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Phantom Limb and the Brain

Fatima Gutierrez
Edward Rodriguez

Santa Monica Community school

Abstract
Phantom limb is an effect in the brain that translates to the body after am amputation of a limb with interior or exterior, this phenomenon has been shown to present long term or temporary. When phantom limb occurs the part of the brain that play. Vital role is the parietal lobe and the central nervous system, sensory neurons sending messages to the central nervous system which gives sensations to the missing limb. There are three characteristics in phantom limb and there are currently three different types of treatments to reduce pain. Phantom limb is reaction to the rewiring of the brain due to an adulation of limb and reaction of the central nervous system. There are currently three types of treatment; immerse virtual reality, prosthetic usage and mirror box to help reduce or remove phantom limb.

Introduction

Phantom limb is a temporary or long term effect on the brain and body that occurs only post amputation of a limb for an intermittent period of time. Phantom brain can be categorized as a mental disorder, and is assumed to originate from the stem of the region of amputation. There are three types of characteristic in the phantom complex. The first is phantom limb pain (PLP) which emphasis on a painful sensation in the spatial area of the missing limb. Phantom limb sensation(PLS) which is anytype of sensation in relation to the absent limb without any pain. Lastly is the description known as stump pain where the amputees pain is focused on the stump, (Anaseth,2001). The central nervous system plays an important role in generating and maintaining sensations and pain.

Method In the article, "Phantom limb pain: a case of maladaptive CNS plasticity, written by Lone Nikolajsen and TroelsStaehelin Jensen reported on the pain amputees say to experience from having different body parts removed. Phantom pain is described as experiencing minimal painful shocks to as far as reoccurring excruciating shocks that do not stop from missing parts of the body. In this experiment, the experimenters wanted to examined whether to consider such pain referred as "phantom" as real agony or to consider it as a type of mental disorder. Also, they researched the role CNS plays when interferring with the pain amputees say to experience and whether it plays and whether it has an effect or not. As discussed in the article, peripheral and cortical changes are examined in order to explain how much effect the CNS has on amputee phantom pain. Researchers discussed how the CNS plays a vital role when concerning the limb pain from different body parts. After studying various experimental studies, it was seen how terminal swelling affects the axons which causes demonstrations of unusual movement to physical and chemical stimuli. Degeneration of central axons occur when a peripheral injury happens. Phantom pain tend to have a big effect when spinal cord nerves are injured resulting in nerve hyperexcitability. The researchers implied withon their findings a study done on a group of amputees on what treatment would be more beneficial to reduce phantom pain. According to the authors, they concluded how the phantom pain could be controlled or reduced through the use of GABA agonists or anticonclusive agents. It is seen as a virtual lesion in which can be aided to reduce cortical hyperexcitability thus minimizing phantom pain.As discussed in the article, peripheral and cortical changes are examined in order to explain how much effect the CNS has on amputee phantom pain. Researchers discussed how the CNS plays a vital role when concerning the limb pain from different body parts. After studying various experimental studies, it was seen how terminal swelling affects the axons which causes demonstrations of unusual movement to physical and chemical stimuli. Degeneration of central axons occur when a peripheral injury happens. Phantom pain tend to have a big effect when spinal cord nerves are injured resulting in nerve hyperexcitability. The researchers implied withon their findings a study done on a group of amputees on what treatment would be more beneficial to reduce phantom pain. According to the authors, they concluded how the phantom pain could be controlled or reduced through the use of GABA agonists or anticonclusive agents. It is seen as a virtual lesion in which can be aided to reduce cortical hyperexcitability thus minimzing phantom pain.
According to the University of Oxford they used MRI imaging to know more about the phantom limb pain on people who have been amputated and the changes that occur in the brain. They did a study on a compared MRI of 18 people with amputees, and 11 natural individuals that were born with one hand through a limb deficiency. There was also a control group of 22 with complete limbs. They asked the people with the amputated limb to move their fingers while in the MRI. By doing this the researchers were able to see how the missing hand is characterized in the brain. They found out that the brain maintained its image of the hand, even when the limb was not there. The rest who had kept the pain the longest had the strongest image of the missing limb. They also found out that the amount of gray matter in the phantom hand area was condensed in amputates compared to those with two hands. People with strong phantom limb pain maintained the local brain arrangement and function for the missing hand. There seems to be fewer connections between the missing limb part and the rest of the cortex that’s incorporate in movement.
Results
Today some treatments that are available to help reduce phantom limp pain (PLP) are such as mirror box, prosthetic usage, and immersive virtual reality. Mirror box is a developmental treatment to help with phantom limb pains and help amputee patients to see their reflection. Patients are able see the space in with their former limb and help induce vivid sensations and reduce phantom limb or help gain control over a paralyzed phantom lim (Murray, 2007). This treatment involves a lot of focus of the image of the reflection in order to help with the illusion that the limb is still inact, this visual therapy help alleviate pain.
Currently there are medical, non-medical, and surgical treatments for phantom limb pain.Medical treatment emphasis in most neuropathic pain conditions and generally for phantom limb pain (PLP), In the journal by Br J Anaesth in “ Phantom limb pain” he mentioned that tricyclic antidepressant ( TCA) proved to the an effective treatment for PLP one of the drugs as mentioned was doxipen when in a well- controlled trail, however Anaesth mentioned beta blockers, capsaicin, and various anesthetic block to be effective but not effective when it came to a well-controlled trial. If an amputee is not experiencing PLP and merely a sensation or stump pain under the other characteristics medication is not suggested and non- medical treatments are provided. During a surgical treatment many of the outcomes from this surgical treatments are unfavorable and not common other than the in the phantom limb characterized as stump pain. A second non-medical treatment for Phantom limb is a prosthetic limb which enables amputees to be able to do normal activities more efficiently, however in Craig D. Murray’s finding about the phantom experience using prosthetics, research showed that patients with PLP were less likely to use a prosthetic leg because of the pain and also showed that patients who don’t use prosthetics are likely to develop depression and everyday restrictions. The last non- medical treatment that is mentioned in Murray’s journal was immersive virtual reality which is a computer generated environments in order to facilitate immersion in order to help amputees see a representation of the patients limb from a sensor that are attached. A virtual representation is given by transposing and mimicking that opposite anatomical limb. During the immersive medical treatment patients are given task for example kicking a ball, or directing the virtual limb toward a target. This treatments help patients experience and decrease phantom pain, however some finding show that after using the immerse reality for a period of time (hours, months) PLP would come with a stronger pain sensation or sometimes more severe.
Conclusion
Based on our finding we saw that Phantom brain is a phenomenon that starts in the brain and goes down that travels down to the body, there are currently various types of classification for this complex and types of phantom limbs are characterized from the weight and mass of the limb and the type of sensation a patient is feeling.There are a variety of treatments but the most efficient that we found was mirror box treatment which is non-medical but has a higher success when it was in the lower amputees limb. What was interesting when researching phantom limb was thatin a group of 76 amputees, 96% reported to have phantom limb and more specifically 84% reported to have (PLP) which was conducted in a study by Halligan. This phenomenon is reported to be present for a short period of time and sometime long term, however many of the treatments resulted that patients with PLP to have returning pains from port medication or non-medical treatment.

