Increased motor control of a phantom leg in humans results from the visual feedback of a virtual leg

Brodie, Eric E.; Whyte, Anne; Waller, Bridget M.

doi:10.1016/s0304-3940(03)00160-5

Cited by 73 publications

(56 citation statements)

References 11 publications

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“…Two randomized controlled studies have shown that such approaches lead to significantly greater improvement in pain and in the ability to move the phantom limb than repeated attempts to move the limb without visual feedback or mental visualization of movements of the limb. 81,82 Pain reduction was also found in patients with amputation or brachial plexus avulsion using visuo-motor training in which a virtual image of a missing or paralyzed limb performing different movements was presented while the patient was asked to follow the movements with his or her phantom limb. 49,83 Interestingly, in one of these studies, an fMRI examination performed before and after the intervention showed that the amount of activity in the primary motor cortex during attempts to move the phantom hand increased after treatment in the two patients who experienced pain relief, while no change occurred in the patient who did not experience a decrease in pain.…”

Section: Can Motor Training Results In Both Motor-cortex Reorganizatiomentioning

confidence: 99%

Interactions between Pain and the Motor Cortex: Insights from Research on Phantom Limb Pain and Complex Regional Pain Syndrome

Mercier

Léonard²

2011

Physiotherapy Canada

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Purpose: Pain is a significantly disabling problem that often interacts with other deficits during the rehabilitation process. The aim of this paper is to review evidence of interactions between pain and the motor cortex in order to attempt to answer the following questions: (1) Does acute pain interfere with motorcortex activity? (2) Does chronic pain interfere with motor-cortex activity, and, conversely, does motor-cortex plasticity contribute to chronic pain? (3) Can the induction of motor plasticity by means of motor-cortex stimulation decrease pain? (4) Can motor training result in both motor-cortex reorganization and pain relief? Summary of Key Points: Acute experimental pain has been clearly shown to exert an inhibitory influence over the motor cortex, which can interfere with motor learning capacities. Current evidence also suggests a relationship between chronic pain and motor-cortex reorganization, but it is still unclear whether one causes the other. However, there is growing evidence that interventions aimed at normalizing motor-cortex organization can lead to pain relief. Conclusions: Interactions between pain and the motor cortex are complex, and more studies are needed to understand these interactions in our patients, as well as to develop optimal rehabilitative strategies.Key Words: motor control, motor cortex, pain, plasticity, rehabilitation RÉ SUMÉObjectif : La douleur est considé rablement invalidante et pré sente souvent des interactions avec d'autres dé ficits au cours du processus de ré adaptation. L'objectif de cet article est d'analyser donné e supportant la pré sence d'interactions entre la douleur et le cortex moteur afin de tenter de ré pondre aux questions suivantes : (1) La douleur aiguë nuit-elle à l'activité du cortex moteur? (2) La douleur chronique altè re-t-elle l'activité du cortex moteur et, ré ciproquement, la ré organisation du cortex moteur contribue-t-elle à la douleur chronique? (3) L'induction de la plasticité motrice par stimulation du cortex moteur peut-elle ré duire la douleur? (4) L'entraînement moteur peut-il amener à la fois une ré organisation du cortex moteur et un soulagement de la douleur? Ré sumé des principaux points : Il a é té clairement dé montré que la douleur aiguë expé rimentale exerce une influence inhibitoire sur le cortex moteur, qui peut entraver les capacité s d'apprentissage moteur. Les donné e actuelles suggè rent é galement qu'il existe une relation entre la douleur chronique et la ré organisation du cortex moteur, mais il n'est pas clair que l'un provoque l'autre. Il existe toutefois des preuves de plus en plus nombreuses que les interventions visant à normaliser l'organisation du cortex peuvent amener un soulagement de la douleur. Conclusions : Les interactions entre la douleur et le cortex moteur sont complexes et d'autres é tudes sont né cessaires pour comprendre ces interactions chez nos patients et pour concevoir des straté gies de ré adaptation optimales.

