Embodying their own wheelchair modifies extrapersonal space perception in people with spinal cord injury

Pain and the perception of space in fibromyalgia

The Economy of action hypothesis postulates that bodily states rescale the perception of the individual's environment's spatial layout. The estimation of distances and slopes in navigation space (i.e. the space reachable by locomotion) is influenced by sensations relating to body condition and the metabolic cost of the actions. The results of the studies investigating the impact of pain on distance estimation remain inconclusive. 28 women suffering from chronic pain and fibromyalgia (FM), and 24 healthy women (HC) were assessed for musculoskeletal, neuropathic, and visceral pain by means of the Widespread Pain Index, the Symptom Severity Scale and an ad-hoc devised questionnaire for pain (the Verona Pain Questionnaire). In a VR-mediated task, they observed a 3D scenario and estimated the distance of a flag positioned at different distances (1, 2, 3, 4 or 5 m) on virtual ramps with either a 4% or 24% inclination in two different conditions: sitting and standing. Overestimation of distances in the steeper ramp condition was expected, if participants executed the task by internally simulating the movement. The results showed a dissociation between the effects of musculoskeletal and visceral-neuropathic pain on distance estimations. While, according to the Economy of Action hypothesis, the HCs estimated the distances as being farther away when the ramp was more inclined (i.e. with a 24% inclination), there was no effect related to the different ramp inclinations in the FM group. Furthermore, visceral and neuropathic pain were found to affect the performance of the FM group. These results suggest that chronic and widespread pain conditions, that typically characterize fibromyalgia, can affect space representations. In line with the Economy of Action hypothesis, bodily based estimation of distances is compromised in these patients.

Representations of the relative proportions of body part width

Despite our wealth of experience with our bodies, our perceptions of our body size are far from veridical. For example, when estimating the relative proportions of their body part lengths, using the hand as a metric, individuals tend to exhibit systematic distortions which vary across body parts. Whilst extensive research with healthy populations has focused on perceptions of body part length, less is known about perceptions of the width of individual body parts and the various components comprising these representations. Across four experiments, representations of the relative proportions of body part width were investigated for both the self and other, and when using both the hand, or a hand-sized stick as the metric. Overall, we found distortions in the perceived width of body parts; however, different patterns of distortions were observed across all experiments. Moreover, the variability across experiments appears not to be moderated by the type of metric used or individuals' posture at the time of estimation. Consequently, findings suggest that, unlike perceptions of body part length, assessed using an identical methodology, our representations of the width of the body parts measured in this task are not fixed and vary across individuals and context. We propose that, as stored width representations of these parts are not necessarily required for navigating our environments, these may not be maintained by our perceptual systems, and thus variable task performance reflects the engagement of idiosyncratic guessing strategies.

The influence of threat on visuospatial perception, affordances, and protective behaviour: A systematic review and meta-analysis

Perception has been conceptualised as an active and adaptive process, based upon incoming sensory inputs, which are modified by top-down factors such as cognitions. Visuospatial perception is thought to be scaled based on threat, with highly threatening objects or contexts visually inflated to promote escape or avoidance behaviours. This meta-analytical systematic review quantified the effect and evidence quality of threat-evoked visuospatial scaling, as well as how visuospatial scaling relates to affordances (perceived action capabilities) and behavioural avoidance/escape outcomes. Databases and grey literature were systematically searched inclusive to 10/04/24. Studies were assessed with a customised Risk of Bias form and meta-analysis was performed using a random-effects model. 12,354 records were identified. Of these, 49 experiments (n = 3027) were included in the review. There was consistent evidence that threat the of height influenced contextual perception (g = 0.66, 95% CI: 0.45, 0.88) and affordances (g = -0.43, 95% CI: -0.84, -0.03). Threatening objects were viewed as larger (g = 0.76, 95% CI: 0.26, 1.26) and as closer (g = 0.30, 95% CI: 0.17, 0.42). Bodily threat (pain) yielded conflicting effects on visuospatial perception/affordances. We conclude that threat may influence visuospatial perception and affordances. However, since behavioural measures were poorly reported, their relationship with visuospatial perception/affordances remains elusive.

