil Neural Repair 2023; 37:3-15. [PMID: 36575812 PMCID: PMC9896536 DOI: 10.1177/15459683221145149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Neuralgic amyotrophy (NA) is a common peripheral nerve disorder caused by auto-immune inflammation of nerves in the brachial plexus territory, characterized by acute pain and weakness of the shoulder muscles, followed by motor impairment. Recent work has confirmed that NA patients with residual motor dysfunction have abnormal cerebral sensorimotor representations of their affected upper extremity. OBJECTIVE To determine whether abnormal cerebral sensorimotor representations associated with NA can be altered by specialized, multidisciplinary outpatient rehabilitation focused on relearning motor control. METHODS 27 NA patients with residual lateralized symptoms in the right upper extremity participated in a randomized controlled trial, comparing 17 weeks of multidisciplinary rehabilitation (n = 16) to usual care (n = 11). We used task-based functional MRI and a hand laterality judgment task, which involves motor imagery and is sensitive to altered cerebral sensorimotor representations of the upper extremity. RESULTS Change in task performance and related brain activity did not differ significantly between the multidisciplinary rehabilitation and usual care groups, whereas the multidisciplinary rehabilitation group showed significantly greater clinical improvement on the Shoulder Rating Questionnaire. Both groups, however, showed a significant improvement in task performance from baseline to follow-up, and significantly increased activity in visuomotor occipito-parietal brain areas, both specific to their affected upper extremity. CONCLUSIONS Abnormal cerebral sensorimotor representations of the upper extremity after peripheral nerve damage in NA can recover toward normality. As adaptations occurred in visuomotor brain areas, multidisciplinary rehabilitation after peripheral nerve damage may be further optimized by applying visuomotor strategies. This study is registered at ClinicalTrials.gov (NCT03441347).
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Affiliation(s)
- Renee Lustenhouwer
- Department of Rehabilitation, Radboud
university medical center, Donders Institute for Brain, Cognition and Behaviour,
Nijmegen, the Netherlands,Donders Centre for Cognitive
Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud
University, Nijmegen, the Netherlands
| | - Ian G.M. Cameron
- Donders Centre for Cognitive
Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud
University, Nijmegen, the Netherlands,Faculty of Electrical Engineering,
Mathematics and Computer Science, University of Twente, Enschede, The
Netherlands
| | - Nens van Alfen
- Department of Neurology, Radboud
university medical center, Donders Institute for Brain, Cognition and Behaviour,
Nijmegen, the Netherlands
| | - Ivan Toni
- Donders Centre for Cognitive
Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud
University, Nijmegen, the Netherlands
| | - Alexander C.H. Geurts
- Department of Rehabilitation, Radboud
university medical center, Donders Institute for Brain, Cognition and Behaviour,
Nijmegen, the Netherlands
| | - Baziel G.M. van Engelen
- Department of Neurology, Radboud
university medical center, Donders Institute for Brain, Cognition and Behaviour,
Nijmegen, the Netherlands
| | - Jan T. Groothuis
- Department of Rehabilitation, Radboud
university medical center, Donders Institute for Brain, Cognition and Behaviour,
Nijmegen, the Netherlands,Jan T. Groothuis, Radboud university
medical center, Department of Rehabilitation, P.O. Box 9101, Nijmegen, 6500 HB,
The Netherlands.
| | - Rick C. Helmich
- Donders Centre for Cognitive
Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud
University, Nijmegen, the Netherlands,Department of Neurology, Radboud
university medical center, Donders Institute for Brain, Cognition and Behaviour,
Nijmegen, the Netherlands
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29
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Carvalho J, Invernizzi A, Martins J, Renken RJ, Cornelissen FW. Local neuroplasticity in adult glaucomatous visual cortex. Sci Rep 2022; 12:21981. [PMID: 36539453 PMCID: PMC9767937 DOI: 10.1038/s41598-022-24709-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 11/18/2022] [Indexed: 12/24/2022] Open
Abstract
The degree to which the adult human visual cortex retains the ability to functionally adapt to damage at the level of the eye remains ill-understood. Previous studies on cortical neuroplasticity primarily focused on the consequences of foveal visual field defects (VFD), yet these findings may not generalize to peripheral defects such as occur in glaucoma. Moreover, recent findings on neuroplasticity are often based on population receptive field (pRF) mapping, but interpreting these results is complicated in the absence of appropriate control conditions. Here, we used fMRI-based neural modeling to assess putative changes in pRFs associated with glaucomatous VFD. We compared the fMRI-signals and pRF in glaucoma participants to those of controls with case-matched simulated VFD. We found that the amplitude of the fMRI-signal is reduced in glaucoma compared to control participants and correlated with disease severity. Furthermore, while coarse retinotopic structure is maintained in all participants with glaucoma, we observed local pRF shifts and enlargements in early visual areas, relative to control participants. These differences suggest that the adult brain retains some degree of local neuroplasticity. This finding has translational relevance, as it is consistent with VFD masking, which prevents glaucoma patients from noticing their VFD and seeking timely treatment.
