Whose arm is it anyway? An fMRI case study of supernumerary phantom limb

Curved sixth fingers: Flexible representation of the shape of supernumerary body parts

A recent perceptual illusion induces the feeling of having a sixth finger on one's hand. It is unclear whether the representation of supernumerary fingers is flexible for shape. To test whether we can embody a sixth finger with a different shape from our own fingers, we induced a sixth finger which curved laterally though 180°. Participants reported feeling both curved and straight sixth fingers, depending on the stimulation pattern. Visual comparative judgements of the felt curvature of the supernumerary finger, showed means of 182° in the curved condition, and 35° in the straight condition. Our results show we can feel a supernumerary finger with different shape from our actual fingers, indicating that shape is represented flexibly in the perception of our hands. This study also adds evidence to the independence of the supernumerary finger from the actual fingers, showing we can represent the sixth finger with its own shape.

The long sixth finger illusion: The representation of the supernumerary finger is not a copy and can be felt with varying lengths

We can have a distorted perception of our body, instantly induced with multisensory illusions, anaesthesia or Virtual Reality, and recent studies show we can also feel extra body parts. Newport and colleagues (Newport et al., 2016) created an illusion that induces the feeling of having a sixth finger on one's hand, for a brief moment. By changing the paradigm with a double back and forth stroking, we were able to extend the duration of this illusion (Cadete & Longo, 2020), which can reflect an endured representation of a supernumerary finger. This innovation allowed us to test one specific distortion in the supernumerary finger: length. Patients with supernumerary phantom limb syndrome feel like they have an extra limb, as if one of their limbs was duplicated (Staub et al., 2006), resembling the same size and shape of the existing one. It is unclear from existing studies whether a supernumerary limb is represented as a copy of the existing limb, or if it is represented independently, with its own features. We therefore aimed to investigate whether the properties of the supernumerary sixth finger could be altered, independently of the actual little finger. Hence, we tested whether we can embody a sixth finger with double the size of the average little finger, and half its size. Participants reported feeling a long and a short sixth finger, and gave visual judgements on the felt length of the supernumerary finger, that matched the condition length. Overall, the results show that the supernumerary sixth finger is not a mere copy of the little finger but is represented independently, with distinct features from the existing finger. Moreover, the representation of the supernumerary finger is flexible, allowing the embodiment of a long or a short sixth finger.

The debate on apraxia and the supplementary motor area in the twentieth century

Hand function and apraxia are equally relevant to neurosurgeons: as a symptom, as well as through the functional anatomy of "praxis" which underlies the dexterity needed for neurosurgical practice. The supplementary motor area is crucial for its understanding. Historically, Hugo Liepmann dominated the apraxia debate at the beginning of the twentieth century, a debate that has remained influential until today. Kurt Goldstein, a contemporary of Liepmann, is regularly mentioned as the first to have described the alien hand syndrome in 1909. Wilder Penfield was a key figure in exploring the role of the fronto-mesial cortex in human motor control and coined the term "supplementary motor area". It was Goldstein who not only contributed substantially to the apraxia debate more than 100 years ago; he also established the link between the dysfunction of the fronto-mesial cortex and abnormal higher motor control in humans.

Duplication of the bodily self: a perceptual illusion of dual full-body ownership and dual self-location

Previous research has shown that it is possible to use multisensory stimulation to induce the perceptual illusion of owning supernumerary limbs, such as two right arms. However, it remains unclear whether the coherent feeling of owning a full-body may be duplicated in the same manner and whether such a dual full-body illusion could be used to split the unitary sense of self-location into two. Here, we examined whether healthy human participants can experience simultaneous ownership of two full-bodies, located either close in parallel or in two separate spatial locations. A previously described full-body illusion, based on visuo-tactile stimulation of an artificial body viewed from the first-person perspective (1PP) via head-mounted displays, was adapted to a dual-body setting and quantified in five experiments using questionnaires, a behavioural self-location task and threat-evoked skin conductance responses. The results of experiments 1-3 showed that synchronous visuo-tactile stimulation of two bodies viewed from the 1PP lying in parallel next to each other induced a significant illusion of dual full-body ownership. In experiment 4, we failed to find support for our working hypothesis that splitting the visual scene into two, so that each of the two illusory bodies was placed in distinct spatial environments, would lead to dual self-location. In a final exploratory experiment (no. 5), we found preliminary support for an illusion of dual self-location and dual body ownership by using dynamic changes between the 1PPs of two artificial bodies and/or a common third-person perspective in the ceiling of the testing room. These findings suggest that healthy people, under certain conditions of multisensory perceptual ambiguity, may experience dual body ownership and dual self-location. These findings suggest that the coherent sense of the bodily self located at a single place in space is the result of an active and dynamic perceptual integration process.

