RESUMEN

OBJECTIVE: To evaluate the effectiveness of mirror therapy (MT) for phantom limb pain (PLP). DATA SOURCES: PubMed, EMBASE, Ovid MEDLINE, Scopus, Cochrane Library, Physiotherapy Evidence Database, CNKI, and WanFang Data were used to search for studies published up to March 31, 2021. STUDY SELECTION: Randomized controlled trials (RCTs) comparing the pain intensity of MT for PLP were performed. A total of 2094 articles were found. Among them, 10 were eligible for the final analysis. DATA EXTRACTION: The quality of the RCTs was assessed using the Physiotherapy Evidence Database (PEDro) scale by 2 independent reviewers. Outcome data were pooled according to follow-up intervals (1, 3, 6, and 12mo). Duration times were used as a basis for distinguishing subgroups. The primary evaluation was by visual analog scale. The PEDro scale was used to assess the methodological quality of studies. DATA SYNTHESIS: Meta-analysis revealed a statistically significant decrease in pain in the MT group vs the control group within 1 month (I2=0%; standardized mean difference [SMD]=-0.46, 95% confidence interval [CI], -0.79 to -0.13; P = .007). The patients with pain for longer than 1 year benefited more from MT (I2=0%; SMD=-0.46; 95% CI, -0.85 to -0.07; P = .02). CONCLUSIONS: MT has beneficial effects for patients with PLP in the short-term, as evidenced by their improved pain scores. There was no evidence that MT had a long-term effect, but that may be a product of limited data. For patients with long-term PLP, MT may be an effective treatment.

Asunto(s)

RESUMEN

Forward models allow individuals to learn to predict the sensory consequences of their own behavior. Social forward models have been proposed as an extension of forward models, allowing individuals to learn to predict the response of another to the individual's own behavior. This article proposes similarly that an individual who treats their reflection as another may learn to predict the behavior of their reflection, offering a new perspective on mirror self-recognition and a potential framework through which to investigate visual delusions. Specifically this article investigates this framework by considering four body image delusions; mirrored-self misidentification, body integrity disorder (BID), phantom limbs, and gender dysphoria, and two delusions associated with visual neglect; somatoparaphrenia and mirror agnosia.

Asunto(s)

RESUMEN

Os distúrbios da imagem do corpo, na forma conferida pelo fenômeno dos "membros fantasmas", tomaram grande parte dos estudos do neurologista indiano V. S. Ramachandran. Seu trabalho, por meio de testes psicofísicos e estudos de imagem funcional em pacientes com "membros fantasmas", demonstrou aquilo que ele denominou "plasticidade neural" ou "plasticidade cortical" em cérebros humanos adultos. Este artigo tem por objetivo analisar criticamente a construção da imagem do corpo, da interioridade e do self a partir das principais teses neurológicas de Ramachandran sobre o fenômeno dos "membros fantasmas". Defende-se a ideia de que, apesar de o autor apresentar novas modalidades de descrições subjetivas e narrativas da mente, a experiência subjetiva e a construção da imagem corporal também devem ser explicadas em termos da relação corpo-ambiente ou corpo-mundo, na qual se destaca o papel da linguagem e das narrativas de si.

The body image problems, as provided by "phantom limbs", took most studies of Indian neurologist V. S. Ramachandran. His work, through psychophysical tests and functional imaging studies in patients with "phantom limbs", demonstrated the "neural plasticity" or "cortical plasticity" in the adult human brain. This paper aims to examine the construction of body image, the inner life and the "self" from the Ramachandran neurological approaches on the phenomenon of "phantom limbs." We supports the idea that although the author presents new subjective and narrative descriptions of mind, the subjective experience and the construction of body image should also be explained in terms of the body-environment or body-world relationship, in which the role language and self-narratives stand out.

Asunto(s)

RESUMEN

Most amputees experience phantom limbs, or the sensation that their amputated limb is still attached to the body. Phantom limbs can be perceived in the location previously occupied by the intact limb, or they can gradually retract inside the stump, a phenomenon referred to as "telescoping". Telescoping is relevant from a clinical point of view, as it tends to be related to increased levels of phantom pain. In the current study we demonstrate how a full-body illusion can be used to temporarily revoke telescoping sensations in upper limb amputees. During this illusion participants view the body of a mannequin from a first person perspective while being subjected to synchronized visuo-tactile stimulation through stroking, which makes them experience the mannequin's body as their own. In Experiment 1 we used an intact mannequin, and showed that amputees can experience ownership of an intact body as well as referral of touch from both hands of the mannequin. In Experiment 2 and 3 we used an amputated mannequin, and demonstrated that depending on the spatial location of the strokes applied to the mannequin, participants experienced their phantom hand to either remain telescoped, or to actually be located below the stump. The effects were supported by subjective data from questionnaires, as well as verbal reports of the perceived location of the phantom hand in a visual judgment task. These findings are of particular interest, as they show that the temporary revoking of telescoping sensations does not necessarily have to involve the visualization of an intact hand or illusory movement of the phantom (as in the rubber hand illusion or mirror visual feedback therapy), but that it can also be obtained through mere referral of touch from the stump to the spatial location corresponding to that previously occupied by the intact hand. Moreover, our study also provides preliminary evidence for the fact that these manipulations can have an effect on phantom pain sensations.

RESUMEN

Phantom limbs refer to the sensation that an amputated or missing limb is still attached to the body. Phantom limbs may be perceived as continuous with the stump so as to resemble a normal limb, or as "telescoped" with the more distal portion of the phantom being perceived as having withdrawn within the stump. Telescoping tends to be related to increased levels of phantom pain, making it a clinically relevant phenomenon to investigate. In the current study we show that a full-body illusion can be used to induce the sensation of a telescoped limb in healthy individuals. For the induction of the full-body illusion, participants saw the body of a mannequin from a first person perspective while being subjected to synchronized visuo-tactile stimulation through stroking. Crucially, the mannequin was missing its left hand so as to resemble an amputee. By manipulating the positioning of the strokes applied to the mannequin's stump with respect to the participants' hand we were able to evoke the sensation of the participants' hand being located either below the stump or, more crucially, "inside" the stump, i.e., telescoped. In three separate experiments these effects were supported by complementary subjective data from questionnaires, verbally reported perceived location of the hand, and manual pointing movements indicating hand position (proprioceptive drift). Taken together our results show that healthy individuals can experience the body of an upper limb amputee as their own, and that this can be associated with telescoping sensations. This is a theoretically important observation as it shows that ownership of an entire body can be evoked in the context of gross anatomical incongruence for a single limb, and that telescoping sensations occur as a consequence of the body representation system trying to reduce this incongruence. Furthermore, the present study might provide a new platform for future studies of the relationship between telescoping and phantom pain in amputees.