The therapy of phantom limbs and mirror boxes

the Phantom member, A term introduced by Silas Weir Mitchell in 1872, refers to a syndrome suffered by some people who have lost an arm, leg or organ and who continue to feel the sensations of amputated limbs.

Patients who suffer from this syndrome have the impression of gesturing, itching or severe pain.

The brain and the body

According to the neurologist at the Brain and Cognition Center at the University of California at San Diego, Vilayanur S. RamachandranAlmost 70% of amputees continue to experience intermittent pain in the lost limb even decades after being amputated, which has devastating consequences in the lives of patients who suffer from it.

Unfortunately, for many years, the treatment had been ineffective because its biological basis was not clear enough. Phantom limb sensations may appear immediately after limb amputation or late, but pain usually appears within the first week after amputation. It usually progresses with a reduction in both frequency and pain attacks, but sometimes the pain can persist for years. In addition, it should be noted that phantom limb syndrome can cause psychological disorders such as depression, anxiety or stress in those who suffer from it.

What Causes Phantom Limb Syndrome?

There are several theories that attempt to explain the cause of the phantom limb. Not so long ago, a simple and unambiguous relationship between injury and pain was proposed, but recent thinking has placed the genesis of the phantom limb in the brain where the cognitive and affective spheres are involved.

Surveys Ronald melzack gave rise to the neuromatric theory, Which attributes the spread of pain and its transmission through the body due to a complex system involving several areas of the central and peripheral nervous system, autonomic nervous system and endocrine system, directly influenced by various psychological, emotional factors, genetic and social. This theory explains that we can feel pain sensations in the body caused from inside us, that is to say from our own body, and through this system we can increase, change or increase ourselves. decrease these sensations in a determined moment. If this matrix is ​​activated in the absence of peripheral sensory information (amputated limb), it would produce the sensation of having a limb present after the loss.

Another line of research is that of the scientist Ramachandran, That in his book “Brain ghosts“, Gives a surprising explanation. A patient with a phantom limb complained of itching in his lost hand. Dr Ramachandran, with a cotton swab in his ears, scratched the patient’s face relieving the itch in his hand . Is that the explanation? ” The explanation can be found in the Penfield homunculus. In the 1950s, Penfield and Rasmussen demonstrated the existence of a cortical map of bodily representation under two aspects: motor and somatosensory.

Is the neurological map has specific characteristics: each part of the body is represented according to its sensorimotor importance (For example: the lips or the hands have more cortical representation than the trunk, so they are more sensitive), that is, one thing is the body and another is the representation of the body in the brain . If a person loses a leg, arm, or organ, their representation in Penfield’s homunculus stops receiving information from that effector, but that area of ​​the map can be overrun by the adjacent representation. In the case of the amputated hand, the adjacent representation is that of the face. In this way, the stimulation on the face can give a feeling of hand (phantom).

Mirror box therapy

It seems to demonstrate the plasticity of the brain, but what about phantom limb pain? Most patients, after an accident, end up with an unnecessary and painful arm. Pain usually persists after limb amputation. Ramachandran think that the basis of this phenomenon lies in the learned paralysisSince the phantom limb already has mobility, the brain remains fixed on the idea of ​​an arm without movement. To do this, the neurologist invented the mirror box.

The mirror box is a box with a mirror in the center, when the patient inserts the arm without amputation, he can see the reflection of his arm in the mirror. Seeing his arm, he feels that the limb is present despite the amputation. The patient then moves the arm, and through the use of the visual feedback and elimination of potentially painful positionsIt manages to give feedback to the brain and relieve the pain it feels. Sometimes even the phantom limb goes missing.

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