A Continuous Illusion of Having a Sixth Finger

Our body is central to our sense of self and personal identity, yet it can be manipulated in the laboratory in surprisingly easy ways. Several multisensory illusions have shown the flexibility of the mental representation of our bodies by inducing the illusion of owning an artificial body part or having a body part with altered features. Recently, new studies showed we can embody additional body parts such as a supernumerary finger. Newport et al. recently reported a novel six-finger illusion using conflicting visual and tactile signals induced with the mirror box to create the illusory perception of having a sixth finger for a brief moment. In this study, we aimed to replicate this result and to investigate whether the experience of embodiment of a sixth finger could be prolonged for an extended duration by applying continuous visual-tactile stimulation. Results showed that a continuous illusion of having a sixth finger can be clearly induced. This shows that the six-finger illusion does not reflect merely a momentary confusion due to conflicting multisensory signals but can reflect an enduring representation of a supernumerary finger.

Supernumerary phantom limb in a patient with basal ganglia hemorrhage - a case report and review of the literature

Background

Supernumerary phantom limb (SPL) is a rare neurologic phenomenon, in which a patient misperceives an extra limb in addition to the original set of limbs. We report a case of SPL in a patient with a right basal ganglia hemorrhage and review the previous literature about this peculiar phenomenon.

Case presentation

Two days after the event of a right basal ganglia hemorrhage, a 78-year-old male reported a phantom arm protruding from his left shoulder. He could not see or touch the phantom arm but he felt the presence of an addition arm lateral to his paretic arm. Pain or sensory discomfort were absent in either the paretic arm or the phantom arm. He stated that he could intentionally move the phantom arm independent of his paretic arm. The examination showed that the passive movement of his paretic arm did not elicit any movement of his phantom arm. We diagnosed the SPL as a complication of the hypertensive basal ganglia hemorrhage and treated him with anti-hypertensive medications. His phantom arm persisted for 3 weeks, and it gradually faded away.

Conclusion

SPL had been reported as a rare complication of various types of cerebral lesions. Right hemispheric lesions were most frequently associated with the SPL. Considering the intentional movement of the phantom arm, we deduced that the SPL might result from the impairment of the sensory feedback system for both internal body image and motor movement.

Cortico-thalamic disconnection in a patient with supernumerary phantom limb

Supernumerary phantom limb (SPL) designates the experience of an illusory additional limb occurring after brain damage. Functional neuroimaging during SPL movements documented increased response in the ipsilesional supplementary motor area (SMA), premotor cortex (PMC), thalamus and caudate. This suggested that motor circuits are important for bodily related cognition, but anatomical evidence is sparse. Here, we tested this hypothesis by studying an extremely rare patient with chronic SPL, still present 3 years after a vascular stroke affecting cortical and subcortical right-hemisphere structures. Anatomical analysis included an advanced in vivo reconstruction of white matter tracts using diffusion-based spherical deconvolution. This reconstruction demonstrated a massive and relatively selective disconnection between anatomically preserved SMA/PMC and the thalamus. Our results provide strong anatomical support for the hypothesis that cortico-thalamic loops involving motor-related circuits are crucial to integrate sensorimotor processing with bodily self-awareness.

Neural correlates of evoked phantom limb sensations

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We present a neural network related to evoked phantom sensations in amputees.

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Such networks were not related to the stimulation from the residual limb.

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Difference in intra- and inter-hemispheric interactions between amputees and yoked controls.

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This finding yields novel insights into the neural basis of phantom sensation.

Previous work showed the existence of changes in the topographic organization within the somatosensory cortex (SI) in amputees with phantom limb pain, however, the link between nonpainful phantom sensations such as cramping or tingling or the percept of the limb and cortical changes is less clear.

We used functional magnetic resonance imaging (fMRI) in a highly selective group of limb amputees who experienced inducible and reproducible nonpainful phantom sensations. A standardized procedure was used to locate body sites eliciting phantom sensations in each amputee. Selected body sites that could systematically evoke phantom sensations were stimulated using electrical pulses in order to induce phasic phantom sensations. Homologous body parts were also stimulated in a group of matched controls.

Activations related to evoked phantom sensations were found bilaterally in SI and the intraparietal sulci (IPS), which significantly correlated with the intensity of evoked phantom sensations. In addition, we found differences in intra- and interhemispheric interaction between amputees and controls during evoked phantom sensations. We assume that phantom sensations might be associated with a functional decoupling between bilateral SI and IPS, possibly resulting from transcallosal reorganization mechanisms following amputation.