References

Anaesth, B. (2001). Phantom limb pain.British Journal of Anesthesia, 87(1), 107 -116.
University of Oxford, Amputee phantom pain linked to brain retaining picture of missing limb. 6 March 2013. http://www.ox.ac.uk/media/news_releases_for_journalists/130306.html

Halligan, P. W. (2002). Phantom limbs: The body in mind. Cognitive Neuropsychiatry, 7(3),
251-269.Halligan, P. W. (2002). Phantom limbs: The body in mind. Cognitive Neuropsychiatry, 7(3), 251-269.Halligan, P. W. (2002). Phantom limbs: The body in mind. Cognitive Neuropsychiatry, 7(3), 251-269.Halligan, P. W. (2002). Phantom limbs: The body in mind. Cognitive Neuropsychiatry, 7(3), 251-269.

Murray C. The treatment of phantom limb pain using immersive virtual reality: Three case studies. Disability & Rehabilitation [serial online]. September 30, 2007;29(18):1465-1469. Available from: Psychology and Behavioral Sciences Collection, Ipswich, MA. Accessed August 7, 2014.Murray C. The treatment of phantom limb pain using immersive virtual reality: Three case studies. Disability & Rehabilitation [serial online]. September 30, 2007;29(18):1465-1469. Available from: Psychology and Behavioral Sciences Collection, Ipswich, MA. Accessed August 7, 2014.

Murray C. The treatment of phantom limb pain using immersive virtual reality: Three case studies. Disability& Rehabilitation [serial online]. September 30, 2007;29(18):1465-1469. Available from: Psychology and Behavioral Sciences Collection, Ipswich, MA. AccessedAugust 7, 2014.

Flor H. Phantom limb pain: a case of maladaptive CNS plasticity?. Nature Reviews Neuroscience
[serial online]. November 2006;7(11):873-881. Available from: Psychology and Behavioral Sciences Collection, Ipswich, MA. Accessed August 7, 2014

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