To test the hypothesis that cortical remapping supports phantom sensations, we examined referred phantom sensations and cortical activation in humans after spinal-cord injury (SCI) at the thoracic level (T3-T12). Of 12 SCI subjects, 9 reported phantom sensations, and 2 reported referred phantom sensations. In both of these subjects, referred phantom sensations were evoked by contact in reference zones (RZ) that were not adjacent in the periphery and were not predicted to be adjacent in the postcentral gyrus (PoCG), suggesting that representations separated by centimeters of cortical space were simultaneously engaged. This finding was supported by functional MRI (fMRI). In a subject with a T6-level complete SCI, contact in RZ on the left or right forearm projected referred phantom sensations to the ipsilateral chest. During fMRI, contact in either forearm RZ evoked activity in the central PoCG (the position of the forearm representation) and the medial PoCG (the position of the chest representation) with >1.6 cm of nonresponsive cortex intervening. In contrast, stimulation in non-RZ forearm and palm regions in this subject and in lesion-matched SCI subjects evoked central but not medial PoCG activation. Our findings support a relation between PoCG activation and the percept of referred phantom sensations. These results, however, present an alternative to somatotopic cortical reorganization, namely, cortical plasticity expressed in coactivation of nonadjacent representations. The observed pattern suggests that somatotopic subcortical remapping, projected to the cortex, can support perceptual and cortical reorganization after deafferentation in humans.A variety of types of deafferentation evoke reorganization of somatosensory maps within the central nervous system (CNS). Rapid reorganization, occurring within minutes after deafferentation, has been observed in the mammalian brainstem, thalamus, and cortex (1-3). This process likely depends on the disinhibition or facilitation of existing divergent subthreshold inputs and may be a general feature of neural coding (4, 5). Long-term deafferentation in monkeys, assessed months to years after sensory loss, induces more extensive remapping (6-10) and is associated with anatomic changes within the CNS. These changes include the sprouting of new connections into deafferented territory [spinal cord and dorsal column nuclei (11, 12); areas 3b and 1 (13)] and transneuronal atrophy in deafferented structures (14,15). The most extensive cortical reorganization, spanning over a centimeter within the cortex, has been observed after the combination of long-term recovery and CNS lesions (9,14,16). Typically, studies of deafferentation-driven plasticity in the cortex have emphasized the takeover of deafferented representations by the expansion of inputs from adjacent representations, a somatotopic pattern of reorganization (6-10).After deafferentation, patients often feel a vivid percept of the deafferented region, a phenomenon referred to as a phantom sensation (17,18). In a subset...