From sensorimotor inhibition to freudian repression: insights from psychosis applied to neurosis

First, three case studies are presented of psychotic patients having in common an inability to hold something down or out. In line with other theories on psychosis, we propose that a key change is at the efference copy system. Going back to Freud's mental apparatus, we propose that the messages of discharge of the motor neurons, mobilized to direct perception, also called "indications of reality," are equivalent to the modern efference copies. With this key, the reading of the cases is coherent with the psychodynamic understanding of psychosis, being a downplay of secondary processes, and consequently, a dominance of primary processes. Moreover, putting together the sensorimotor idea of a failure of efference copy-mediated inhibition with the psychoanalytic idea of a failing repression in psychosis, the hypothesis emerges that the attenuation enabled by the efference copy dynamics is, in some instances, the physiological instantiation of repression. Second, we applied this idea to the mental organization in neurosis. Indeed, the efference copy-mediated attenuation is thought to be the mechanism through which sustained activation of an intention, without reaching it - i.e., inhibition of an action - gives rise to mental imagery. Therefore, as inhibition is needed for any targeted action or for normal language understanding, acting in the world, or processing language, structurally induces mental imagery, constituting a subjective unconscious mental reality. Repression is a special instance of inhibition for emotionally threatening stimuli. These stimuli require stronger inhibition, leaving (the attenuation of) the motor intentions totally unanswered, in order to radically prevent execution which would lead to development of excess affect. This inhibition, then, yields a specific type of motor imagery, called "phantoms," which induce mental preoccupation, as well as symptoms which, especially through their form, refer to the repressed motor fragments.

Complex-number representation of informed basis functions in general linear modeling of Functional Magnetic Resonance Imaging

Functional Magnetic Resonance Imaging (fMRI), measuring Blood Oxygen Level-Dependent (BOLD), is a widely used tool to reveal spatiotemporal pattern of neural activity in human brain. Standard analysis of fMRI data relies on a general linear model and the model is constructed by convolving the task stimuli with a hypothesized hemodynamic response function (HRF). To capture possible phase shifts in the observed BOLD response, the informed basis functions including canonical HRF and its temporal derivative, have been proposed to extend the hypothesized hemodynamic response in order to obtain a good fitting model. Different t contrasts are constructed from the estimated model parameters for detecting the neural activity between different task conditions. However, the estimated model parameters corresponding to the orthogonal basis functions have different physical meanings. It remains unclear how to combine the neural features detected by the two basis functions and construct t contrasts for further analyses. In this paper, we have proposed a novel method for representing multiple basis functions in complex domain to model the task-driven fMRI data. Using this method, we can treat each pair of model parameters, corresponding respectively to canonical HRF and its temporal derivative, as one complex number for each task condition. Using the specific rule we have defined, we can conveniently perform arithmetical operations on the estimated model parameters and generate different t contrasts. We validate this method using the fMRI data acquired from twenty-two healthy participants who underwent an auditory stimulation task.

How does interoceptive awareness interact with the subjective experience of emotion? An fMRI study

Recent studies in cognitive neuroscience have suggested that the integration of information about the internal bodily state and the external environment is crucial for the experience of emotion. Extensive overlap between the neural mechanisms underlying the subjective emotion and those involved in interoception (perception of that which is arising from inside the body) has been identified. However, the mechanisms of interaction between the neural substrates of interoception and emotional experience remain unclear. We examined the common and distinct features of the neural activity underlying evaluation of emotional and bodily state using functional magnetic resonance imaging (fMRI). The right anterior insular cortex and ventromedial prefrontal cortex (VMPFC) were identified as commonly activated areas. As both of these areas are considered critical for interoceptive awareness, these results suggest that attending to the bodily state underlies awareness of one's emotional state. Uniquely activated areas involved in the evaluation of emotional state included the temporal pole, posterior and anterior cingulate cortex, medial frontal gyrus, and inferior frontal gyrus. Also the precuneus was functionally associated with activity of the right anterior insular cortex and VMPFC when evaluating emotional state. Our findings indicate that activation in these areas and the precuneus are functionally associated for accessing interoceptive information and underpinning subjective experience of the emotional state. Thus, awareness of one's own emotional state appears to involve the integration of interoceptive information with an interpretation of the current situation.

Dynamic changes in the perceived posture of the hand during ischaemic anaesthesia of the arm

Contorted 'phantom' limbs often form when sensory inputs are removed, but the neural mechanisms underlying their formation are poorly understood. We tracked the evolution of an experimental phantom hand during ischaemic anaesthesia of the arm. In the first study subjects showed the perceived posture of their hand and fingers using a model hand. Surprisingly, if the wrist and fingers were held straight before and during anaesthesia, the final phantom hand was bent at the wrist and fingers, but if the wrist and fingers were flexed before and during anaesthesia, the final phantom was extended at wrist and fingers. Hence, no 'default' posture existed for the phantom hand. The final perceived posture may depend on the initial and evolving sensory input during the block rather than the final sensory input (which should not differ for the two postures). In the second study subjects selected templates to indicate the perceived size of their hand. Perceived hand size increased by 34 ± 4% (mean ± 95% CI) during the block. Sensory changes were monitored. In all subjects, impairment of large-fibre cutaneous sensation began distally with von Frey thresholds increasing before cold detection thresholds (Aδ fibres) increased. Some C fibres subserving heat pain still conducted at the end of cuff inflation. These data suggest that changes in both perceived hand size and perceived position of the finger joints develop early when large-fibre cutaneous sensation is beginning to degrade. Hence it is unlikely that block of small-fibre afferents is critical for phantom formation in an ischaemic block.

