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Ritter C, Geisler M, Blume KR, Nehrdich S, Hofmann GO, Koehler H, Miltner WHR, Weiss T. Stimulation of peroneal nerves reveals maintained somatosensory representation in transtibial amputees. Front Hum Neurosci 2023; 17:1240937. [PMID: 37746055 PMCID: PMC10512738 DOI: 10.3389/fnhum.2023.1240937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 08/18/2023] [Indexed: 09/26/2023] Open
Abstract
Introduction Several studies have found changes in the organization of the primary somatosensory cortex (SI) after amputation. This SI reorganization was mainly investigated by stimulating neighboring areas to amputation. Unexpectedly, the somatosensory representation of the deafferented limb has rarely been directly tested. Methods We stimulated the truncated peroneal nerve in 24 unilateral transtibial amputees and 15 healthy controls. The stimulation intensity was adjusted to make the elicited percept comparable between both stimulation sides. Neural sources of the somatosensory-evoked magnetic fields (SEFs) to peroneal stimulation were localized in the contralateral foot/leg areas of SI in 19 patients and 14 healthy controls. Results We demonstrated the activation of functionally preserved cortical representations of amputated lower limbs. None of the patients reported evoked phantom limb pain (PLP) during stimulation. Stimulation that evoked perceptions in the foot required stronger intensities on the amputated side than on the intact side. In addition to this, stronger stimulation intensities were required for amputees than for healthy controls. Exploratorily, PLP intensity was neither associated with stimulation intensity nor dipole strength nor with differences in Euclidean distances (between SEF sources of the healthy peroneus and mirrored SEF sources of the truncated peroneus). Discussion Our results provide hope that the truncated nerve may be used to establish both motor control and somatosensory feedback via the nerve trunk when a permanently functional connection between the nerve trunk and the prosthesis becomes available.
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Affiliation(s)
- Caroline Ritter
- Department of Clinical Psychology, Institute of Psychology, Friedrich Schiller University Jena, Jena, Germany
- Clinic for Psychosomatics and Psychotherapy, Jena University Hospital, Jena, Germany
| | - Maria Geisler
- Department of Clinical Psychology, Institute of Psychology, Friedrich Schiller University Jena, Jena, Germany
- Clinic for Psychosomatics and Psychotherapy, Jena University Hospital, Jena, Germany
| | - Kathrin R. Blume
- Department of Clinical Psychology, Institute of Psychology, Friedrich Schiller University Jena, Jena, Germany
- Institute of Psychosocial Medicine, Psychotherapy and Psychooncology, Jena University Hospital, Jena, Germany
| | - Sandra Nehrdich
- Department of Clinical Psychology, Institute of Psychology, Friedrich Schiller University Jena, Jena, Germany
- Clinic for Psychosomatics and Psychotherapy, Jena University Hospital, Jena, Germany
| | - Gunther O. Hofmann
- Berufsgenossenschaftliche Kliniken Bergmannstrost Halle/Saale, Halle, Germany
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Jena, Jena, Germany
| | - Hanna Koehler
- Department of Clinical Psychology, Institute of Psychology, Friedrich Schiller University Jena, Jena, Germany
- Biomagnetic Center, Department of Neurology, University Hospital Jena, Jena, Germany
| | - Wolfgang H. R. Miltner
- Department of Clinical Psychology, Institute of Psychology, Friedrich Schiller University Jena, Jena, Germany
| | - Thomas Weiss
- Department of Clinical Psychology, Institute of Psychology, Friedrich Schiller University Jena, Jena, Germany
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2
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Gaetz W, Dockstader C, Furlong PL, Amaral S, Vossough A, Schwartz ES, Roberts TPL, Scott Levin L. Somatosensory and motor representations following bilateral transplants of the hands: A 6-year longitudinal case report on the first pediatric bilateral hand transplant patient. Brain Res 2023; 1804:148262. [PMID: 36706858 DOI: 10.1016/j.brainres.2023.148262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 01/19/2023] [Accepted: 01/21/2023] [Indexed: 01/26/2023]
Abstract
A vascularized composite tissue allotransplantation (VCA) was performed at the Children's Hospital of Philadelphia (CHOP), on an 8-year-old patient in 2015, six years after bilateral hand and foot amputation. Hand VCA resulted in reafferentation of the medial, ulnar, and radial nerves serving hand somatosensation and motor function. We used magnetoencephalography (MEG) to assess somatosensory cortical plasticity following the post-transplantation recovery of the peripheral sensory nerves of the hands. Our 2-year postoperative MEG showed that somatosensory lip representations, initially observed at "hand areas", reverted to canonical, orthotopic lip locations with recovery of post-transplant hand function. Here, we continue the assessment of motor and somatosensory responses up to 6-years post-transplant. Magnetoencephalographic somatosensory responses were recorded eight times over a six-year period following hand transplantation, using a 275-channel MEG system. Somatosensory tactile stimuli were presented to the right lower lip (all 8 visits) as well as right and left index fingers (visits 3-8) and fifth digits (visits 4-8). In addition, left and right-hand motor responses were also recorded for left index finger and right thumb (visit 8 only).During the acute recovery phase (visits 3 and 4), somatosensory responses of the digits were observed to be significantly larger and more phasic (i.e., smoother) than controls. Subsequent measures showed that digit responses maintain this atypical response profile (evoked-response magnitudes typically exceed 1 picoTesla). Orthotopic somatosensory localization of the lip, D2, and D5 was preserved. Motor beta-band desynchrony was age-typical in localization and response magnitude; however, the motor gamma-band response was significantly larger than that observed in a reference population.These novel findings show that the restoration of somatosensory input of the hands resulted in persistent and atypically large cortical responses to digit stimulation, which remain atypically large at 6 years post-transplant; there is no known perceptual correlate, and no reports of phantom pain. Normal somatosensory organization of the lip, D2, and D5 representation remain stable following post-recovery reorganization of the lip's somatosensory response.