Multisensory conflict affects body schema and reaching space

Multisensory integration plays a crucial role in building the sense of body ownership, i.e., the perceptual status of one's body for which the body is perceived as belonging to oneself. Temporal and spatial mismatching of visual and tactile signals coming from one's body can reduce ownership feelings towards the body and its parts, i.e., produce disownership feelings. Here, we investigated whether visuo-tactile conflict also affects the sensorimotor representation of the body in space (i.e., body schema) and the perception of the space around the body in terms of action potentiality (i.e., reaching space). In two experiments, body schema (Experiment 1) and reaching space (Experiment 2) were assessed before and after either synchronous or asynchronous visuo-tactile stimulation. Results showed that the asynchronous condition, provoking multisensory conflict, caused disownership over one's hand and concurrently affected the body schema and the reaching space. These findings indicate that body schema and reaching space could be dynamically shaped by the multisensory regularities that build up the sense of body ownership.

Massive body-brain disconnection consequent to spinal cord injuries drives profound changes in higher-order cognitive and emotional functions: A PRISMA scoping review

Spinal cord injury (SCI) leads to a massive disconnection between the brain and the body parts below the lesion level representing a unique opportunity to explore how the body influences a person's mental life. We performed a systematic scoping review of 59 studies on higher-order cognitive and emotional changes after SCI. The results suggest that fluid abilities (e.g. attention, executive functions) and emotional regulation (e.g. emotional reactivity and discrimination) are impaired in people with SCI, with progressive deterioration over time. Although not systematically explored, the factors that are directly (e.g. the severity and level of the lesion) and indirectly associated (e.g. blood pressure, sleeping disorders, medication) with the damage may play a role in these deficits. The inconsistency which was found in the results may derive from the various methods used and the heterogeneity of samples (i.e. the lesion completeness, the time interval since lesion onset). Future studies which are specifically controlled for methods, clinical and socio-cultural dimensions are needed to better understand the role of the body in cognition.

Event-related potentials during mental rotation of body-related stimuli in spinal cord injury population

Mental rotations of body-related stimuli are known to engage the motor system and activate body schema. Sensorimotor deficits following spinal cord injury (SCI) alter the representation of the body with a negative impact on the performance during motor-related tasks, such as mental rotation of body parts. Here we investigated the relationship between event-related potentials in SCI participants and the difficulty in mentally rotating a body-part. Participants with SCI and healthy control subjects performed a laterality judgment task, in which left or right images of hands, feet or animals (as a control stimulus) were presented in two different orientation angles (75° and 150°), and participants reported the laterality of the stimulus. We found that reaction times of participants with SCI were slower for the rotation of body-related stimuli compared to non-body-related stimuli and healthy controls. At the brain level, we found that relative to healthy controls SCI participants show: 1) reduced amplitudes of the posterior P100 and anterior N100 and larger amplitudes of the anterior P200 for overall stimuli; 2) an absence of the modulation of the rotation related negativity by stimulus type and rotation angles. Our results show that body representation changes after SCI affecting both components of early stimulus processing and late components that process high-order cognitive aspects of body-representation and task complexity.

Embodiment for Robotic Lower-Limb Exoskeletons: A Narrative Review

Research on embodiment of objects external to the human body has revealed important information about how the human nervous system interacts with robotic lower limb exoskeletons. Typical robotic exoskeleton control approaches view the controllers as an external agent intending to move in coordination with the human. However, principles of embodiment suggest that the exoskeleton controller should ideally coordinate with the human such that the nervous system can adequately model the input-output dynamics of the exoskeleton controller. Measuring embodiment of exoskeletons should be a necessary step in the exoskeleton development and prototyping process. Researchers need to establish high fidelity quantitative measures of embodiment, rather than relying on current qualitative survey measures. Mobile brain imaging techniques, such as high-density electroencephalography, is likely to provide a deeper understanding of embodiment during human-machine interactions and advance exoskeleton research and development. In this review we show why future exoskeleton research should include quantitative measures of embodiment as a metric of success.

What the study of spinal cord injured patients can tell us about the significance of the body in cognition

Although in the last three decades philosophers, psychologists and neuroscientists have produced numerous studies on human cognition, the debate concerning its nature is still heated and current views on the subject are somewhat antithetical. On the one hand, there are those who adhere to a view implying 'disembodiment' which suggests that cognition is based entirely on symbolic processes. On the other hand, a family of theories referred to as the Embodied Cognition Theories (ECT) postulate that creating and maintaining cognition is linked with varying degrees of inherence to somatosensory and motor representations. Spinal cord injury induces a massive body-brain disconnection with the loss of sensory and motor bodily functions below the lesion level but without directly affecting the brain. Thus, SCI may represent an optimal model for testing the role of the body in cognition. In this review, we describe post-lesional cognitive modifications in relation to body, space and action representations and various instances of ECT. We discuss the interaction between body-grounded and symbolic processes in adulthood with relevant modifications after body-brain disconnection.