Atypical supernumerary phantom limb and phantom limb pain in two patients with pontine hemorrhage

Phantom limbs are usually observed after amputation of extremities. In patients after a stroke, a similar but rarely occurring phenomenon consisting of the patient experiencing the presence of an additional limb has been described. This phenomenon, generally called supernumerary phantom limb (SPL), may be caused by lesions in the right or left cerebral hemisphere, but has been predominantly reported in patients who have had a right hemispheric stroke. We report two cases of atypical SPL and phantom limb pain (PLP) after pontine hemorrhage. The patients were treated conservatively and their symptoms lasted more than 1 month. This is the first report of SPLs after left pontine hemorrhage, and phantom perception and pain lasted longer than those in previously observed cases. Our results indicate that SPL may be more common than reported; therefore, thorough examinations are essential for the care of stroke patients.

The illusion of owning a third arm

Could it be possible that, in the not-so-distant future, we will be able to reshape the human body so as to have extra limbs? A third arm helping us out with the weekly shopping in the local grocery store, or an extra artificial limb assisting a paralysed person? Here we report a perceptual illusion in which a rubber right hand, placed beside the real hand in full view of the participant, is perceived as a supernumerary limb belonging to the participant's own body. This effect was supported by questionnaire data in conjunction with physiological evidence obtained from skin conductance responses when physically threatening either the rubber hand or the real one. In four well-controlled experiments, we demonstrate the minimal required conditions for the elicitation of this “supernumerary hand illusion”. In the fifth, and final experiment, we show that the illusion reported here is qualitatively different from the traditional rubber hand illusion as it is characterised by less disownership of the real hand and a stronger feeling of having two right hands. These results suggest that the artificial hand ‘borrows’ some of the multisensory processes that represent the real hand, leading to duplication of touch and ownership of two right arms. This work represents a major advance because it challenges the traditional view of the gross morphology of the human body as a fundamental constraint on what we can come to experience as our physical self, by showing that the body representation can easily be updated to incorporate an additional limb.

Supernumerary phantom limbs in spinal cord injury

STUDY DESIGN AND OBJECTIVES

Case report and review of supernumerary phantom limbs in patients suffering from spinal cord injury (SCI).

SETTING

SCI rehabilitation centre.

CASE REPORT

After a ski accident, a 71-year-old man suffered an incomplete SCI (level C3; AIS C, central cord syndrome), with a C3/C4 dislocation fracture. From the first week after injury, he experienced a phantom duplication of both upper limbs that lasted for 7 months. The supernumerary limbs were only occasionally related to painful sensation, specifically when they were perceived as crossed on his trunk. Although the painful sensations were responsive to pain medication, the presence of the illusory limb sensations were persistent. During neurological recovery, the supernumerary limbs gradually disappeared. A rubber hand illusion paradigm was used twice during recovery to monitor the patient's ability to integrate visual, tactile and proprioceptive stimuli.

CONCLUSION

Overall, the clinical relevance of supernumerary phantom limbs is not clear, specific treatment protocols have not yet been developed, and the underlying neural mechanisms are not fully understood. Supernumerary phantom limbs have been previously reported in patients with (sub)cortical lesions, but might be rather undocumented in patients suffering from traumatic SCI. For the appropriate diagnosis and treatment after SCI, supernumerary phantoms should be distinguished from other phantom sensations and pain syndromes after SCI.

Self awareness and the body image

What mental representations give us the sense of our body as a unique object in the world? We investigated this issue in the context of the rubber hand illusion (RHI), an illusion of body image in which a prosthetic hand brushed synchronously, but not asynchronously, with one's own hand is perceived as actually being one's hand. We conducted a large-scale study of the RHI, and used psychometric analysis to reveal the structure of the subjective experience of embodiment [Longo et al. (2008). What is embodiment? A psychometric approach. Cognition,107, 978-998]. Here, we use this dataset to investigate the relation between incorporation of a rubber hand into the body image and the perceived similarity between the participant's hand and the rubber hand. Objective similarity (as measured by skin luminance, hand shape, and third-person similarity ratings) did not appear to influence participants' experience of the RHI. Conversely, incorporation of the rubber hand into the body image did affect the similarity that participants perceived between their own hand and the rubber hand. Participants who had experienced the RHI perceived their hand and the rubber hand as significantly more similar than participants who had not experienced the illusion. That is, embodiment leads to perceived similarity, but perceived similarity does not lead to embodiment. Furthermore, similarity ratings following the illusion were selectively correlated with some components of embodiment, but not with others. These results suggest an important role of a mental body image in the perception of the relation between the self and others.