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Affiliation(s)
- W Gaetz
- Lurie Family Foundations' MEG Imaging Center, Department of Radiology, Children's Hospital of Philadelphia, Philadelphia PA, USA; Department of Radiology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - C Dockstader
- Human Biology Program, University of Toronto, Toronto ON, Canada
| | - P L Furlong
- Institute of Health and Neurodevelopment, Aston University, Birmingham, UK
| | - S Amaral
- Department of Pediatrics, Division of Nephrology, The Children's Hospital of Philadelphia, University of Pennsylvania, Perelman School of Medicine, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA
| | - A Vossough
- Lurie Family Foundations' MEG Imaging Center, Department of Radiology, Children's Hospital of Philadelphia, Philadelphia PA, USA; Department of Radiology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Division of Neuroradiology, Department of Radiology, The Children's Hospital of Philadelphia, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA 19104, USA
| | - E S Schwartz
- Lurie Family Foundations' MEG Imaging Center, Department of Radiology, Children's Hospital of Philadelphia, Philadelphia PA, USA; Department of Radiology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Division of Neuroradiology, Department of Radiology, The Children's Hospital of Philadelphia, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA 19104, USA
| | - T P L Roberts
- Lurie Family Foundations' MEG Imaging Center, Department of Radiology, Children's Hospital of Philadelphia, Philadelphia PA, USA; Department of Radiology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - L Scott Levin
- Department of Orthopaedic Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA 19104, USA; Division of Plastic and Reconstructive Surgery, The Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA; Department of Orthopaedic Surgery, The Children's Hospital of Philadelphia, PA 19104, USA
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3
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Washington KM, Solari MG, Zanoun RR, Kwegyir-Afful EE, Su AJA, Carvell GE, Lee WPA, Simons DJ. Cortical reintegration after facial allotransplantation. J Neurophysiol 2023; 129:421-430. [PMID: 36542405 DOI: 10.1152/jn.00349.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Neural plasticity of the brain or its ability to reorganize following injury has likely coincided with the successful clinical correction of severe deformity by facial transplantation since 2005. In this study, we present the cortical reintegration outcomes following syngeneic hemifacial vascularized composite allograft (VCA) in a small animal model. Specifically, changes in the topographic organization and unit response properties of the rodent whisker-barrel somatosensory system were assessed following hemifacial VCA. Clear differences emerged in the barrel-cortex system when comparing naïve and hemiface transplanted animals. Neurons in the somatosensory cortex of transplanted rats had decreased sensitivity albeit increased directional sensitivity compared with naïve rats and evoked responses in transplanted animals were more temporally dispersed. In addition, receptive fields were often topographically mismatched with the indication that the mismatched topography reorganized within adjacent barrel (same row-arc bias following hemifacial transplant). These results suggest subcortical changes in the thalamus and/or brainstem play a role in hemifacial transplantation cortical plasticity and demonstrate the discrete and robust data that can be derived from this clinically relevant small animal VCA model for use in optimizing postsurgical outcomes.NEW & NOTEWORTHY Robust rodent hemifacial transplant model was used to record functional changes in somatosensory cortex after transplantation. Neurons in the somatosensory cortex of face transplant recipients had decreased sensitivity to stimulation of whiskers with increased directional sensitivity vs. naive rats. Transplant recipient cortical unit response was more dispersed in temporary vs. naive rats. Despite histological similarities to naive cortices, transplant recipient cortices had a mix of topographically appropriate and inappropriate whiskered at barrel cortex relationships.