Does who I am and what I feel determine what I see (or say)? A meta-analytic systematic review exploring the influence of real and perceived bodily state on spatial perception of the external environment

Background

Bodily state is theorised to play a role in perceptual scaling of the environment, whereby low bodily capacity shifts visuospatial perception, with distances appearing farther and hills steeper, and the opposite seen for high bodily capacity. This may play a protective role, where perceptual scaling discourages engaging with the environment when capacity is low.

Methodology

Our protocol was pre-registered via Open Science Framework (https://osf.io/6zya5/) with all amendments to the protocol tracked. We performed a systematic review and meta-analysis examining the role of bodily state/capacity on spatial perception measures of the environment. Databases (Medline, PsychINFO, Scopus, Embase, and Emcare) and grey literature were searched systematically, inclusive to 26/8/21. All studies were assessed using a customised Risk of Bias form. Standard mean differences and 95% CIs were calculated via meta-analysis using a random-effects model.

Results

A total of 8,034 studies were identified from the systematic search. Of these, 68 experiments (3,195 participants) met eligibility and were included in the review. These were grouped into the following categories: fatigue; pain; age; embodiment; body size/body paty size; glucose levels; fitness; and interoception, and interoceptive accuracy. We found low level evidence (limited studies, high risk of bias) for the effect of bodily state on spatial perception. There was consistent evidence that both glucose manipulations and age influence spatial perception of distances and hills in a hypothesised direction (lower capacity associated with increased distance and hill steepness). Mixed evidence exists for the influence of external loads, embodiment, body/body-part size manipulations, pain, and interoceptive accuracy. Evidence for fitness and/or fatigue influencing spatial perception was conflicting; notably, methodological flaws with fitness and fatigue paradigms and heterogenous spatial perception measures may underlie null/conflicting results.

Conclusion

We found limited evidence for bodily state influencing spatial perception of the environment. That all studies had high risk of bias makes conclusions about reported effects reflecting actual perceptual shifts (vs merely reflecting experimental demands or error due to inadequate study design) pre-emptive. Rigorous evaluation is needed to determine whether reported effects reflect more than bias (e.g., experimental demands, inadequate blinding). Future work using reliable measures of spatial perception, comprehensive evaluation of relevant confounders, and methodologically robust (and experimentally confirmed) bodily state experimental paradigms is warranted.

Development of the "Kalmer" relaxation intervention: co-design with stroke survivors with aphasia

PURPOSE

Anxiety is common after stroke and more prevalent in survivors with aphasia. Relaxation is an effective first-line therapy. The current study aimed to obtain the perspectives of stroke survivors with aphasia to inform the development of an accessible, technology-based, relaxation intervention.

MATERIALS AND METHODS

Qualitative co-design methods were used with twelve people with aphasia after stroke. The "Kalmer" Relaxation treatment package materials were iteratively based on participants' experiences and preferences; barriers and facilitators to treatment compliance were explored. Participants were also asked to consider how the intervention might be evaluated in a research trial.

RESULTS

A thematic analysis highlighted the importance and need for the development of an appropriate and inclusive relaxation product, to be implemented by health professionals early post-stroke. Several behavioural strategies to improve treatment adherence were recommended. Participants had varying perspectives on clinically meaningful treatment outcomes.

CONCLUSIONS

Overall, a co-designed accessible relaxation product was viewed as a necessary component of usual stroke care. Acceptability and feasibility and preliminary efficacy of the "Kalmer" intervention should be trialled in future studies. IMPLICATIONS FOR REHABILITATIONCo-designing psychological interventions for people with aphasia after stroke is needed to meet the needs of this at-risk population.Technology-based relaxation interventions to manage anxiety after stroke are viewed positively by people with aphasia and deemed acceptable and feasible.Clinical trials of these co-designed relaxation interventions are required before recommending integration into routine practice.