Seeing the phantom: a functional magnetic resonance imaging study of a supernumerary phantom limb

OBJECTIVE

Supernumerary phantom limb (SPL) is a rare neurological manifestation where patients with a severe stroke-induced sensorimotor deficit experience the illusory presence of an extra limb that duplicates a real one. The illusion is most often experienced as a somesthetic phantom, but rarer SPLs may be intentionally triggered or seen. Here, we report the case of a left visual, tactile, and intentional SPL caused by right subcortical damage in a nondeluded woman.

METHODS

Using functional magnetic resonance imaging, we investigated the multimodal nature of this phantom, which the patient claimed to be able see, use, and move intentionally. The patient participated in a series of sensorimotor and motor imagery tasks involving the right, the left plegic, and the SPL's hand.

RESULTS

Right premotor and motor regions were engaged when she imagined that she was scratching her left cheek with her left plegic hand, whereas when she performed the same task with the SPL, additional left middle occipital areas were recruited. Moreover, comparison of responses induced by left cheek (subjectively feasible) versus right cheek scratching (reportedly unfeasible movement) with the SPL demonstrated significant activation in right somesthetic areas.

INTERPRETATION

These findings demonstrate that intentional movements of a seen and felt SPL activate premotor and motor areas together with visual and sensory cortex, confirming its multimodal dimension and the reliability of the patient's verbal reports. This observation, interpreted for cortical deafferentation/disconnection caused by subcortical brain damage, constitutes a new but theoretically predictable entity among disorders of bodily awareness.

My third arm: shifts in topography of the somatosensory homunculus predict feeling of an artificial supernumerary arm

The classic understanding of the role of the primary somatosensory cortex (SI) is to be a first major unimodal area processing somatosensory input and reflecting the physical location of peripheral stimulation in the form of the famous homunculus. Whereas in the past this functional topography was believed to be fixed, recent studies challenge this view. For example, in upper extremity amputees the cortical representation of the mouth was found to invade the region that formerly represented the amputated limb. Moreover, several studies demonstrated dynamic modulations of the body map in SI by tactile illusions. The present study aims to further explore the role of SI by creating an illusion of feeling a supernumerary artificial limb. Using an artificial hand and arm that were connected to their body, subjects were given the visual impression that they had a supernumerary third arm. The topography in SI was examined with neuromagnetic source localization. Results revealed that the participants not only viewed the artificial arm but felt to have three arms. Thus, a simple visuo-tactile illusion evoked feelings of ownership of a supernumerary body part. Furthermore, during the illusion the cortical representation of the thumb shifted to a more medial and superior position. Because this modulation in SI could predict the strength of the feeling that the third arm was belonging to the own body, the results suggest that the somatosensory homunculus is reflecting the perceived shape of the body rather than physical aspects of peripheral stimulation even when feeling an artificial third arm.

Roughness perception during the rubber hand illusion

Watching a rubber hand being stroked by a paintbrush while feeling identical stroking of one's own occluded hand can create a compelling illusion that the seen hand becomes part of one's own body. It has been suggested that this so-called rubber hand illusion (RHI) does not simply reflect a bottom-up multisensory integration process but that the illusion is also modulated by top-down, cognitive factors. Here we investigated for the first time whether the conceptual interpretation of the sensory quality of the visuotactile stimulation in terms of roughness can influence the occurrence of the illusion and vice versa, whether the presence of the RHI can modulate the perceived sensory quality of a given tactile stimulus (i.e., in terms of roughness). We used a classical RHI paradigm in which participants watched a rubber hand being stroked by either a piece of soft or rough fabric while they received synchronous or asynchronous tactile stimulation that was either congruent or incongruent with respect to the sensory quality of the material touching the rubber hand. (In)congruencies between the visual and tactile stimulation did neither affect the RHI on an implicit level nor on an explicit level, and the experience of the RHI in turn did not cause any modulations of the felt sensory quality of touch on participant's own hand. These findings first suggest that the RHI seems to be resistant to top-down knowledge in terms of a conceptual interpretation of tactile sensations. Second, they argue against the hypothesis that participants own hand tends to disappear during the illusion and that the rubber hand actively replaces it.