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Affiliation(s)
- Kia M Washington
- Department of Plastic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,Department of Surgery, University of Colorado School of Medicine, CU Anschutz Medical Campus, Aurora, Colorado
| | - Mario G Solari
- Department of Plastic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Rami R Zanoun
- Department of Neurobiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Ernest E Kwegyir-Afful
- Department of Neurobiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - An-Jey A Su
- Department of Plastic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,Department of Neurobiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,Department of Surgery, University of Colorado School of Medicine, CU Anschutz Medical Campus, Aurora, Colorado
| | - George E Carvell
- Department of Neurobiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - W P Andrew Lee
- Department of Plastic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Daniel J Simons
- Department of Neurobiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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4
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Browne JD, Fraiser R, Cai Y, Leung D, Leung A, Vaninetti M. Unveiling the phantom: What neuroimaging has taught us about phantom limb pain. Brain Behav 2022; 12:e2509. [PMID: 35218308 PMCID: PMC8933774 DOI: 10.1002/brb3.2509] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 12/05/2021] [Accepted: 01/11/2022] [Indexed: 11/08/2022] Open
Abstract
Phantom limb pain (PLP) is a complicated condition with diverse clinical challenges. It consists of pain perception of a previously amputated limb. The exact pain mechanism is disputed and includes mechanisms involving cerebral, peripheral, and spinal origins. Such controversy limits researchers' and clinicians' ability to develop consistent therapeutics or management. Neuroimaging is an essential tool that can address this problem. This review explores diffusion tensor imaging, functional magnetic resonance imaging, electroencephalography, and magnetoencephalography in the context of PLP. These imaging modalities have distinct mechanisms, implications, applications, and limitations. Diffusion tensor imaging can outline structural changes and has surgical applications. Functional magnetic resonance imaging captures functional changes with spatial resolution and has therapeutic applications. Electroencephalography and magnetoencephalography can identify functional changes with a strong temporal resolution. Each imaging technique provides a unique perspective and they can be used in concert to reveal the true nature of PLP. Furthermore, researchers can utilize the respective strengths of each neuroimaging technique to support the development of innovative therapies. PLP exemplifies how neuroimaging and clinical management are intricately connected. This review can assist clinicians and researchers seeking a foundation for applications and understanding the limitations of neuroimaging techniques in the context of PLP.
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Affiliation(s)
- Jonathan D Browne
- School of Medicine, California University of Science and Medicine, Colton, California, USA
| | - Ryan Fraiser
- Center for Pain Medicine, University of California San Diego, La Jolla, California, USA
| | - Yi Cai
- Center for Pain Medicine, University of California San Diego, La Jolla, California, USA
| | - Dillon Leung
- College of Letters and Science, University of California Berkeley, Berkeley, California, USA
| | - Albert Leung
- Center for Pain Medicine, University of California San Diego, La Jolla, California, USA
| | - Michael Vaninetti
- Center for Pain Medicine, University of California San Diego, La Jolla, California, USA
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5
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Ernst J, Weiss T, Wanke N, Frahm J, Felmerer G, Farina D, Schilling AF, Wilke MA. Case Report: Plasticity in Central Sensory Finger Representation and Touch Perception After Microsurgical Reconstruction of Infraclavicular Brachial Plexus Injury. Front Neurosci 2022; 16:793036. [PMID: 35281503 PMCID: PMC8914191 DOI: 10.3389/fnins.2022.793036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 01/26/2022] [Indexed: 11/13/2022] Open
Abstract
After brachial plexus injury (BPI), early microsurgery aims at facilitating reconnection of the severed peripheral nerves with their orphan muscles and sensory receptors and thereby reestablishing communication with the brain. In order to investigate this sensory recovery, here we combined functional magnetic resonance imaging (fMRI) and tactile psychophysics in a patient who suffered a sharp, incomplete amputation of the dominant hand at the axilla level. To determine somatosensory detection and discomfort thresholds as well as sensory accuracy for fingers of both the intact and affected hand, we used electrotactile stimulation in the framework of a mislocalization test. Additionally, tactile stimulation was performed in the MRI scanner in order to determine the cortical organization of the possibly affected primary somatosensory cortex. The patient was able to detect electrotactile stimulation in 4 of the 5 fingertips (D1, D2, D4, D5), and in the middle phalanx in D3 indicating some innervation. The detection and discomfort threshold were considerably higher at the affected side than at the intact side, with higher detection and discomfort thresholds for the affected side. The discrimination accuracy was rather low at the affected side, with stimulation of D1/D2/D3/D4/D5 eliciting most commonly a sensation at D4/D1/D3/D2/D5, respectively. The neuroimaging data showed a mediolateral succession from D2 to D5 to D1 to D4 (no activation was observed for D3). These results indicate a successful regrowth of the peripheral nerve fibers from the axilla to four fingertips. The data suggest that some of the fibers have switched location in the process and there is a beginning of cortical reorganization in the primary somatosensory cortex, possibly resulting from a re-education of the brain due to conflicting information (touch vs. vision).