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Affiliation(s)
- Joana Carvalho
- grid.4494.d0000 0000 9558 4598Laboratory of Experimental Ophthalmology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands ,grid.421010.60000 0004 0453 9636Pre-Clinical MRI Laboratory, Champalimaud Centre for the Unknown, Avenida de Brasilia, 1400-038 Lisbon, Portugal
| | - Azzurra Invernizzi
- grid.4494.d0000 0000 9558 4598Laboratory of Experimental Ophthalmology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands ,grid.59734.3c0000 0001 0670 2351Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Joana Martins
- grid.4494.d0000 0000 9558 4598Laboratory of Experimental Ophthalmology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Remco J. Renken
- grid.4494.d0000 0000 9558 4598Laboratory of Experimental Ophthalmology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands ,grid.4494.d0000 0000 9558 4598Cognitive Neuroscience Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Frans W. Cornelissen
- grid.4494.d0000 0000 9558 4598Laboratory of Experimental Ophthalmology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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30
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Rizzo M, Petrini L, Del Percio C, Lopez S, Arendt‐Nielsen L, Babiloni C. Mirror visual feedback during unilateral finger movements is related to the desynchronization of cortical electroencephalographic somatomotor alpha rhythms. Psychophysiology 2022; 59:e14116. [PMID: 35657095 PMCID: PMC9788070 DOI: 10.1111/psyp.14116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 04/21/2022] [Accepted: 05/04/2022] [Indexed: 12/30/2022]
Abstract
Using a mirror adequately oriented, the motion of just one hand induces the illusion of the movement with the other hand. Here, we tested the hypothesis that such a mirror phenomenon may be underpinned by an electroencephalographic (EEG) event-related desynchronization/synchronization (ERD/ERS) of central alpha rhythms (around 10 Hz) as a neurophysiological measure of the interactions among cerebral cortex, basal ganglia, and thalamus during movement preparation and execution. Eighteen healthy right-handed male participants performed standard auditory-triggered unilateral (right) or bilateral finger movements in the No Mirror (M-) conditions. In the Mirror (M+) condition, the unilateral right finger movements were performed in front of a mirror oriented to induce the illusion of simultaneous left finger movements. EEG activity was recorded from 64 scalp electrodes, and the artifact-free event-related EEG epochs were used to compute alpha ERD. In the M- conditions, a bilateral prominent central alpha ERD was observed during the bilateral movements, while left central alpha ERD and right alpha ERS were seen during unilateral right movements. In contrast, the M+ condition showed significant bilateral and widespread alpha ERD during the unilateral right movements. These results suggest that the above illusion of the left movements may be related to alpha ERD measures reflecting excitatory desynchronizing signals in right lateral premotor and primary somatomotor areas possibly in relation to basal ganglia-thalamic loops.
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Affiliation(s)
- Marco Rizzo
- Center for Neuroplasticity and Pain (CNAP), SMIDepartment of Health Science and TechnologyAalborg UniversityAalborgDenmark
| | - Laura Petrini
- Center for Neuroplasticity and Pain (CNAP), SMIDepartment of Health Science and TechnologyAalborg UniversityAalborgDenmark
| | - Claudio Del Percio
- Department of Physiology and Pharmacology “V. Erspamer”Sapienza University of RomeRomeItaly
| | - Susanna Lopez
- Department of Physiology and Pharmacology “V. Erspamer”Sapienza University of RomeRomeItaly
| | - Lars Arendt‐Nielsen
- Center for Neuroplasticity and Pain (CNAP), SMIDepartment of Health Science and TechnologyAalborg UniversityAalborgDenmark,Department of Medical Gastroenterology, Mech‐SenseAalborg University HospitalAalborgDenmark
| | - Claudio Babiloni
- Department of Physiology and Pharmacology “V. Erspamer”Sapienza University of RomeRomeItaly
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31
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Yanagisawa T, Fukuma R, Seymour B, Tanaka M, Yamashita O, Hosomi K, Kishima H, Kamitani Y, Saitoh Y. Neurofeedback Training without Explicit Phantom Hand Movements and Hand-Like Visual Feedback to Modulate Pain: A Randomized Crossover Feasibility Trial. THE JOURNAL OF PAIN 2022; 23:2080-2091. [PMID: 35932992 DOI: 10.1016/j.jpain.2022.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 06/25/2022] [Accepted: 07/20/2022] [Indexed: 01/04/2023]
Abstract
Phantom limb pain is attributed to abnormal sensorimotor cortical representations, although the causal relationship between phantom limb pain and sensorimotor cortical representations suffers from the potentially confounding effects of phantom hand movements. We developed neurofeedback training to change sensorimotor cortical representations without explicit phantom hand movements or hand-like visual feedback. We tested the feasibility of neurofeedback training in fourteen patients with phantom limb pain. Neurofeedback training was performed in a single-blind, randomized, crossover trial using two decoders constructed using motor cortical currents measured during phantom hand movements; the motor cortical currents contralateral or ipsilateral to the phantom hand (contralateral and ipsilateral training) were estimated from magnetoencephalograms. Patients were instructed to control the size of a disk, which was proportional to the decoding results, but to not move their phantom hands or other body parts. The pain assessed by the visual analogue scale was significantly greater after contralateral training than after ipsilateral training. Classification accuracy of phantom hand movements significantly increased only after contralateral training. These results suggested that the proposed neurofeedback training changed phantom hand representation and modulated pain without explicit phantom hand movements or hand-like visual feedback, thus showing the relation between the phantom hand representations and pain. PERSPECTIVE: Our work demonstrates the feasibility of using neurofeedback training to change phantom hand representation and modulate pain perception without explicit phantom hand movements and hand-like visual feedback. The results enhance the mechanistic understanding of certain treatments, such as mirror therapy, that change the sensorimotor cortical representation.
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Affiliation(s)
- Takufumi Yanagisawa
- Osaka University, Institute for Advanced Co-Creation Studies, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan; Osaka University Graduate School of Medicine, Department of Neurosurgery, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan; ATR Computational Neuroscience Laboratories, Department of Neuroinformatics, 2-2-2 Hikaridai, Seika-cho, Kyoto 619-0288, Japan.