Searching for the elusive neural substrates of body part terms: a neuropsychological study

Previous neuropsychological studies suggest that, compared to other categories of concrete entities, lexical and conceptual aspects of body part knowledge are frequently spared in brain-damaged patients. To further investigate this issue, we administered a battery of 12 tests assessing lexical and conceptual aspects of body part knowledge to 104 brain-damaged patients with lesions distributed throughout the telencephalon. There were two main outcomes. First, impaired oral naming of body parts, attributable to a disturbance of the mapping between lexical-semantic and lexical-phonological structures, was most reliably and specifically associated with lesions in the left frontal opercular and anterior/inferior parietal opercular cortices and in the white matter underlying these regions (8 patients). Also, 1 patient with body part anomia had a left occipital lesion that included the "extrastriate body area" (EBA). Second, knowledge of the meanings of body part terms was remarkably resistant to impairment, regardless of lesion site; in fact, we did not uncover a single patient who exhibited significantly impaired understanding of the meanings of these terms. In the 9 patients with body part anomia, oral naming of concrete entities was evaluated, and this revealed that 4 patients had disproportionately worse naming of body parts relative to other types of concrete entities. Taken together, these findings extend previous neuropsychological and functional neuroimaging studies of body part knowledge and add to our growing understanding of the nuances of how different linguistic and conceptual categories are operated by left frontal and parietal structures.

Stroke with supernumerary phantom limb: case study, review of literature and pathogenesis

OBJECTIVE

Constitute hypothesis for origin of supernumerary phantom limb (SPL) after stroke.

METHOD

Single case description, review of literature and formulation of hypothesis.

RESULTS

A 59-year-old lady was evaluated for complaints of left-sided hemiparesis and extra limbs attached to her left shoulder for the past 7 months. Neuropsychological assessment revealed left hemineglect with SPL, and profile suggested bilateral frontal, right parietotemporal and basal ganglia involvement. Magnetic resonance imaging brain scan showed gliotic cavity secondary to the old haematoma in right putamen with white matter changes in the right frontoparietotemporal lobes.

CONCLUSIONS

The conceptual framework of body schema can be used to classify many of the neurological disorders of body representation. Generation of SPL comes under the subtype of pathology of updating among the disorders of body schema. The continuous updating allows the body schema to modulate perceptual processing of objects according to their position in space. Brain areas classified as parts of motor system can, under pathological conditions (haemorrhage), influence body perception. So, when she used to move her arm, the representation of the estimated position was not updated by the motor commands. Sensory and motor information therefore becomes discrepant, and failure to integrate these two sources of information leads to loss of normal coherence, and the perceived shape of the body was altered by adding a SPL to accommodate the discrepancy.

Somatoparaphrenia: a body delusion. A review of the neuropsychological literature

A review of published brain-damaged patients showing delusional beliefs concerning the contralesional side of the body (somatoparaphrenia) is presented. Somatoparaphrenia has been reported, with a few exceptions, in right-brain-damaged patients, with motor and somatosensory deficits, and the syndrome of unilateral spatial neglect. Somatoparaphrenia, most often characterized by a delusion of disownership of left-sided body parts, may however occur without associated anosognosia for motor deficits, and personal neglect. Also somatosensory deficits may not be a core pathological mechanism of somatoparaphrenia, and visual field disorders may be absent. Deficits of proprioception, however, may play a relevant role. Somatoparaphrenia is often brought about by extensive right-sided lesions, but patients with posterior (parietal-temporal), and insular damage are on record, as well as a few patients with subcortical lesions. Possible pathological factors include a deranged representation of the body concerned with ownership, mainly right-hemisphere-based, and deficits of multisensory integration. Finally, the rubber hand illusion, that brings about a bodily misattribution in neurologically unimpaired participants, as somatoparaphrenia does in brain-damaged patients, is briefly discussed.

Mechanisms underlying embodiment, disembodiment and loss of embodiment

Bodily experience is a complex, mostly unconscious, process that requires the integration of multiple sensory inputs. This paper reviews the sensory systems involved in internal representations of the body--primarily the proprioceptive, motor, vestibular, and visual systems. Various neurological disorders are defined by aberrations in bodily experience--including the perceptual ablation or disembodiment of body parts, "filling in" of amputated body parts, or reduplication of body parts. These perceptual aberrations are discussed and their implications for the central and peripheral systems involved in updating and retrieving internal representations of the body are highlighted. Bodily perception and egocentric frames of reference can be experimentally manipulated through visual capture (e.g., using rubber limbs), functional adaptation and embodiment of tools and prostheses, and changes in afferent sensory feedback (e.g., through stimulation of muscle spindles). These perceptual illusions are described, and discussed for their implications for the mechanisms underlying bodily perception.

Advances in functional magnetic resonance imaging: technology and clinical applications

Functional MRI (fMRI) is a valuable method for use by clinical investigators to study task-related brain activation in patients with neurological or neuropsychiatric illness. Despite the relative infancy of the field, the rapid adoption of this functional neuroimaging technology has resulted from, among other factors, its ready availability, its relatively high spatial and temporal resolution, and its safety as a noninvasive imaging tool that enables multiple repeated scans over the course of a longitudinal study, and thus may lend itself well as a measure in clinical drug trials. Investigators have used fMRI to identify abnormal functional brain activity during task performance in a variety of patient populations, including those with neurodegenerative, demyelinating, cerebrovascular, and other neurological disorders that highlight the potential utility of fMRI in both basic and clinical spheres of research. In addition, fMRI studies reveal processes related to neuroplasticity, including compensatory hyperactivation, which may be a universally-occurring, adaptive neural response to insult. Functional MRI is being used to study the modulatory effects of genetic risk factors for neurological disease on brain activation; it is being applied to differential diagnosis, as a predictive biomarker of disease course, and as a means to identify neural correlates of neurotherapeutic interventions. Technological advances are rapidly occurring that should provide new applications for fMRI, including improved spatial resolution, which promises to reveal novel insights into the function of fine-scale neural circuitry of the human brain in health and disease.

