Intentional motor phantom limb syndrome

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.

Intentional Supernumerary Motor Phantom Limb after Right Cerebral Stroke: A Case Report

A 47-year-old right-handed man was admitted to our hospital for rehabilitation after right basal ganglion hematoma. On day 57, he noticed a supernumerary motor phantom limb (SPL) involving his right arm, originating at the level of the elbow. The most notable finding of his SPL was the motor characteristic. When the subject had the intention to move the upper paralyzed limb simultaneously with the trainer's facilitating action, he said "there is another arm." The intention to move the paralyzed arm alone or passive movement of the paralyzed arm did not induce the SPL. He showed a severe left sensorimotor impairment and mild hemineglect, but no neglect syndromes of the body (e.g., asomatognosia, somatoparaphrenia, personification and misoplegia, or anosognosia) were observed. Brain MRI demonstrated a hematoma in the right temporal lobe subcortex, subfrontal cortex, putamen, internal capsule, and thalamus. Single-photon emission computed tomography images showed more widespread hypoperfusion in the right hemisphere in comparison to the lesions on MRI. However, the premotor cortex was preserved. Our case is different from Staub's case in that SPL was not induced by the intention to move the paralyzed limb alone; rather, it was induced when the patient intended to move the paralyzed limb with a trainer's simultaneous facilitating action. The SPL may reflect that an abnormal closed-loop function of the thalamocortical system underlies the phantom phenomenon. However, despite the severe motor and sensory impairment, the afferent pathway from the periphery to the premotor cortex may have been partially preserved, and this may have been related to the induction of SPL.

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.

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.

Post-traumatic Visualized Supernumerary Phantom Limbs: A Case Presentation

The experience of supernumerary phantom limbs (SPLs) is a rare phenomenon known to occur following a variety of neurological ailments. This case report details visualized supernumerary phantom arms and legs in a polytrauma patient with suspicion of seizure as the primary contributing factor. Fewer than 30 cases of SPLs have been previously described. SPLs are usually confined to the phantom proprioception/sensation of the limb, with only 6 prior cases reporting visualized SPLs, all of which occurred in the setting of isolated stroke. This case presentation is notable because it is the first to describe visualized SPLs in a polytrauma patient.

LEVEL OF EVIDENCE

V.

Supernumerary phantom limbs in ICU patients with acute inflammatory demyelinating polyneuropathy

OBJECTIVE

To explore the previously undescribed phenomenon of phantom limb generation in patients with severe acute inflammatory demyelinating polyradiculoneuropathy (AIDP).

METHODS

Between April 2011 and January 2014, we encountered 3 patients with AIDP in our intensive care unit who experienced features of self-limited supernumerary phantom limbs (SPLs) during their course.

RESULTS

The following case series describes the phenomenon of SPLs in AIDP.

CONCLUSIONS

This report aims to raise awareness of the possibility of SPLs in the course of AIDP. The pathophysiology and management strategies for this clinical phenomenon are unknown.

Phantoms in artists: the lost limbs of Blaise Cendrars,Arthur Rimbaud, and Paul Wittgenstein

There have been an increasing number of reports of postamputation pain and problems linked to phantom limbs over recent years, particularly in relation to war-related amputations. These problems, which are often poorly understood and considered rather mysterious, are still relevant because they are difficult to treat medically. Functional neuroimaging techniques now enable us to better understand their pathophysiology and to consider new rehabilitation techniques. Phantom limbs have often been a source of inspiration to writers, particularly in the period following the First World War, which was responsible for thousands of amputees. Some artists have suffered from postamputation complications themselves and have expressed them through their artistic works. Blaise Cendrars (1887-1961), one of the greatest authors of the twentieth century, suffered from stump pain and phantom limb phenomena for almost half a century following the amputation of his right arm during the First World War. He suffered from these phenomena until the end of his life and his literary work and personal correspondence are peppered with references to them. Arthur Rimbaud (1854-1891), one of the most famous poets in world literature, developed severe stump pain after his right leg was amputated due to a tumor. He survived for only six months after the procedure but left behind an account of the pain he experienced in correspondence to his family. The famous pianist Paul Wittgenstein (1887-1961), whose right arm was amputated during the First World War, became a famous left-handed concert pianist. The phantom movements of his right hand helped him to develop the dexterity of his left hand. The impact on the artistic life of these three men provides an original illustration of the various postamputation complications, specifically phantom limbs, stump pain, and moving phantom.

The phantom and the supernumerary phantom limb: historical review and new case

The way we experience the world is determined by the way our brain works. The phantom limb phenomenon, which is a delusional belief of the presence of a non-existent limb, has a particular fascination in neurology. This positive phenomenon of the phantom limb raises theoretical questions about its nature. After a stroke, some patients experience the perception of an extra limb in addition to the regular set of two arms and two legs. This complex cognitive and perceptual distortion is called supernumerary phantom limb. Here, we review the pathogenesis and historical aspects, and report a new case.

Supernumerary phantom limb as a rare symptom of epileptic seizures--case report and literature review

Supernumerary phantom limbs, that is, the awareness of an illusory extra limb is a fascinating neurologic symptom that has been described in a number of neurologic diseases including stroke, spinal injury, and epilepsy. Herein we report a case of a 70-year-old male patient with new-onset focal seizures with left-sided supernumerary phantom arm and leg as the only seizure manifestation. Ictal single-photon emission computed tomography (SPECT) revealed a hyperperfusion in the right temporoparietal junction and allowed localization of the seizure-onset zone. This report is accompanied by a discussion of phenomenology and terminology in the context of existing literature.

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.

Abnormal functioning of the thalamocortical system underlies the conscious awareness of the phantom limb phenomenon

Phantom limb (PL), a phenomenon experienced by most patients after amputation, has mostly served as a paradigm to study experiences that appear to be associated with neural plasticity within the CNS. However, the subjective nature of PL experiences has had no definitive means of reliable assessment other than using patients' direct reports, nor was there a way to study the neural mechanisms involved in the conscious awareness of this mental phenomenon. Here we obtained patients' indirect responses to PL experiences for an objective evaluation using functional magnetic resonance imaging (fMRI). Six control subjects and six lower limb (LL) amputees participated in a motor imagery task for both the intact and the particular phantom toes. While all subjects shared neural processing of distinctive regional cerebral activations during motor imagery of the intact toes (prefrontal (PF), supplementary motor area (SMA), primary motor cortex (M1), superior temporal gyrus (STG)), it was only during motor imagery of the amputated toes in amputees that we observed an increased blood oxygen level-dependent (BOLD) signal in the contralateral basal ganglia at the medial globus pallidus (MGP), substantia nigra (SN), and thalamus. This increased BOLD signal in the basal ganglia-thalamus-cortex pathway during imaginary movement of the phantom toes may reflect an abnormal open loop functioning of the thalamocortical system underlying the conscious awareness of the phantom phenomenon. We suggest that the reduction in afferent information contributes to and coalesces with the higher-level reorganization resulting in the subjective conscious awareness of the phantom 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.

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.

Dr. William Thornton's views on sleep, dreams, and resuscitation

William Thornton, MD, was a polymath who designed the Capitol of the U.S. Capital and the Octagon House, present home of the American Institute of Architecture. He was the founding director of the U.S. Patent Office. His collected papers, which are now preserved at the U.S. Library of Congress, though pruned by the wife who lived almost 40 years after him, are extensive and include comments on science, education, slavery, and politics. His views on sleep and dreaming and his concepts of resuscitation are reviewed as the opinions of an educated man early in the nineteenth century.