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Martin Diers, et al. 2010

Mirrored, imagined and executed movements differentially activated sensorimotor cortex in amputees with and without phantom limb pain. Martin Diers, et al. 2010. Phantom Limb Pain. Phantom Sensations Phantom Pain Can occur anywhere but most common in amputated limbs

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Martin Diers, et al. 2010

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  1. Mirrored, imagined and executed movements differentially activated sensorimotor cortex in amputees with and without phantom limb pain Martin Diers, et al. 2010

  2. Phantom Limb Pain • Phantom Sensations • Phantom Pain • Can occur anywhere but most common in amputated limbs • 50-85% of people with amputated limbs experience phantom limb pain

  3. Theories • CNS • Cortical Reorganization and Neuroplasticity • Body Schema • Neuromatrix Theory • …others… • PNS • Ex. neuromas

  4. Cortical Reorganization and Neuroplasticity Penfield sensory (left) and motor (right) homunculi (Penfield and Boldrey, 1937).

  5. Cortical Reorganization cont. • Used microelectrodes to prove cortical plasticity. • When 1 finger was amputated, the sensory input from adjacent digits took over • The amount of cortical reorganization has been found to be dependent upon the size of the deafferented region(s) Mr. and Mrs. Owl Monkey

  6. More Cortical Reorganization • When the ipsilateral face was touched, patient felt touch on face and hand.

  7. “If I’m in a buttload of pain, I need a buttload of pills.” Dr. Gregory House Head of Diagnostic Medicine Princeton-Plainsboro Teaching Hospital

  8. Treatment Options for PLP • Pharmaceuticals • Opioids • Anticonvulsants • Lidocaine/mexiletine • Clonidine • Ketamine • Amitriptyline • Nonsteroidals anti-inflammatory drugs • Calcitonin

  9. More Treatments TENS Deep brain and spinal cord stimulation Acupuncture Virtual reality Mirror visual feedback

  10. Video Clip House: Mirror therapy http://www.youtube.com/watch?v=Tl70d9MR_so

  11. What are Mirror Neurons? • 1990’s • Empathy neurons • Monkey see- monkey do. • Frontal and parietal lobes • Vision dominates touch and proprioception (Rock and Victor, 1964)

  12. Video Clip American’s Got Talent Magic Tricks http://www.youtube.com/watch?v=6Mpi-MFsq1s

  13. Hypothesis • Mirrored movements of the intact hand might provide input into the cortical representation zone that previously received input from the now amputated limb (i.e. cortical reorganization), • and, executed and imagined movements might have similar but less pronounced effects.

  14. Design Executed (with dominant or intact hand) Mirrored Imagined (non-dominant or amputated hand)

  15. fMRI • 1990’s • Measures hemodynamic response (changes in blood flow) • Blood flow and blood oxygenation in brain is related to neural activity. • Metabolism- neurons don’t store blood & oxygen • Disadvantages- Correlation does not imply causation

  16. Mirrored Activation of the sensorimotor cortex contralateral to the hand seen in the mirror in the nonPLP and the HC but not in the PLP.

  17. Executed Activation of the contralateral sensorimotor area in all three groups but ipsilateral cortex was only activated in the nonPLP and HC group.

  18. Imagined Imagined movement activated the supplementary motor are in all groups and the contralateral primary sensorimotor cortex in the nonPLP and HG but not in the PLP

  19. Results Imagined movement in all three groups showed activation in the supplementary motor cortex.

  20. * * *

  21. Conclusions Viewing one’s own hand in a mirror produces activity in sensory and motor cortices contralateral to the hand that is perceived. The larger the shift of neighboring activations into the cortical amputation area, the more pain was present.

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