Central mechanisms in phantom limb perception: The past, present and future

Phantom limbs provide valuable insight into the mechanisms underlying bodily awareness and ownership. This paper reviews the complexity of phantom limb phenomena (proprioception, form, position, posture and telescoping), and the various contributions of internal constructs of the body, or body schema, and neuromatrix theory in explaining these phenomena. Specific systems and processes that have received little attention in phantom limb research are also reviewed and highlighted as important future directions, These include prosthesis embodiment and extended physiological proprioception (i.e., the extension of the body's "area of influence" that thereby extends one's innate sense of proprioception, mirror neurons and cross-referencing of the phantom limb with the intact limb (and the related phenomena of perceiving referred sensations and mirrored movements in the phantom form the intact limb). The likely involvements of the body schema and the body-self neuromatrix, mirror neurons, and cross-callosal and ipsilateral mechanisms in phantom limb phenomena all suggest that the perception of a "normal" phantom limb (that is, a non-painful phantom that has the sensory qualities of an intact limb) is more than likely an epiphenomenon of normal functioning, action understanding and empathy, and potentially may even be evolutionarily adaptive and perhaps necessary. Phantom pain, however, may be a maladaptive failure of the neuromatrix to maintain global bodily constructs.

Computational models of dementia and neurological problems

A critical goal of neuroscience is to fully understand neural processes and their relations to mental processes, and cognitive, affective, and behavioral disorders. Computational modeling, although still in its infancy, continues to play a central role in this endeavor. Presented here is a review of different aspects of computational modeling that help to explain many features of neuropsychological syndromes and psychiatric disease. Recent advances in computational modeling of epilepsy, cortical reorganization after lesions, Parkinson's and Alzheimer diseases are also reviewed. Additionally, this chapter will also identify some trends in the computational modeling of brain functions.

Cortical correlates of TMS-induced phantom hand movements revealed with concurrent TMS-fMRI

We studied an amputee patient who experiences a conscious sense of movement (SoM) in her phantom hand, without significant activity in remaining muscles, when transcranial magnetic stimulation (TMS) is applied at appropriate intensity over the corresponding sector of contralateral motor cortex. We used the novel methodological combination of TMS during fMRI to reveal the neural correlates of her phantom SoM. A critical contrast concerned trials at intermediate TMS intensities: low enough not to produce overt activity in remaining muscles; but high enough to produce a phantom SoM on approximately half such trials. Comparing trials with versus without a phantom SoM reported phenomenally, for the same intermediate TMS intensities, factored out any non-specific TMS effects on brain activity to reveal neural correlates of the phantom SoM itself. Areas activated included primary motor cortex, dorsal premotor cortex, anterior intraparietal sulcus, and caudal supplementary motor area, regions that are also involved in some hand movement illusions and motor imagery in normals. This adds support to proposals that a conscious sense of movement for the hand can be conveyed by activity within corresponding motor-related cortical structures.

Bodily Illusions Modulate Tactile Perception

Touch differs from other exteroceptive senses in that the body itself forms part of the tactile percept. Interactions between proprioception and touch provide a powerful way to investigate the implicit body representation underlying touch. Here, we demonstrate that an intrinsic primary quality of a tactile object, for example its size, is directly affected by the perceived size of the body part touching it. We elicited proprioceptive illusions that the left index finger was either elongating or shrinking by vibrating the biceps or triceps tendon of the right arm while subjects grasped the tip of their left index finger. Subjects estimated the distance between two simultaneous tactile contacts on the left finger during tendon vibration. We found that tactile distances feel bigger when the touched body part feels elongated. Control tests showed that the modulation of touch was linked to the perceived index-finger size induced by tendon vibration. Vibrations that did not produce proprioceptive illusion had no effect on touch. Our results show that the perception of tactile objects is referenced to an implicit body representation and that proprioception contributes to this body representation. We also provide, for the first time, a quantitative, implicit measure of distortions of body size.

Fundamental Principles and Mechanisms of the Conscious Self

We start by assuming that the self is implemented in the brain as a functional unit, with a definite set of properties. We deduce the fundamental properties of the self from an analysis of neurological disorders and from introspection. We formulate a functionalist concept of the self based on these properties reduced to constraints. We use the formalism of schemas in our functionalist analysis, i.e. a symbolic level description of brain dynamics. We then reformulate the functionalist model at a connectionist level and address the emergent "context shifting" problem. We suggest how the model might be mapped onto the functional neuroanatomy of the brain, and how it could be used to give an account of a range of neurological disorders, including hippocampal amnesia, various forms of schizophrenia, multiple personality, autism, PTSD, hemineglect, and reversible anosognosia. Finally, we briefly discuss future perspectives and possible applications of computer implementations of the model.