Are tools truly incorporated as an extension of the body representation?: Assessing the evidence for tool embodiment

The predominant view on human tool-use suggests that an action-oriented body representation, the body schema, is altered to fit the tool being wielded, a phenomenon termed tool embodiment. While observations of perceptual change after tool-use purport to support this hypothesis, several issues undermine their validity in this context, discussed at length in this critical review. The primary measures used as indicators of tool embodiment each face unique challenges to their construct validity. Further, the perceptual changes taken as indicating extension of the body representation only appear to account for a fraction of the tool's size in any given experiment, and do not demonstrate the covariance with tool length that the embodiment hypothesis would predict. The expression of tool embodiment also appears limited to a narrow range of tool-use tasks, as deviations from a simple reaching paradigm can mollify or eliminate embodiment effects altogether. The shortcomings identified here generate important avenues for future research. Until the source of the kinematic and perceptual effects that have substantiated tool embodiment is disambiguated, the hypothesis that the body representation changes to fit tools during tool-use should not be favored over other possibilities such as the formation of separable internal tool models, which seem to offer a more complete account of human tool-use behaviors. Indeed, studies of motor learning have observed analogous perceptual changes as aftereffects to adaptation despite the absence of handheld tool-use, offering a compelling alternative explanation, though more work is needed to confirm this possibility.

Peripersonal Space from a multisensory perspective: the distinct effect of the visual and tactile components of Visuo-Tactile stimuli

Peripersonal Space (PPS) is defined as the space close to the body where all interactions between the individual and the environment take place. Behavioural experiments on PPS exploit multisensory integration, using Multisensory Visuo-Tactile stimuli (MVT), whose visual and tactile components target the same body part (i.e. the face, the hand, the foot). However, the effects of visual and tactile stimuli targeting different body parts on PPS representation are unknown, and the relationship with the RTs for Tactile-Only stimuli is unclear. In this study, we addressed two research questions: (1) if the MVT-RTs are independent of Tactile-Only-RTs and if the latter is influenced by time-dependency effects, and (2) if PPS estimations derived from MVT-RTs depend on the location of the Visual or Tactile component of MVTs. We studied 40 right-handed participants, manipulating the body location (right hand, cheek or foot) and the distance of administration. Visual and Tactile components targeted different or the same body parts and were delivered respectively at five distances. RTs to Tactile-Only trials showed a non-monotonic trend, depending on the delay of stimulus administration. Moreover, RTs to Multisensory Visuo-Tactile trials were found to be dependent on the Distance and location of the Visual component of the stimulus. In conclusion, our results show that Tactile-Only RTs should be removed from Visuo-Tactile RTs and that the Visual and Tactile components of Visuo-Tactile stimuli do not necessarily have to target the same body part. These results have a relevant impact on the study of PPS representations, providing new important methodological information.

Bodily Illusions and Motor Imagery in Fibromyalgia

Fibromyalgia (FM) is characterised by chronic, continuous, widespread pain, often associated with a sense of fatigue, non-restorative sleep and physical exhaustion. Due to the nature of this condition and the absence of other neurological issues potentially able to induce disorders in body representations per se, it represents a perfect model since it provides an opportunity to study the relationship between pain and the bodily self. Corporeal illusions were investigated in 60 participants with or without a diagnosis of FM by means of an ad hoc devised interview. In addition, motor imagery was investigated and illusions relating to body part movements and changes in body size, feelings of alienness, and sensations of body parts not belonging to one's own body (disownership and somatoparaphrenic-like sensations) were found. Crucially, these symptoms do not correlate with any of the clinical measures of pain or functional deficits. The results showed that motor imagery was also impaired, and the severity of the deficits found correlated with the functional impairment of the participant. This indicates that disorders in body representations and motor imagery are part of the clinical expression of FM. However, while motor imagery seems to be linked to reduced autonomy and functional deficits, bodily illusions are independent and potentially represent a concurrent symptom.

Maladaptive reorganization following SCI: The role of body representation and multisensory integration

In this review we focus on maladaptive brain reorganization after spinal cord injury (SCI), including the development of neuropathic pain, and its relationship with impairments in body representation and multisensory integration. We will discuss the implications of altered sensorimotor interactions after SCI with and without neuropathic pain and possible deficits in multisensory integration and body representation. Within this framework we will examine published research findings focused on the use of bodily illusions to manipulate multisensory body representation to induce analgesic effects in heterogeneous chronic pain populations and in SCI-related neuropathic pain. We propose that the development and intensification of neuropathic pain after SCI is partly dependent on brain reorganization associated with dysfunctional multisensory integration processes and distorted body representation. We conclude this review by suggesting future research avenues that may lead to a better understanding of the complex mechanisms underlying the sense of the body after SCI, with a focus on cortical changes.