| | - Ryohei Fukuma
- Osaka University, Institute for Advanced Co-Creation Studies, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan; Osaka University Graduate School of Medicine, Department of Neurosurgery, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan; ATR Computational Neuroscience Laboratories, Department of Neuroinformatics, 2-2-2 Hikaridai, Seika-cho, Kyoto 619-0288, Japan
| | - Ben Seymour
- University of Oxford, Institute of Biomedical Engineering, Department of Engineering Science, Old Road Campus Research Building, Oxford OX3 7DQ, UK; National Institute for Information and Communications Technology, Center for Information and Neural Networks, 1-3 Suita, Osaka 565-0871, Japan
| | - Masataka Tanaka
- Osaka University Graduate School of Medicine, Department of Neurosurgery, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Okito Yamashita
- RIKEN Center for Advanced Intelligence Project, Nihonbashi 1-chome Mitsui Building, 15th floor, 1-4-1 Nihonbashi, Chuo-ku, Tokyo 103-0027, Japan; ATR Neural Information Analysis Laboratories, Department of Computational Brain Imaging, 2-2-2 Hikaridai, Seika-cho, Kyoto 619-0288, Japan
| | - Koichi Hosomi
- Osaka University Graduate School of Medicine, Department of Neurosurgery, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan; Osaka University Graduate School of Medicine, Department of Neuromodulation and Neurosurgery, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Haruhiko Kishima
- Osaka University Graduate School of Medicine, Department of Neurosurgery, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Yukiyasu Kamitani
- ATR Computational Neuroscience Laboratories, Department of Neuroinformatics, 2-2-2 Hikaridai, Seika-cho, Kyoto 619-0288, Japan; Kyoto University, Graduate School of Informatics, Yoshidahonmachi, Sakyoku, Kyoto, Kyoto 606-8501, Japan
| | - Youichi Saitoh
- Osaka University Graduate School of Medicine, Department of Neurosurgery, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan; Osaka University Graduate School of Medicine, Department of Neuromodulation and Neurosurgery, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
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Liu S, Fu W, Wei C, Ma F, Cui N, Shan X, Zhang Y. Interference of unilateral lower limb amputation on motor imagery rhythm and remodeling of sensorimotor areas. Front Hum Neurosci 2022; 16:1011463. [DOI: 10.3389/fnhum.2022.1011463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 10/19/2022] [Indexed: 11/05/2022] Open
Abstract
PurposeThe effect of sensorimotor stripping on neuroplasticity and motor imagery capacity is unknown, and the physiological mechanisms of post-amputation phantom limb pain (PLP) illness remain to be investigated.Materials and methodsIn this study, an electroencephalogram (EEG)-based event-related (de)synchronization (ERD/ERS) analysis was conducted using a bilateral lower limb motor imagery (MI) paradigm. The differences in the execution of motor imagery tasks between left lower limb amputations and healthy controls were explored, and a correlation analysis was calculated between level of phantom limb pain and ERD/ERS.ResultsThe multiple frequency bands showed a significant ERD phenomenon when the healthy control group performed the motor imagery task, whereas amputees showed significant ERS phenomena in mu band. Phantom limb pain in amputees was negatively correlated with bilateral sensorimotor areas electrode powers.ConclusionSensorimotor abnormalities reduce neural activity in the sensorimotor cortex, while the motor imagination of the intact limb is diminished. In addition, phantom limb pain may lead to over-activation of sensorimotor areas, affecting bilateral sensorimotor area remodeling.
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Significance and clinical suggestions for the somatosensory evoked potentials increased in amplitude revealed by a large sample of neurological patients. Neurol Sci 2022; 43:5553-5562. [DOI: 10.1007/s10072-022-06236-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 06/20/2022] [Indexed: 10/17/2022]
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Rackerby R, Lukosch S, Munro D. Understanding and Measuring the Cognitive Load of Amputees for Rehabilitation and Prosthesis Development. Arch Rehabil Res Clin Transl 2022; 4:100216. [PMID: 36123983 PMCID: PMC9482031 DOI: 10.1016/j.arrct.2022.100216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Objective To derive a definition of cognitive load that is applicable for amputation as well as analyze suitable research models for measuring cognitive load during prosthesis use. Defining cognitive load for amputation will improve rehabilitation methods and enable better prosthesis design. Data Sources Elsevier, Springer, PLoS, IEEE Xplore, and PubMed. Study Selection Studies on upper limb myoelectric prostheses and neuroprostheses were prioritized. For understanding measurement, lower limb amputations and studies with individuals without lower limb amputations were included. Data Extraction Queries including “cognitive load,” “neural fatigue,” “brain plasticity,” “neuroprosthetics,” “upper limb prosthetics,” and “amputation” were used with peer-reviewed journals or articles. Articles published within the last 6 years were prioritized. Articles on foundational principles were included regardless of date. A total of 69 articles were found: 12 on amputation, 15 on cognitive load, 8 on phantom limb, 22 on sensory feedback, and 12 on measurement methods. Data Synthesis The emotional, physiological, and neurologic aspects of amputation, prosthesis use, and rehabilitation aspects of cognitive load were analyzed in conjunction with measurement methods, including resolution, invasiveness, and sensitivity to user movement and environmental noise. Conclusions Use of “cognitive load” remains consistent with its original definition. For amputation, 2 additional elements are needed: “emotional fatigue,” defined as an amputee's emotional response, including mental concentration and emotions, and “neural fatigue,” defined as the physiological and neurologic effects of amputation on brain plasticity. Cognitive load is estimated via neuroimaging techniques, including electroencephalography, functional magnetic resonance imaging, and functional near-infrared spectroscopy (fNIRS). Because fNIRS measures cognitive load directly, has good temporal and spatial resolution, and is not as restricted by user movement, fNIRS is recommended for most cognitive load studies.
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Resting-State Functional Connectivity Analyses: Brain Functional Reorganization in a Rat Model of Postherpetic Neuralgia. Brain Sci 2022; 12:brainsci12081029. [PMID: 36009092 PMCID: PMC9405817 DOI: 10.3390/brainsci12081029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/20/2022] [Accepted: 08/01/2022] [Indexed: 11/17/2022] Open
Abstract
Postherpetic neuralgia (PHN) is a chronic neuropathic pain syndrome, similar to other chronic pains, the mechanisms of which are not fully understood. To further understand the neural mechanism of this chronic pain and its transition, we performed functional magnetic resonance imaging (fMRI) scans on PHN rat models. Twelve PHN rat models were established by intraperitoneal injection of resiniferatoxin, with an additional 12 rats serving as controls. Nociceptive behavioral tests were performed on these rats and fMRI scans were performed on days 7 and 14 after modeling. Functional connection (FC) analysis was used to investigate the brain FC alterations associated with chronic pain in PHN rats, with the anterior cingulate cortex (ACC) as a seed. Nociceptive behavioral tests showed that PHN rats presented symptoms similar to those of PHN patients. FC analysis showed that compared to the control group, the PHN group showed different FC patterns on days 7 and 14. As can be seen, the brain FC alterations in the rat model of PHN changed dynamically, shifting from brain regions processing sensory information to regions processing emotions and motives.