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Affiliation(s)
- Jennifer Ernst
- Department of Trauma Surgery, Orthopaedics, and Plastic Surgery, Universitätsmedizin Göttingen, Göttingen, Germany
- *Correspondence: Jennifer Ernst
| | - Thomas Weiss
- Clinical Psychology, Friedrich Schiller University Jena, Jena, Germany
| | - Nadine Wanke
- Fakultät Life Sciences, Hamburg University of Applied Sciences (HAW Hamburg), Hamburg, Germany
| | - Jens Frahm
- Biomedizinische Nuclear Magnetic Resonance (NMR) Forschungs-GmbH am Max-Planck-Institut für biophysikalische Chemie, Göttingen, Germany
| | - Gunther Felmerer
- Department of Trauma Surgery, Orthopaedics, and Plastic Surgery, Universitätsmedizin Göttingen, Göttingen, Germany
| | - Dario Farina
- Department of Bioengineering, Imperial College London, London, United Kingdom
| | - Arndt F. Schilling
- Department of Trauma Surgery, Orthopaedics, and Plastic Surgery, Universitätsmedizin Göttingen, Göttingen, Germany
| | - Meike A. Wilke
- Department of Trauma Surgery, Orthopaedics, and Plastic Surgery, Universitätsmedizin Göttingen, Göttingen, Germany
- Fakultät Life Sciences, Hamburg University of Applied Sciences (HAW Hamburg), Hamburg, Germany
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6
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Complementary Phenomena: Phantom Hand and Phantom Face. Cogn Behav Neurol 2021; 34:150-159. [PMID: 34074869 DOI: 10.1097/wnn.0000000000000258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 08/11/2020] [Indexed: 11/26/2022]
Abstract
After tissue or limb loss, the development of sensation and perception of the lost or deafferent tissue is defined as a phantom phenomenon. We investigated the presence of phantom phenomena in individuals who underwent a full face transplant as well as those who had a hand transplant. Specifically, we investigated sensory perception of the face on the fingers and sensory perception of the fingers on the face in three full face and four hand transplant patients. In all seven individuals, we used a brush to separately stimulate the right and left sides of the face or the palmar and dorsal faces of the hand. We then asked the individuals if they felt a sensation of touch on any other part of their body and, if so, to describe their perceptions. Changes in the regions of the primary sensory cortex representing the hand and face were defined using fMRI obtained via tactile sensory stimulation of the clinical examination areas. Two of the full face transplant patients reported sensory perceptions such as a prominent sensation of touch on their faces during sensory stimulation of their fingers. Three of the hand transplant patients reported sensory perceptions, which we referred to as finger patches, during sensory stimulation of the face area. In fMRI, overlaps were observed in the cortical hand and face representation areas. We consider the phantom hand and phantom face phenomena we observed to be complementary due to the neighborhood of the representations of the hand and face in the somatosensory cortex.
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7
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Assessment of cortical reorganization and preserved function in phantom limb pain: a methodological perspective. Sci Rep 2020; 10:11504. [PMID: 32661345 PMCID: PMC7359300 DOI: 10.1038/s41598-020-68206-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 06/19/2020] [Indexed: 02/07/2023] Open
Abstract
Phantom limb pain (PLP) has been associated with reorganization in primary somatosensory cortex (S1) and preserved S1 function. Here we examined if methodological differences in the assessment of cortical representations might explain these findings. We used functional magnetic resonance imaging during a virtual reality movement task, analogous to the classical mirror box task, in twenty amputees with and without PLP and twenty matched healthy controls. We assessed the relationship between task-related activation maxima and PLP intensity in S1 and motor cortex (M1) in individually-defined or group-conjoint regions of interest (ROI) (overlap of task-related activation between the groups). We also measured cortical distances between both locations and correlated them with PLP intensity. Amputees compared to controls showed significantly increased activation in M1, S1 and S1M1 unrelated to PLP. Neural activity in M1 was positively related to PLP intensity in amputees with PLP when a group-conjoint ROI was chosen. The location of activation maxima differed between groups in S1 and M1. Cortical distance measures were unrelated to PLP. These findings suggest that sensory and motor maps differentially relate to PLP and that methodological differences might explain discrepant findings in the literature.
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8
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Dietrich C, Blume KR, Franz M, Huonker R, Carl M, Preißler S, Hofmann GO, Miltner WHR, Weiss T. Dermatomal Organization of SI Leg Representation in Humans: Revising the Somatosensory Homunculus. Cereb Cortex 2018; 27:4564-4569. [PMID: 28119344 DOI: 10.1093/cercor/bhx007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 01/06/2017] [Indexed: 11/14/2022] Open
Abstract
Penfield and Rasmussen's homunculus is the valid map of the neural body representation of nearly each textbook of biology, physiology, and neuroscience. The somatosensory homunculus places the foot representation on the mesial surface of the postcentral gyrus followed by the representations of the lower leg and the thigh in superio-lateral direction. However, this strong homuncular organization contradicts the "dermatomal" organization of spinal nerves. We used somatosensory-evoked magnetic fields and source analysis to study the leg's neural representation in the primary somatosensory cortex (SI). We show that the representation of the back of the thigh is located inferior to the foot's representation in SI whereas the front of the thigh is located laterally to the foot's representation. This observation indicates that the localization of the leg in SI rather follows the dermatomal organization of spinal nerves than the typical map of neighboring body parts as depicted in Penfield and Rasmussen's illustration of the somatosensory homunculus.