Dominance of the right hemisphere and role of area 2 in human kinesthesia

We have previously shown that motor areas are engaged when subjects experience illusory limb movements elicited by tendon vibration. However, traditionally cytoarchitectonic area 2 is held responsible for kinesthesia. Here we use functional magnetic resonance imaging and cytoarchitectural mapping to examine whether area 2 is engaged in kinesthesia, whether it is engaged bilaterally because area 2 in non-human primates has strong callosal connections, which other areas are active members of the network for kinesthesia, and if there is a dominance for the right hemisphere in kinesthesia as has been suggested. Ten right-handed blindfolded healthy subjects participated. The tendon of the extensor carpi ulnaris muscles of the right or left hand was vibrated at 80 Hz, which elicited illusory palmar flexion in an immobile hand (illusion). As control we applied identical stimuli to the skin over the processus styloideus ulnae, which did not elicit any illusions (vibration). We found robust activations in cortical motor areas [areas 4a, 4p, 6; dorsal premotor cortex (PMD) and bilateral supplementary motor area (SMA)] and ipsilateral cerebellum during kinesthetic illusions (illusion-vibration). The illusions also activated contralateral area 2 and right area 2 was active in common irrespective of illusions of right or left hand. Right areas 44, 45, anterior part of intraparietal region (IP1) and caudo-lateral part of parietal opercular region (OP1), cortex rostral to PMD, anterior insula and superior temporal gyrus were also activated in common during illusions of right or left hand. These right-sided areas were significantly more activated than the corresponding areas in the left hemisphere. The present data, together with our previous results, suggest that human kinesthesia is associated with a network of active brain areas that consists of motor areas, cerebellum, and the right fronto-parietal areas including high-order somatosensory areas. Furthermore, our results provide evidence for a right hemisphere dominance for perception of limb movement.

fMRI analysis with the general linear model: removal of latency-induced amplitude bias by incorporation of hemodynamic derivative terms

Functional magnetic resonance imaging (fMRI) data are often analyzed using the general linear model employing a hypothesized neural model convolved with a hemodynamic response function. Mismatches between this hemodynamic model and the data can be induced by spatially varying delays or slice-timing differences. It is common practice to desensitize the analysis to such delays by incorporation of the hemodynamic model plus its temporal derivative. The rationale often used is that additional variance will be captured and regressed out from the data. Though this is true, it ignores the potential for amplitude bias induced by small model mismatches due to, for example, variable hemodynamic delays and is not helpful for "random effects" analyses which typically do not account for the first level variance at all. Amplitude bias is due to the use of only the nonderivative portion of the model in the final test for significant amplitudes. We propose instead testing an amplitude value that is a function of both the nonderivative and the derivative terms of the model. Using simulations, we show that the proposed amplitude test does not suffer from delay-induced bias and that a model incorporating temporal derivatives is a more natural test for amplitude differences. The proposed test is applied in a random-effects analysis of 100 subjects. It reveals increased amplitudes in areas consistent with the task, with the largest increases in regions with greater hemodynamic delays.

Supernumerary phantom limbs associated with left hemispheric stroke: case report and review of the literature

OBJECTIVE AND IMPORTANCE

Supernumerary phantom limb (SPL) is extremely rare. Literature reports noted 17 cases that occurred after right cerebral hemispheric stroke and 2 cases that occurred after left cerebral hemispheric stroke, but without imaging diagnoses.

CLINICAL PRESENTATION

A 45-year-old male patient complained of SPLs on the right side after recurrent left thalamic hemorrhage. Computed tomography and magnetic resonance imaging demonstrated the lesion causing the left hemispheric stroke.

INTERVENTION

The patient was treated conservatively. Computed tomographic scans demonstrated that the lesion had disappeared by 15 days after admission. The sensation of SPLs disappeared after 28 days.

CONCLUSION

SPL may occur among patients with left hemispheric stroke, especially those with lesions in the thalamus, spastic paresis on the right side immediately after stroke, and psychiatric disorders such as alcohol and tobacco intoxication.

Supernumerary phantoms: a comment on Grossi, et al.'s (2002) spare thoughts on spare limbs

A recently published case report of a supernumerary phantom limb in a man with left-sided hemiplegia did not take note that this phenomenon has been extensively documented in the neurological literature for well over 100 years. The present comment provides a brief introduction to the clinical and experimental approaches to supernumerary phantom limbs. It also emphasizes the theoretical importance of this condition for understanding the neurological mechanisms subserving the experience of having a body.