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36
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Pang D, Ashkan K. Deep brain stimulation for phantom limb pain. Eur J Paediatr Neurol 2022; 39:96-102. [PMID: 35728428 DOI: 10.1016/j.ejpn.2022.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 03/25/2022] [Accepted: 05/23/2022] [Indexed: 11/29/2022]
Abstract
Phantom limb pain is a rare cause of chronic pain in children but it is associated with extremely refractory pain and disability. The reason for limb amputation is often due to treatment for cancer or trauma and it has a lower incidence compared to adults. The mechanism of why phantom pain exists remains uncertain and may be a result of cortical reorganisation as well as ectopic peripheral input. Treatment is aimed at reducing both symptoms as well as managing pain related disability and functional restoration. Neuromodulatory approaches using deep brain stimulation for phantom limb pain is reserved for only the most refractory cases. The targets for brain stimulation include the thalamic nuclei and motor cortex. Novel targets such as the anterior cingulate cortex remain experimental as cases of serious adverse effects such as seziures have limited their widespread uptake. A multidisciplinary approach is crucial to successful rehabilitation using a biopsychosocial pain management approach.
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Affiliation(s)
- David Pang
- Consultant in Pain Management, Pain Management Centre, INPUT St Thomas Hospital, London, SE1 7EH, UK.
| | - Keyoumars Ashkan
- Department of Neurosurgery, Kins's College Hospital NHS Foundation Trust, London, UK
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Vittersø AD, Halicka M, Buckingham G, Proulx MJ, Bultitude JH. The sensorimotor theory of pathological pain revisited. Neurosci Biobehav Rev 2022; 139:104735. [PMID: 35705110 DOI: 10.1016/j.neubiorev.2022.104735] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 05/13/2022] [Accepted: 06/07/2022] [Indexed: 01/31/2023]
Abstract
Harris (1999) proposed that pain can arise in the absence of tissue damage because changes in the cortical representation of the painful body part lead to incongruences between motor intention and sensory feedback. This idea, subsequently termed the sensorimotor theory of pain, has formed the basis for novel treatments for pathological pain. Here we review the evidence that people with pathological pain have changes to processes contributing to sensorimotor function: motor function, sensory feedback, cognitive representations of the body and its surrounding space, multisensory processing, and sensorimotor integration. Changes to sensorimotor processing are most evident in the form of motor deficits, sensory changes, and body representations distortions, and for Complex Regional Pain Syndrome (CRPS), fibromyalgia, and low back pain. Many sensorimotor changes are related to cortical processing, pain, and other clinical characteristics. However, there is very limited evidence that changes in sensorimotor processing actually lead to pain. We therefore propose that the theory is more appropriate for understanding why pain persists rather than how it arises.
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Affiliation(s)
- Axel D Vittersø
- Centre for Pain Research, University of Bath, Bath, Somerset, United Kingdom; Department of Psychology, University of Bath, Bath, Somerset, United Kingdom; Department of Sport & Health Sciences, University of Exeter, Exeter, Devon, United Kingdom; Department of Psychology, Oslo New University College, Oslo, Norway.
| | - Monika Halicka
- Centre for Pain Research, University of Bath, Bath, Somerset, United Kingdom; Department of Psychology, University of Bath, Bath, Somerset, United Kingdom
| | - Gavin Buckingham
- Department of Sport & Health Sciences, University of Exeter, Exeter, Devon, United Kingdom
| | - Michael J Proulx
- Department of Psychology, University of Bath, Bath, Somerset, United Kingdom; Centre for Real and Virtual Environments Augmentation Labs, Department of Computer Science, University of Bath, Bath, Somerset, United Kingdom
| | - Janet H Bultitude
- Centre for Pain Research, University of Bath, Bath, Somerset, United Kingdom; Department of Psychology, University of Bath, Bath, Somerset, United Kingdom
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38
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Schone HR, Baker CI, Katz J, Nikolajsen L, Limakatso K, Flor H, Makin TR. Making sense of phantom limb pain. J Neurol Neurosurg Psychiatry 2022; 93:jnnp-2021-328428. [PMID: 35609964 PMCID: PMC9304093 DOI: 10.1136/jnnp-2021-328428] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 04/04/2022] [Indexed: 01/01/2023]
Abstract
Phantom limb pain (PLP) impacts the majority of individuals who undergo limb amputation. The PLP experience is highly heterogenous in its quality, intensity, frequency and severity. This heterogeneity, combined with the low prevalence of amputation in the general population, has made it difficult to accumulate reliable data on PLP. Consequently, we lack consensus on PLP mechanisms, as well as effective treatment options. However, the wealth of new PLP research, over the past decade, provides a unique opportunity to re-evaluate some of the core assumptions underlying what we know about PLP and the rationale behind PLP treatments. The goal of this review is to help generate consensus in the field on how best to research PLP, from phenomenology to treatment. We highlight conceptual and methodological challenges in studying PLP, which have hindered progress on the topic and spawned disagreement in the field, and offer potential solutions to overcome these challenges. Our hope is that a constructive evaluation of the foundational knowledge underlying PLP research practices will enable more informed decisions when testing the efficacy of existing interventions and will guide the development of the next generation of PLP treatments.