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Affiliation(s)
- Caroline Dietrich
- Department of Biological and Clinical Psychology, Friedrich Schiller UniversityJena, D-07743, Germany
| | - Kathrin R Blume
- Department of Biological and Clinical Psychology, Friedrich Schiller UniversityJena, D-07743, Germany
| | - Marcel Franz
- Department of Biological and Clinical Psychology, Friedrich Schiller UniversityJena, D-07743, Germany
| | - Ralph Huonker
- Department of Neurology, Biomagnetic Center, University Hospital Jena, Jena, D-07747,Germany
| | - Maria Carl
- Department of Biological and Clinical Psychology, Friedrich Schiller UniversityJena, D-07743, Germany
| | - Sandra Preißler
- Department of Biological and Clinical Psychology, Friedrich Schiller UniversityJena, D-07743, Germany
| | - Gunther O Hofmann
- Berufsgenossenschaftliche Kliniken Bergmannstrost Halle, Halle/Saale, D-06112, Germany.,Department of Trauma, Hand and Reconstructive Surgery, University Hospital Jena, Jena, D-07747, Germany
| | - Wolfgang H R Miltner
- Department of Biological and Clinical Psychology, Friedrich Schiller UniversityJena, D-07743, Germany
| | - Thomas Weiss
- Department of Biological and Clinical Psychology, Friedrich Schiller UniversityJena, D-07743, Germany
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9
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Persistierende Schmerzen und kortikale Reorganisation nach Makroreplantationen der oberen Extremität. Schmerz 2018; 32:207-210. [DOI: 10.1007/s00482-018-0271-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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10
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Kikkert S, Johansen-Berg H, Tracey I, Makin TR. Reaffirming the link between chronic phantom limb pain and maintained missing hand representation. Cortex 2018; 106:174-184. [PMID: 30005369 PMCID: PMC6143485 DOI: 10.1016/j.cortex.2018.05.013] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 04/16/2018] [Accepted: 05/23/2018] [Indexed: 12/20/2022]
Abstract
Phantom limb pain (PLP) is commonly considered to be a result of maladaptive brain plasticity. This model proposes that PLP is mainly caused by reorganisation in the primary somatosensory cortex, presumably characterised by functional degradation of the missing hand representation and remapping of other body part representations. In the current study, we replicate our previous results by showing that chronic PLP correlates with maintained representation of the missing hand in the primary sensorimotor missing hand cortex. We asked unilateral upper-limb amputees to move their phantom hand, lips or other body parts and measured the associated neural responses using functional magnetic resonance imaging (fMRI). We confirm that amputees suffering from worse chronic PLP have stronger activity in the primary sensorimotor missing hand cortex while performing phantom hand movements. We find no evidence of lip representation remapping into the missing hand territory, as assessed by measuring activity in the primary sensorimotor missing hand cortex during lip movements. We further show that the correlation between chronic PLP and maintained representation of the missing hand cannot be explained by the experience of chronic non-painful phantom sensations or compensatory usage of the residual arm or an artificial arm (prosthesis). Together, our results reaffirm a likely relationship between persistent peripheral inputs pertaining to the missing hand representation and chronic PLP. Our findings emphasise a need to further study the role of peripheral inputs from the residual nerves to better understand the mechanisms underlying chronic PLP.
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Affiliation(s)
- Sanne Kikkert
- Wellcome Centre for Integrative Neuroimaging, MRIB Centre, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Heidi Johansen-Berg
- Wellcome Centre for Integrative Neuroimaging, MRIB Centre, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Irene Tracey
- Wellcome Centre for Integrative Neuroimaging, MRIB Centre, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom; Nuffield Division of Anaesthetics, University of Oxford, Oxford, United Kingdom
| | - Tamar R Makin
- Wellcome Centre for Integrative Neuroimaging, MRIB Centre, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom; Institute of Cognitive Neuroscience, University College London, London, United Kingdom.
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11
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Blume KR, Racz J, Franz M, Dietrich C, Puta C, Friedel R, Hofmann GO, Miltner WHR, Weiss T. Quantitative sensory testing after macroreplantation: evidence for a specific somatosensory profile. Pain 2018; 159:1289-1296. [PMID: 29554015 DOI: 10.1097/j.pain.0000000000001210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A comprehensive functional recovery is one of the criteria for successful replantation of an amputated limb. Functionality of a replanted limb is strongly dependent on its regained sensibility. In previous studies concerning the sensibility of replanted limbs, only a few somatosensory submodalities were examined in small samples. The purpose of this study is to provide a full pattern of somatosensory symptoms after replantation. Quantitative sensory testing was performed according to a standardized protocol in a sample of 15 patients who underwent replantation of their upper limb proximal to the radiocarpal joint (macroreplantation). Results indicate that most of these patients showed a specific somatosensory profile characterized by thermal and mechanical hypoesthesia and hyperalgesia in response to pressure pain, whereas no single case of hyperalgesia to heat pain occurred. This distinct profile of impaired somatosensation shares some features of the somatosensory profile of neuropathic pain syndromes. Patients' limbs that were replanted many years before the present quantitative sensory testing showed more sensory deficits than patients with more recent replantations. This knowledge might be helpful in the development of more specific and more successful rehabilitation programs with replanted patients and improves the behavioral function of the replanted limb.