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Section: Can Motor Training Results In Both Motor-cortex Reorganizatiomentioning

confidence: 99%

Interactions between Pain and the Motor Cortex: Insights from Research on Phantom Limb Pain and Complex Regional Pain Syndrome

Mercier

Léonard²

2011

Physiotherapy Canada

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“…PLM and subsequent PLP alleviation was experienced by patients with vivid as well as sparse MV abilities (Brodie et al, 2003). And after a single treatment of MV the control group of Brodie et al (2007) had significant PLP alleviation.…”

Section: Discussionmentioning

confidence: 97%

Mirror therapy for the alleviation of phantom limb pain following amputation: A literature review

Timms

Carus

2015

International Journal of Therapy and Rehabilitation

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Introduction: Phantom Limb pain (PLP) affects up to 85% of all patients following an amputation, causing debilitating effects on their quality of life. Mirror Therapy (MT) has been reported to have potential success for the alleviation of PLP. Current understanding of PLP and the efficacy of MT for its alleviation are still unclear, therefore guidelines for treatment protocols are lacking. This literature review assesses the current best evidence for using MT to alleviate PLP of patients with amputation. Method:The authors systematically searched the academic databases Medline, Amed, CINAHL and Google Scholar, using key search terms with inclusion and exclusion criteria to identify relevant articles on the use of MT in populations of patients suffering PLP after unilateral limb amputation.Findings: Seven primary papers were identified and appraised. All the articles reported significant PLP alleviation after using MT with a trend for achieving phantom limb movement (PLM) prior to pain relief. Conclusions:Mirror Therapy is a promising intervention for PLP. Regular MT sessions are required to maintain treatment effect. Causes of PLP and pathways to its alleviation may be multifactorial; therefore further well-conducted RCTs are required to identify best practice.

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“…It needs to be explored whether or not these procedures are practical in a clinical setting. 13,14 However, the general principle has been established that input from an intact sensory system can be used to access and recruit dormant neural circuits in other brain regions, and has led to a whole new approach to neurorehabilitation.…”

Section: Mirror Visual Feedback (Mvf)mentioning

confidence: 99%

Plasticity and functional recovery in neurology

Ramachandran¹

2005

Clinical Medicine

109

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-Experiments on patients with phantom limbs suggest that neural connections in the adult human brain are much more malleable than previously assumed. Three weeks after amputation of an arm, sensations from the ipsilateral face are referred to the phantom; this effect is caused by the sensory input from the face skin 'invading' and activating deafferented hand zones in the cortex and thalamus. Many phantom arms are 'paralysed' in a painful position. If a mirror is propped vertically in the sagittal plane and the patient looks at the reflection of his/her normal hand, this reflection appears superimposed on the 'felt' position of the phantom. Remarkably, if the real arm is moved, the phantom is felt to move as well and this sometimes relieves the painful cramps in the phantom. Mirror visual feedback (MVF) has shown promising results with chronic regional pain syndrome and hemiparesis following stroke. These results suggest two reasons for a paradigm shift in neurorehabilitation. First, there appears to be tremendous latent plasticity even in the adult brain. Second, the brain should be thought of, not as a hierarchy of organised autonomous modules, each of which delivers its output to the next level, but as a set of complex interacting networks that are in a state of dynamic equilibrium with the brain's environment. Both principles can be potentially exploited in a clinical context to facilitate recovery of function.

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Increased motor control of a phantom leg in humans results from the visual feedback of a virtual leg

Cited by 73 publications

References 11 publications

Interactions between Pain and the Motor Cortex: Insights from Research on Phantom Limb Pain and Complex Regional Pain Syndrome

Interactions between Pain and the Motor Cortex: Insights from Research on Phantom Limb Pain and Complex Regional Pain Syndrome

Mirror therapy for the alleviation of phantom limb pain following amputation: A literature review

Plasticity and functional recovery in neurology

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