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Affiliation(s)
- Hunter R Schone
- NIMH, National Institutes of Health, Bethesda, Maryland, USA
- Institute of Cognitive Neuroscience, University College London, London, UK
| | - Chris I Baker
- NIMH, National Institutes of Health, Bethesda, Maryland, USA
| | - Joel Katz
- Department of Psychology, York University, Toronto, Ontario, Canada
- Transitional Pain Service, Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, Ontario, Canada
| | - Lone Nikolajsen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Katleho Limakatso
- Department of Anaesthesia and Perioperative Medicine, Pain Management Unit, Neuroscience Institute, University of Cape Town, Rondebosch, Western Cape, South Africa
| | - Herta Flor
- Institute of Cognitive and Clinical Neuroscience, Central Institute of Mental Health/Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Center for Neuroplasticity and Pain, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Tamar R Makin
- Institute of Cognitive Neuroscience, University College London, London, UK
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Clinical Manifestations of Body Memories: The Impact of Past Bodily Experiences on Mental Health. Brain Sci 2022; 12:brainsci12050594. [PMID: 35624981 PMCID: PMC9138975 DOI: 10.3390/brainsci12050594] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 04/29/2022] [Accepted: 04/30/2022] [Indexed: 12/04/2022] Open
Abstract
Bodily experiences such as the feeling of touch, pain or inner signals of the body are deeply emotional and activate brain networks that mediate their perception and higher-order processing. While the ad hoc perception of bodily signals and their influence on behavior is empirically well studied, there is a knowledge gap on how we store and retrieve bodily experiences that we perceived in the past, and how this influences our everyday life. Here, we explore the hypothesis that negative body memories, that is, negative bodily experiences of the past that are stored in memory and influence behavior, contribute to the development of somatic manifestations of mental health problems including somatic symptoms, traumatic re-experiences or dissociative symptoms. By combining knowledge from the areas of cognitive neuroscience and clinical neuroscience with insights from psychotherapy, we identify Clinical Body Memory (CBM) mechanisms that specify how mental health problems could be driven by corporeal experiences stored in memory. The major argument is that the investigation of the neuronal mechanisms that underlie the storage and retrieval of body memories provides us with empirical access to reduce the negative impact of body memories on mental health.
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40
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Central Neuropathic Pain Syndromes: Current and Emerging Pharmacological Strategies. CNS Drugs 2022; 36:483-516. [PMID: 35513603 DOI: 10.1007/s40263-022-00914-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/10/2022] [Indexed: 12/31/2022]
Abstract
Central neuropathic pain is caused by a disease or lesion of the brain or spinal cord. It is difficult to predict which patients will develop central pain syndromes after a central nervous system injury, but depending on the etiology, lifetime prevalence may be greater than 50%. The resulting pain is often highly distressing and difficult to treat, with no specific treatment guidelines currently available. This narrative review discusses mechanisms contributing to central neuropathic pain, and focuses on pharmacological approaches for managing common central neuropathic pain conditions such as central post-stroke pain, spinal cord injury-related pain, and multiple sclerosis-related neuropathic pain. Tricyclic antidepressants, serotonin-norepinephrine reuptake inhibitors, and gabapentinoids have some evidence for efficacy in central neuropathic pain. Medications from other pharmacologic classes may also provide pain relief, but current evidence is limited. Certain non-pharmacologic approaches, neuromodulation in particular, may be helpful in refractory cases. Emerging data suggest that modulating the primary afferent input may open new horizons for the treatment of central neuropathic pain. For most patients, effective treatment will likely require a multimodal therapy approach.
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41
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Wesselink DB, Sanders ZB, Edmondson LR, Dempsey-Jones H, Kieliba P, Kikkert S, Themistocleous AC, Emir U, Diedrichsen J, Saal HP, Makin TR. Malleability of the cortical hand map following a finger nerve block. SCIENCE ADVANCES 2022; 8:eabk2393. [PMID: 35452294 PMCID: PMC9032959 DOI: 10.1126/sciadv.abk2393] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Electrophysiological studies in monkeys show that finger amputation triggers local remapping within the deprived primary somatosensory cortex (S1). Human neuroimaging research, however, shows persistent S1 representation of the missing hand's fingers, even decades after amputation. Here, we explore whether this apparent contradiction stems from underestimating the distributed peripheral and central representation of fingers in the hand map. Using pharmacological single-finger nerve block and 7-tesla neuroimaging, we first replicated previous accounts (electrophysiological and other) of local S1 remapping. Local blocking also triggered activity changes to nonblocked fingers across the entire hand area. Using methods exploiting interfinger representational overlap, however, we also show that the blocked finger representation remained persistent despite input loss. Computational modeling suggests that both local stability and global reorganization are driven by distributed processing underlying the topographic map, combined with homeostatic mechanisms. Our findings reveal complex interfinger representational features that play a key role in brain (re)organization, beyond (re)mapping.
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Affiliation(s)
- Daan B. Wesselink
- Institute of Cognitive Neuroscience, University College London, London, UK
- Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, UK
- Department of Neurobiology, Harvard Medical School, Boston, MA, USA
- Corresponding author.
| | - Zeena-Britt Sanders
- Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, UK
| | - Laura R. Edmondson
- Active Touch Laboratory, Department of Psychology, The University of Sheffield, Sheffield, UK
| | - Harriet Dempsey-Jones
- Institute of Cognitive Neuroscience, University College London, London, UK
- Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, UK
- School of Psychology, University of Queensland, Brisbane, Australia
| | - Paulina Kieliba
- Institute of Cognitive Neuroscience, University College London, London, UK
| | - Sanne Kikkert
- Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, UK
| | - Andreas C. Themistocleous
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Brain Function Research Group, University of the Witwatersrand, Johannesburg, South Africa
| | - Uzay Emir
- Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, UK
| | - Jörn Diedrichsen
- Brain and Mind Institute, University of Western Ontario, London, Canada
| | - Hannes P. Saal
- Active Touch Laboratory, Department of Psychology, The University of Sheffield, Sheffield, UK
| | - Tamar R. Makin
- Institute of Cognitive Neuroscience, University College London, London, UK
- Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, UK
- Wellcome Centre for Human Neuroimaging, University College London, London, UK
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42
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Bazzari AH, Bazzari FH. Advances in targeting central sensitization and brain plasticity in chronic pain. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2022. [DOI: 10.1186/s41983-022-00472-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
AbstractMaladaptation in sensory neural plasticity of nociceptive pathways is associated with various types of chronic pain through central sensitization and remodeling of brain connectivity. Within this context, extensive research has been conducted to evaluate the mechanisms and efficacy of certain non-pharmacological pain treatment modalities. These include neurostimulation, virtual reality, cognitive therapy and rehabilitation. Here, we summarize the involved mechanisms and review novel findings in relation to nociceptive desensitization and modulation of plasticity for the management of intractable chronic pain and prevention of acute-to-chronic pain transition.