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Affiliation(s)
- Kathrin R Blume
- Department of Clinical Psychology, Friedrich Schiller University, Jena, Germany
| | - Juliane Racz
- Department of Trauma, Hand, and Reconstructive Surgery, University Hospital, Jena, Germany
| | - Marcel Franz
- Department of Clinical Psychology, Friedrich Schiller University, Jena, Germany
| | - Caroline Dietrich
- Department of Clinical Psychology, Friedrich Schiller University, Jena, Germany
| | - Christian Puta
- Department of Sports Medicine and Health Promotion, Friedrich Schiller University, Jena, Germany
| | - Reinhard Friedel
- Department of Trauma, Hand, and Reconstructive Surgery, University Hospital, Jena, Germany
| | - Gunther O Hofmann
- Department of Trauma, Hand, and Reconstructive Surgery, University Hospital, Jena, Germany.,Department of Trauma, Hand, and Reconstructive Surgery, Berufsgenossenschaftliche Kliniken Bergmannstrost, Halle, Germany
| | | | - Thomas Weiss
- Department of Clinical Psychology, Friedrich Schiller University, Jena, Germany
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12
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Gaetz W, Kessler SK, Roberts TPL, Berman JI, Levy TJ, Hsia M, Humpl D, Schwartz ES, Amaral S, Chang B, Levin LS. Massive cortical reorganization is reversible following bilateral transplants of the hands: evidence from the first successful bilateral pediatric hand transplant patient. Ann Clin Transl Neurol 2017; 5:92-97. [PMID: 29376095 PMCID: PMC5771315 DOI: 10.1002/acn3.501] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 10/03/2017] [Indexed: 01/20/2023] Open
Abstract
In this repeated measures case study, we show that sensory deafferentation after limb amputation leads to changes in cortical somatotopic maps which are reversible after restoration of sensory input. Using magnetoencephalography (MEG), we observed in a child with bilateral hand transplants large‐scale shifts in somatosensory lip cortical representation from anatomic hand area to anatomic face region. After recovery of tactile sensation in the digits, responses to finger stimulation were localized to orthotopic sensory cortex, but with atypical electrophysiologic features (amplitude and frequencies).
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Affiliation(s)
- William Gaetz
- Lurie Family Foundations' MEG Imaging Center Department of Radiology Children's Hospital of Philadelphia Philadelphia Pennsylvania.,Department of Radiology Children's Hospital of Philadelphia Perelman School of Medicine University of Pennsylvania Philadelphia Pennsylvania
| | - Sudha K Kessler
- Departments of Neurology and Pediatrics Children's Hospital of Philadelphia Perelman School of Medicine University of Pennsylvania Philadelphia Pennsylvania
| | - Tim P L Roberts
- Lurie Family Foundations' MEG Imaging Center Department of Radiology Children's Hospital of Philadelphia Philadelphia Pennsylvania.,Department of Radiology Children's Hospital of Philadelphia Perelman School of Medicine University of Pennsylvania Philadelphia Pennsylvania
| | - Jeffrey I Berman
- Lurie Family Foundations' MEG Imaging Center Department of Radiology Children's Hospital of Philadelphia Philadelphia Pennsylvania.,Department of Radiology Children's Hospital of Philadelphia Perelman School of Medicine University of Pennsylvania Philadelphia Pennsylvania
| | - Todd J Levy
- Department of Occupational Therapy Center for Rehabilitation Children's Hospital of Philadelphia Philadelphia Pennsylvania
| | - Michelle Hsia
- Department of Occupational Therapy Center for Rehabilitation Children's Hospital of Philadelphia Philadelphia Pennsylvania
| | - Deborah Humpl
- Department of Occupational Therapy Center for Rehabilitation Children's Hospital of Philadelphia Philadelphia Pennsylvania
| | - Erin S Schwartz
- Lurie Family Foundations' MEG Imaging Center Department of Radiology Children's Hospital of Philadelphia Philadelphia Pennsylvania.,Department of Radiology Children's Hospital of Philadelphia Perelman School of Medicine University of Pennsylvania Philadelphia Pennsylvania
| | - Sandra Amaral
- Department of Pediatrics Division of Nephrology Children's Hospital of Philadelphia Perelman School of Medicine University of Pennsylvania Philadelphia Pennsylvania
| | - Ben Chang
- Department of Surgery and Orthopaedic Surgery Division of Plastic and Reconstructive Surgery Children's Hospital of Philadelphia Perelman School of Medicine University of Pennsylvania Philadelphia Pennsylvania
| | - Lawrence Scott Levin
- Department of Surgery and Orthopaedic Surgery Division of Plastic and Reconstructive Surgery Children's Hospital of Philadelphia Perelman School of Medicine University of Pennsylvania Philadelphia Pennsylvania
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13
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Yanagisawa T, Fukuma R, Seymour B, Hosomi K, Kishima H, Shimizu T, Yokoi H, Hirata M, Yoshimine T, Kamitani Y, Saitoh Y. Induced sensorimotor brain plasticity controls pain in phantom limb patients. Nat Commun 2016; 7:13209. [PMID: 27807349 PMCID: PMC5095287 DOI: 10.1038/ncomms13209] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 09/12/2016] [Indexed: 12/02/2022] Open
Abstract