Development of a New Negative Obstacle Sensor for Augmented Electric Wheelchair

Due to pathologies or age-related problems, in some disabled people, motor impairment is associated with cognitive and/or visual impairments. This combination of limitations unfortunately leads to an inability to move around independently. Indeed, their situation does not allow them to use a conventional electric wheelchair, for safety reasons, and for the moment there is no other technological solution providing safe movement capacity. This lack of access to an autonomous travel solution has the consequence of weakening the intellectual, personal, social, cultural and moral development, as well as the life expectancy, of the people concerned. In this context, our team is working on the development of an optoelectronic system that secures the displacement of electric wheelchairs. This is a large project that requires the development of several functionalities such as: the anti-collision of the wheelchair with its environment, the prevention of falls from the wheelchair on uneven levels, and the adaptation of the system mechanically and electronically to the majority of commercially available electric wheelchair models, among others. In this article, we introduce our solution for detecting dangerous height differences, also called “negative obstacles”, through the creation of a dedicated sensor. This sensor works by optical triangulation and can embed several laser beams in order to extend its detection zone. It has the particularity of being robust in direct sunlight and rain and has a sufficiently high measurement rate to be suitable for the displacement of electric wheelchairs. We develop an adapted algorithm, and point out compromises, in particular between the orientation of the laser beams and the maximal speed of the wheelchair.

Cognitive Training Improves Disconnected Limbs' Mental Representation and Peripersonal Space after Spinal Cord Injury

Paraplegia following spinal cord injury (SCI) affects the mental representation and peripersonal space of the paralysed body parts (i.e., lower limbs). Physical rehabilitation programs can improve these aspects, but the benefits are mostly partial and short-lasting. These limits could be due to the absence of trainings focused on SCI-induced cognitive deficits combined with traditional physical rehabilitation. To test this hypothesis, we assessed in 15 SCI-individuals the effects of adding cognitive recovery protocols (motor imagery–MI) to standard physical rehabilitation programs (Motor + MI training) on mental body representations and space representations, with respect to physical rehabilitation alone (control training). Each training comprised at least eight sessions administered over two weeks. The status of participants’ mental body representation and peripersonal space was assessed at three time points: before the training (T0), after the training (T1), and in a follow-up assessment one month later (T2). The Motor + MI training induced short-term recovery of peripersonal space that however did not persist at T2. Body representation showed a slower neuroplastic recovery at T2, without differences between Motor and the Motor + MI. These results show that body and space representations are plastic after lesions, and open new rehabilitation perspectives.

Expertise in Tool Use Promotes Tool Embodiment

Body representations are known to be dynamically modulated or extended through tool use. Here, we review findings that demonstrate the importance of a user's tool experience or expertise for successful tool embodiment. Examining expert tool users, such as individuals who use tools in professional sports, people who use chopsticks at every meal, or spinal injury patients who use a wheelchair daily, offers new insights into the role of expertise in tool embodiment: Not only does tool embodiment differ between novices and experts, but experts may experience enhanced changes to their body representation when interacting with their own, personal tool. The findings reviewed herein reveal the importance of assessing tool skill in future studies of tool embodiment.

The impact of neurological disability and sensory loss on mindfulness practice

OBJECTIVES

Mindfulness-based approaches are increasingly recommended in the management of medical conditions associated with sensory loss and absence, such as Spinal Cord Injury (SCI), Multiple Sclerosis (MS) and Functional Neurological Disorder (FND). Yet the implications of undertaking practices such as body scanning when living with sensory loss have not been considered. This study aimed to explore the impact of sensory loss on the practice and experience of mindfulness in qualified mindfulness teachers with SCI/FND/MS.

METHODS

Eight mindfulness teachers (5 females, 3 males) with SCI/FND/MS, sensory loss and wheelchair use were recruited from mindfulness teacher databases. In-depth, semi-structured interviews were undertaken, lasting between 50 and 93 min. Interviews were transcribed verbatim and analysed using Interpretative Phenomenological Analysis. Idiographic analyses for descriptive, linguistic and conceptual themes were completed before cross-case analyses.