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43
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Fitzpatrick SM, Brogan D, Grover P. Hand Transplants, Daily Functioning, and the Human Capacity for Limb Regeneration. Front Cell Dev Biol 2022; 10:812124. [PMID: 35309909 PMCID: PMC8930848 DOI: 10.3389/fcell.2022.812124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 02/08/2022] [Indexed: 11/24/2022] Open
Abstract
Unlike some of our invertebrate and vertebrate cousins with the capacity to regenerate limbs after traumatic loss, humans do not have the ability to regrow arms or legs lost to injury or disease. For the millions of people worldwide who have lost a limb after birth, the primary route to regaining function and minimizing future complications is via rehabilitation, prosthetic devices, assistive aids, health system robustness, and social safety net structures. The majority of limbs lost are lower limbs (legs), with diabetes and vascular disorders being significant causal contributors. Upper limbs (arms) are lost primarily because of trauma; digits and hands are the most common levels of loss. Even if much of the arm remains intact, upper limb amputation significantly impacts function, largely due to the loss of the hand. Human hands are marvels of evolution and permit a dexterity that enables a wide variety of function not readily replaced by devices. It is not surprising, therefore, for some individuals, dissatisfaction with available prosthetic options coupled with remarkable advances in hand surgery techniques is resulting in patients undertaking the rigors of a hand transplantation. While not “regeneration” in the sense of the enviable ability with which Axolotls can replace a lost limb, hand transplants do require significant regeneration of tissues and nerves. Regaining sophisticated hand functions also depends on “reconnecting” the donated hand with the areas of the human brain responsible for the sensory and motor processing required for complex actions. Human hand transplants are not without controversy and raise interesting challenges regarding the human regenerative capacity and the status of transplants for enabling function. More investigation is needed to address medical and ethical questions prior to expansion of hand transplants to a wider patient population.
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Affiliation(s)
- Susan M. Fitzpatrick
- James S. McDonnell Foundation, St. Louis, MO, United States
- *Correspondence: Susan M. Fitzpatrick,
| | - David Brogan
- Department of Orthopaedic Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Prateek Grover
- Division of Neurorehabilitation, Orthopaedic Surgery and Neurology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
- The Rehabilitation Institute of St Louis, St. Louis, MO, United States
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Le Ray D, Guayasamin M. How Does the Central Nervous System for Posture and Locomotion Cope With Damage-Induced Neural Asymmetry? Front Syst Neurosci 2022; 16:828532. [PMID: 35308565 PMCID: PMC8927091 DOI: 10.3389/fnsys.2022.828532] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 02/07/2022] [Indexed: 12/28/2022] Open
Abstract
In most vertebrates, posture and locomotion are achieved by a biomechanical apparatus whose effectors are symmetrically positioned around the main body axis. Logically, motor commands to these effectors are intrinsically adapted to such anatomical symmetry, and the underlying sensory-motor neural networks are correspondingly arranged during central nervous system (CNS) development. However, many developmental and/or life accidents may alter such neural organization and acutely generate asymmetries in motor operation that are often at least partially compensated for over time. First, we briefly present the basic sensory-motor organization of posturo-locomotor networks in vertebrates. Next, we review some aspects of neural plasticity that is implemented in response to unilateral central injury or asymmetrical sensory deprivation in order to substantially restore symmetry in the control of posturo-locomotor functions. Data are finally discussed in the context of CNS structure-function relationship.
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45
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Browne JD, Fraiser R, Cai Y, Leung D, Leung A, Vaninetti M. Unveiling the phantom: What neuroimaging has taught us about phantom limb pain. Brain Behav 2022; 12:e2509. [PMID: 35218308 PMCID: PMC8933774 DOI: 10.1002/brb3.2509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 12/05/2021] [Accepted: 01/11/2022] [Indexed: 11/08/2022] Open
Abstract
Phantom limb pain (PLP) is a complicated condition with diverse clinical challenges. It consists of pain perception of a previously amputated limb. The exact pain mechanism is disputed and includes mechanisms involving cerebral, peripheral, and spinal origins. Such controversy limits researchers' and clinicians' ability to develop consistent therapeutics or management. Neuroimaging is an essential tool that can address this problem. This review explores diffusion tensor imaging, functional magnetic resonance imaging, electroencephalography, and magnetoencephalography in the context of PLP. These imaging modalities have distinct mechanisms, implications, applications, and limitations. Diffusion tensor imaging can outline structural changes and has surgical applications. Functional magnetic resonance imaging captures functional changes with spatial resolution and has therapeutic applications. Electroencephalography and magnetoencephalography can identify functional changes with a strong temporal resolution. Each imaging technique provides a unique perspective and they can be used in concert to reveal the true nature of PLP. Furthermore, researchers can utilize the respective strengths of each neuroimaging technique to support the development of innovative therapies. PLP exemplifies how neuroimaging and clinical management are intricately connected. This review can assist clinicians and researchers seeking a foundation for applications and understanding the limitations of neuroimaging techniques in the context of PLP.