The cause of pain in a phantom limb after partial or complete deafferentation is an important problem. A popular but increasingly controversial theory is that it results from maladaptive reorganization of the sensorimotor cortex, suggesting that experimental induction of further reorganization should affect the pain, especially if it results in functional restoration. Here we use a brain–machine interface (BMI) based on real-time magnetoencephalography signals to reconstruct affected hand movements with a robotic hand. BMI training induces significant plasticity in the sensorimotor cortex, manifested as improved discriminability of movement information and enhanced prosthetic control. Contrary to our expectation that functional restoration would reduce pain, the BMI training with the phantom hand intensifies the pain. In contrast, BMI training designed to dissociate the prosthetic and phantom hands actually reduces pain. These results reveal a functional relevance between sensorimotor cortical plasticity and pain, and may provide a novel treatment with BMI neurofeedback. Pain in a phantom limb after limb deafferentation may be due to maladaptive sensorimotor representation. Here the authors find that sensorimotor plasticity induced by BMI training with the phantom hand, contrary to expectation, increased pain while dissociating prosthetic movements from the phantom arm relieved the pain.
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Affiliation(s)
- Takufumi Yanagisawa
- Department of Neurosurgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan.,Division of Functional Diagnostic Science, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan.,Department of Neuroinformatics, ATR Computational Neuroscience Laboratories, 2-2-2 Hikaridai, Seika-cho, Kyoto 619-0288, Japan.,Department of Neuroinformatics, CiNet Computational Neuroscience Laboratories, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan.,JST PRESTO, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan.,Division of Clinical Neuroengineering, Osaka University, Global Center for Medical Engineering and Informactics, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Ryohei Fukuma
- Department of Neurosurgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan.,Department of Neuroinformatics, ATR Computational Neuroscience Laboratories, 2-2-2 Hikaridai, Seika-cho, Kyoto 619-0288, Japan.,Department of Neuroinformatics, CiNet Computational Neuroscience Laboratories, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan.,Graduate School of Information Science, Nara Institute of Science and Technology, 8916-5 Takayamacho, Ikoma, Nara 630-0192, Japan
| | - Ben Seymour
- Department of Engineering, University of Cambridge, Computational and Biological Learning Laboratory, Trumpington Street, Cambridge CB2 1PZ, UK.,National Institute for Information and Communications Technology, Center for Information and Neural Networks, 1-3 Suita, Osaka 565-0871, Japan
| | - Koichi Hosomi
- Department of Neurosurgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan.,Department of Neuromodulation and Neurosurgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Haruhiko Kishima
- Department of Neurosurgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Takeshi Shimizu
- Department of Neurosurgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan.,Department of Neuromodulation and Neurosurgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Hiroshi Yokoi
- Department of Mechanical Engineering and Intelligent Systems, The University of Electro-Communications, 1-5-1 Chofugaoka, Chofu, Tokyo 182-8585, Japan
| | - Masayuki Hirata
- Department of Neurosurgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan.,Department of Neuroinformatics, CiNet Computational Neuroscience Laboratories, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan.,Division of Clinical Neuroengineering, Osaka University, Global Center for Medical Engineering and Informactics, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Toshiki Yoshimine
- Department of Neurosurgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan.,Department of Neuroinformatics, CiNet Computational Neuroscience Laboratories, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan.,Division of Clinical Neuroengineering, Osaka University, Global Center for Medical Engineering and Informactics, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Yukiyasu Kamitani
- Department of Neuroinformatics, ATR Computational Neuroscience Laboratories, 2-2-2 Hikaridai, Seika-cho, Kyoto 619-0288, Japan.,Graduate School of Information Science, Nara Institute of Science and Technology, 8916-5 Takayamacho, Ikoma, Nara 630-0192, Japan.,Graduate School of Informatics, Kyoto University, Yoshidahonmachi, Sakyoku, Kyoto 606-8501, Japan
| | - Youichi Saitoh
- Department of Neurosurgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan.,Department of Neuromodulation and Neurosurgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
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14
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Weiss T. Plasticity and Cortical Reorganization Associated With Pain. ZEITSCHRIFT FUR PSYCHOLOGIE-JOURNAL OF PSYCHOLOGY 2016. [DOI: 10.1027/2151-2604/a000241] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Abstract. This review focuses on plasticity and reorganization associated with pain. It is well established that noxious stimulation activates a large network of neural structures in the human brain, which is often denominated as the neuromatrix of pain. Repeated stimulation is able to induce plasticity in nearly all structures of this neuromatrix. While the plasticity to short-term stimulation is usually transient, long-term stimulation might induce persistent changes within the neuromatrix network and reorganize its functions and structures. Interestingly, a large longitudinal study on patients with subacute back pain found predictors for the persistence of pain versus remission in mesolimbic structures not usually included in the neuromatrix of pain. From these results, new concepts of nociception, pain, and transition from acute to chronic pain emerged. Overall, this review outlines a number of plastic changes in response to pain. However, the role of plasticity for chronic pain has still to be established.