RESULTS

Analyses resulted in two superordinate themes: (1) Adopting your Body; and (2) Sensation without Loss. These themes reflected the challenge of overcoming initial resistance to areas of the body with sensory disruption, building a relationship with the whole body, such that sensory awareness could be visualised and experienced without proprioception.

CONCLUSIONS

Mindfulness offers a unique approach to accepting and working with the body after paralysis or sensory loss. Fundamental to the use of mindfulness with such populations, is the prioritisation of inclusive sensory language and exploring sensory absence as well as sensory presence. The cognitive and emotional outcomes of body scanning may be uniquely elevated in populations with neurophysiological disorders, highlighting the benefits of mindfulness for adaptive and protective self-management.IMPLICATIONS FOR REHABILITATIONMindfulness-based practices which focus on the body and sensation are accessible to people with neurological limitations.Mindfulness techniques can be extended through the use of visualisation strategies to encourage (non-proprioceptive) awareness of paralysed limbs or areas of the body with sensory loss.The language used in mindfulness-based interventions may need adapted by practitioners so that it remains inclusive for people with sensory loss as well as sensory presence.Additional care needs to be taken when using body scans during mindfulness as they have the potential to exacerbate psychological distress in people with reduced sensory awareness.

Go Virtual to Get Real: Virtual Reality as a Resource for Spinal Cord Treatment

Increasingly, refined virtual reality (VR) techniques allow for the simultaneous and coherent stimulation of multiple sensory and motor domains. In some clinical interventions, such as those related to spinal cord injuries (SCIs), the impact of VR on people's multisensory perception, movements, attitudes, and even modulations of socio-cognitive aspects of their behavior may influence every phase of their rehabilitation treatment, from the acute to chronic stages. This work describes the potential advantages of using first-person-perspective VR to treat SCIs and its implications for manipulating sensory-motor feedback to alter body signals. By situating a patient with SCI in a virtual environment, sensorial perceptions and motor intention can be enriched into a more coherent bodily experience that also promotes processes of neural regeneration and plasticity. In addition to the great potential of research, the most significant areas of interest concern is managing neuropathic pain, motor rehabilitation, and psychological well-being.

Proprioceptive drift is affected by the intermanual distance rather than the distance from the body's midline in the rubber hand illusion

In the rubber hand illusion (RHI), simultaneous brush stroking of a subject’s hidden hand and a visible rubber hand induces a transient illusion of the latter to “feel like it’s my hand” and a proprioceptive drift of the hidden own hand toward the rubber hand. Recent accounts of the RHI have suggested that the illusion would only occur if weighting of conflicting sensory information and their subsequent integration results in a statistically plausible compromise. In three different experiments, we investigated the role of distance between the two hands as well as their proximity to the body’s midline in influencing the occurrence of the illusion. Overall, the results suggest that the illusion is abolished when placing the two hands apart, therefore increasing the mismatch between the visual and proprioceptive modality, whereas the proximity of the two hands to the body’s midline plays only a minor role on the subjective report of the illusion. This might be driven by the response properties of visuotactile bimodal cells encoding the peripersonal space around the hand.

Visuo-motor and interoceptive influences on peripersonal space representation following spinal cord injury

Peripersonal space (PPS) representation is modulated by information coming from the body. In paraplegic individuals, whose lower limb sensory-motor functions are impaired or completely lost, the representation of PPS around the feet is reduced. However, passive motion can have short-term restorative effects. What remains unclear is the mechanisms underlying this recovery, in particular with regard to the contribution of visual and motor feedback and of interoception. Using virtual reality technology, we dissociated the motor and visual feedback during passive motion in paraplegics with complete and incomplete lesions and in healthy controls. The results show that in the case of paraplegics, the presence of motor feedback was necessary for the recovery of PPS representation, both when the motor feedback was congruent and when it was incongruent with the visual feedback. In contrast, visuo-motor incongruence led to an inhibition of PPS representation in the control group. There were no differences in sympathetic responses between the three groups. Nevertheless, in individuals with incomplete lesions, greater interoceptive sensitivity was associated with a better representation of PPS around the feet in the visuo-motor incongruent conditions. These results shed new light on the modulation of PPS representation, and demonstrate the importance of residual motor feedback and its integration with other bodily information in maintaining space representation.