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Affiliation(s)
- Jonathan D Browne
- School of Medicine, California University of Science and Medicine, Colton, California, USA
| | - Ryan Fraiser
- Center for Pain Medicine, University of California San Diego, La Jolla, California, USA
| | - Yi Cai
- Center for Pain Medicine, University of California San Diego, La Jolla, California, USA
| | - Dillon Leung
- College of Letters and Science, University of California Berkeley, Berkeley, California, USA
| | - Albert Leung
- Center for Pain Medicine, University of California San Diego, La Jolla, California, USA
| | - Michael Vaninetti
- Center for Pain Medicine, University of California San Diego, La Jolla, California, USA
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Kim S, Shin DY, Kim T, Lee S, Hyun JK, Park SM. Enhanced Recognition of Amputated Wrist and Hand Movements by Deep Learning Method Using Multimodal Fusion of Electromyography and Electroencephalography. SENSORS 2022; 22:s22020680. [PMID: 35062641 PMCID: PMC8778369 DOI: 10.3390/s22020680] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 01/09/2022] [Accepted: 01/14/2022] [Indexed: 02/04/2023]
Abstract
Motion classification can be performed using biometric signals recorded by electroencephalography (EEG) or electromyography (EMG) with noninvasive surface electrodes for the control of prosthetic arms. However, current single-modal EEG and EMG based motion classification techniques are limited owing to the complexity and noise of EEG signals, and the electrode placement bias, and low-resolution of EMG signals. We herein propose a novel system of two-dimensional (2D) input image feature multimodal fusion based on an EEG/EMG-signal transfer learning (TL) paradigm for detection of hand movements in transforearm amputees. A feature extraction method in the frequency domain of the EEG and EMG signals was adopted to establish a 2D image. The input images were used for training on a model based on the convolutional neural network algorithm and TL, which requires 2D images as input data. For the purpose of data acquisition, five transforearm amputees and nine healthy controls were recruited. Compared with the conventional single-modal EEG signal trained models, the proposed multimodal fusion method significantly improved classification accuracy in both the control and patient groups. When the two signals were combined and used in the pretrained model for EEG TL, the classification accuracy increased by 4.18-4.35% in the control group, and by 2.51-3.00% in the patient group.
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Affiliation(s)
- Sehyeon Kim
- Department of Convergence IT Engineering, Pohang University of Science and Technology, Pohang 37673, Korea;
| | - Dae Youp Shin
- Department of Rehabilitation Medicine, College of Medicine, Dankook University, Cheonan 31116, Korea;
| | - Taekyung Kim
- Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul 03063, Korea;
| | - Sangsook Lee
- Department of Rehabilitation Medicine, Daejeon Hospital, Daejeon 34383, Korea;
| | - Jung Keun Hyun
- Department of Rehabilitation Medicine, College of Medicine, Dankook University, Cheonan 31116, Korea;
- Department of Nanobiomedical Science & BK21 NBM Global Research Center for Regenerative Medicine, Dankook University, Cheonan 31116, Korea
- Institute of Tissue Regeneration Engineering (ITREN), Dankook University, Cheonan 31116, Korea
- Correspondence: (J.K.H.); (S.-M.P.); Tel.: +82-10-2293-3415 (J.K.H.); +82-10-7208-7740 (S.-M.P.)
| | - Sung-Min Park
- Department of Convergence IT Engineering, Pohang University of Science and Technology, Pohang 37673, Korea;
- Department of Electrical Engineering, Pohang University of Science and Technology, Pohang 37673, Korea
- Department of Mechanical Engineering, Pohang University of Science and Technology, Pohang 37673, Korea
- Correspondence: (J.K.H.); (S.-M.P.); Tel.: +82-10-2293-3415 (J.K.H.); +82-10-7208-7740 (S.-M.P.)
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47
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Jadidi AF, Stevenson AJT, Zarei AA, Jensen W, Lontis R. Effect of Modulated TENS on Corticospinal Excitability in Healthy Subjects. Neuroscience 2022; 485:53-64. [PMID: 35031397 DOI: 10.1016/j.neuroscience.2022.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 01/04/2022] [Accepted: 01/05/2022] [Indexed: 11/29/2022]
Abstract
Conventional transcutaneous electrical nerve stimulation (TENS) has been reported to effectively alleviate chronic pain, including phantom limb pain (PLP). Recently, literature has focused on modulated TENS patterns, such as pulse width modulation (PWM) and burst modulation (BM), as alternatives to conventional, non-modulated (NM) sensory neurostimulation to increase the efficiency of rehabilitation. However, there is still limited knowledge of how these modulated TENS patterns affect corticospinal (CS) and motor cortex activity. Therefore, our aim was to first investigate the effect of modulated TENS patterns on CS activity and corticomotor map in healthy subjects. Motor evoked potentials (MEP) elicited by transcranial magnetic stimulation (TMS) were recorded from three muscles before and after the application of TENS interventions. Four different TENS patterns (PWM, BM, NM 40 Hz, and NM 100 Hz) were applied. The results revealed significant facilitation of CS excitability following the PWM intervention. We also found an increase in the volume of the motor cortical map following the application of the PWM and NM (40 Hz). Although PLP alleviation has been reported to be associated with an enhancement of corticospinal excitability, the efficiency of the PWM intervention to induce pain alleviation should be validated in a future clinical study in amputees with PLP.
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Affiliation(s)
- Armita Faghani Jadidi
- Center for Neuroplasticity and Pain (CNAP) Department of Health Science and Technology, Aalborg University, Denmark.
| | | | - Ali Asghar Zarei
- Center for Neuroplasticity and Pain (CNAP) Department of Health Science and Technology, Aalborg University, Denmark
| | - Winnie Jensen
- Center for Neuroplasticity and Pain (CNAP) Department of Health Science and Technology, Aalborg University, Denmark
| | - Romulus Lontis
- Center for Neuroplasticity and Pain (CNAP) Department of Health Science and Technology, Aalborg University, Denmark
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48
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Gurgone S, Borzelli D, De Pasquale P, Berger DJ, Lisini Baldi T, D'Aurizio N, Prattichizzo D, d'Avella A. Simultaneous control of natural and extra degrees of freedom by isometric force and electromyographic activity in the muscle-to-force null space. J Neural Eng 2022; 19. [PMID: 34983036 DOI: 10.1088/1741-2552/ac47db] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 01/04/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Muscle activation patterns in the muscle-to-force null space, i.e., patterns that do not generate task-relevant forces, may provide an opportunity for motor augmentation by allowing to control additional end-effectors simultaneously to natural limbs. Here we tested the feasibility of muscular null space control for augmentation by assessing simultaneous control of natural and extra degrees of freedom. APPROACH We instructed eight participants to control translation and rotation of a virtual 3D end-effector by simultaneous generation of isometric force at the hand and null space activity extracted in real-time from the electromyographic signals recorded from 15 shoulder and arm muscles. First, we identified the null space components that each participant could control more naturally by voluntary co-contraction. Then, participants performed several blocks of a reaching and holding task. They displaced an ellipsoidal cursor to reach one of nine targets by generating force, and simultaneously rotated the cursor to match the target orientation by activating null space components. We developed an information-theoretic metric, an index of difficulty defined as the sum of a spatial and a temporal term, to assess individual null space control ability for both reaching and holding. MAIN RESULTS On average, participants could reach the targets in most trials already in the first block (72%) and they improved with practice (maximum 93%) but holding performance remained lower (maximum 43%). As there was a high inter-individual variability in performance, we performed a simulation with different spatial and temporal task conditions to estimate those for which each individual participants would have performed best. SIGNIFICANCE Muscular null space control is feasible and may be used to control additional virtual or robotics end-effectors. However, decoding of motor commands must be optimized according to individual null space control ability.
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Affiliation(s)
- Sergio Gurgone
- University of Messina, Viale Ferdinando Stagno D'Alcontres 31, Messina, 98166, ITALY
| | - Daniele Borzelli
- University of Messina, Via Consolare Valeria, Messina, Messina, 98122, ITALY
| | - Paolo De Pasquale
- Scienze Biomediche, Odontoiatriche e delle Immagini Morfologiche e Funzionali, Università degli Studi di Messina, Via Consolare Valeria, 1, Messina, Messina, ME, 98124, ITALY
| | - Denise J Berger
- Laboratorio di Fisiologia Neuromotoria, Fondazione Santa Lucia, Via Ardeatina 306, Via Ardeatina 306, Roma, 00179, ITALY
| | | | - Nicole D'Aurizio
- Università degli Studi di Siena, Via Roma 56, Siena, 53100, ITALY
| | | | - Andrea d'Avella
- Scienze Biomediche, Odontoiatriche e delle Immagini Morfologiche e Funzionali, Università degli Studi di Messina, Via Consolare Valeria, 1, Messina, Messina, ME, 98124, ITALY
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49
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Smith JL, Trofimova A, Ahluwalia V, Casado Garrido JJ, Hurtado J, Frank R, Hodge A, Gore RK, Allen JW. The "vestibular neuromatrix": A proposed, expanded vestibular network from graph theory in post-concussive vestibular dysfunction. Hum Brain Mapp 2021; 43:1501-1518. [PMID: 34862683 PMCID: PMC8886666 DOI: 10.1002/hbm.25737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 11/21/2021] [Accepted: 11/23/2021] [Indexed: 11/07/2022] Open
Abstract
Convergent clinical and neuroimaging evidence suggests that higher vestibular function is subserved by a distributed network including visuospatial, cognitive-affective, proprioceptive, and integrative brain regions. Clinical vestibular syndromes may perturb this network, resulting in deficits across a variety of functional domains. Here, we leverage structural and functional neuroimaging to characterize this extended network in healthy control participants and patients with post-concussive vestibular dysfunction (PCVD). Then, 27 healthy control subjects (15 females) and 18 patients with subacute PCVD (12 female) were selected for participation. Eighty-two regions of interest (network nodes) were identified based on previous publications, group-wise differences in BOLD signal amplitude and connectivity, and multivariate pattern analysis on affective tests. Group-specific "core" networks, as well as a "consensus" network comprised of connections common to all participants, were then generated based on probabilistic tractography and functional connectivity between the 82 nodes and subjected to analyses of node centrality and community structure. Whereas the consensus network was comprised of affective, integrative, and vestibular nodes, PCVD participants exhibited diminished integration and centrality among vestibular and affective nodes and increased centrality of visual, supplementary motor, and frontal and cingulate eye field nodes. Clinical outcomes, derived from dynamic posturography, were associated with approximately 62% of all connections but best predicted by amygdalar, prefrontal, and cingulate connectivity. No group-wise differences in diffusion metrics or tractography were noted. These findings indicate that cognitive, affective, and proprioceptive substrates contribute to vestibular processing and performance and highlight the need to consider these domains during clinical diagnosis and treatment planning.
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Affiliation(s)
- Jeremy L Smith
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Anna Trofimova
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Vishwadeep Ahluwalia
- Georgia State University, Atlanta, Georgia, USA.,Center for Advanced Brain Imaging, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Jose J Casado Garrido
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia, USA
| | | | | | | | - Russell K Gore
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia, USA.,Shepherd Center, Atlanta, Georgia, USA
| | - Jason W Allen
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA.,Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia, USA.,Department of Neurology, Emory University School of Medicine Emory University Hospital, Atlanta, Georgia, USA
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50
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Management of Phantom Limb Pain through Thalamotomy of the Centro-Median Nucleus. Neurol Int 2021; 13:587-593. [PMID: 34842785 PMCID: PMC8628935 DOI: 10.3390/neurolint13040058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 10/18/2021] [Accepted: 10/22/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Phantom limb syndrome is defined as the perception of intense pain or other sensations that are secondary to a neural lesion in a limb that does not exist. It can be treated using pharmacological and surgical interventions. Most medications are prescribed to improve patients’ lives; however, the response rate is low. In this case report, we present a case of phantom limb syndrome in a 42-year-old female with a history of transradial amputation of the left thoracic limb due to an accidental compression one year before. The patient underwent placement of a deep brain stimulator at the ventral posteromedial nucleus (VPM) on the right side and removal secondary to loss of battery. The patient continued to have a burning pain throughout the limb with a sensation of still having the limb, which was subsequently diagnosed as phantom limb syndrome. After a thorough discussion with the patient, a right stereotactic centro-median thalamotomy was offered. An immediate response was reported with a reduction in pain severity on the visual analogue scale (VAS) from a value of 9–10 preoperative to a value of 2 postoperative, with no postoperative complications. Although phantom limb pain is one of the most difficult to treat conditions, centro-median thalamotomy may provide an effective stereotactic treatment procedure with adequate outcomes.
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