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Affiliation(s)
- Thomas Weiss
- Department of Biological and Clinical Psychology, Friedrich Schiller University Jena, Germany
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15
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Neuropathic Pain and Functional Reorganization in the Primary Sensorimotor Cortex After Spinal Cord Injury. THE JOURNAL OF PAIN 2015; 16:1256-1267. [DOI: 10.1016/j.jpain.2015.08.008] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 07/24/2015] [Accepted: 08/21/2015] [Indexed: 11/18/2022]
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16
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Jutzeler CR, Curt A, Kramer JLK. Relationship between chronic pain and brain reorganization after deafferentation: A systematic review of functional MRI findings. NEUROIMAGE-CLINICAL 2015; 9:599-606. [PMID: 26740913 PMCID: PMC4644246 DOI: 10.1016/j.nicl.2015.09.018] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 09/25/2015] [Accepted: 09/29/2015] [Indexed: 11/08/2022]
Abstract
Background Mechanisms underlying the development of phantom limb pain and neuropathic pain after limb amputation and spinal cord injury, respectively, are poorly understood. The goal of this systematic review was to assess the robustness of evidence in support of “maladaptive plasticity” emerging from applications of advanced functional magnetic resonance imaging (MRI). Methods Using MeSH heading search terms in PubMed and SCOPUS, a systematic review was performed querying published manuscripts. Results From 146 candidate publications, 10 were identified as meeting the inclusion criteria. Results from fMRI investigations provided some level of support for maladaptive cortical plasticity, including longitudinal studies that demonstrated a change in functional organization related to decreases in pain. However, a number of studies have reported no relationship between reorganization, pain and deafferentation, and emerging evidence has also suggested the opposite — that is, chronic pain is associated with preserved cortical function. Conclusion Based solely on advanced functional neuroimaging results, there is only limited evidence for a relationship between chronic pain intensity and reorganization after deafferentation. The review demonstrates the need for additional neuroimaging studies to clarify the relationship between chronic pain and reorganization. There is evidence of a relationship between brain reorganization, deafferentation, and chronic pain. Emerging evidence suggests that reorganization in the CNS could be an adaptive process, preventing the emergence of pain. Future studies adopting standardized protocols are needed to clarify the role of chronic pain and plasticity in the brain.
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Affiliation(s)
- C R Jutzeler
- Spinal Cord Injury Center, University Hospital Balgrist, University of Zurich, Zurich, Switzerland
| | - A Curt
- Spinal Cord Injury Center, University Hospital Balgrist, University of Zurich, Zurich, Switzerland
| | - J L K Kramer
- Spinal Cord Injury Center, University Hospital Balgrist, University of Zurich, Zurich, Switzerland; ICORD, School of Kinesiology, University of British Columbia, Vancouver, BC, Canada
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17
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18
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Yao J, Chen A, Kuiken T, Carmona C, Dewald J. Sensory cortical re-mapping following upper-limb amputation and subsequent targeted reinnervation: A case report. NEUROIMAGE-CLINICAL 2015; 8:329-36. [PMID: 26106558 PMCID: PMC4473101 DOI: 10.1016/j.nicl.2015.01.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 12/31/2014] [Accepted: 01/03/2015] [Indexed: 11/30/2022]
Abstract
This case study demonstrates the change of sensory cortical representations of the residual parts of the arm in an individual who underwent a trans-humeral amputation and subsequent targeted reinnervation (TR). As a relatively new surgical technique, TR restores a direct neural connection from amputated sensorimotor nerves to specific target muscles. This method has been successfully applied to upper-limb and lower-limb amputees, and has shown effectiveness in regaining control signals via the newly re-innervated muscles. Correspondingly, recent study results have shown that motor representations for the missing limb move closer to their original locations following TR. Besides regaining motor control signals, TR also restores the sensation in the re-innervated skin areas. We therefore hypothesize that TR causes analogous cortical sensory remapping that may return closer to their original locations. In order to test this hypothesis, cortical activity in response to sensory-level electrical stimulation in different parts of the arm was studied longitudinally in one amputated individual before and up to 2 years after TR. Our results showed that 1) before TR, the cortical response to sensory electrical stimulation in the residual limb showed a diffuse bilateral pattern without a clear focus in either the time or spatial domain; and 2) 2 years after TR, the sensory map of the reinnervated median nerve reorganized, showing predominant activity over the contralateral S1 hand area as well as moderate activity over the ipsilateral S1. Therefore, this work provides new evidence for long-term sensory cortical plasticity in the human brain after TR. We studied sensory cortical mapping before and after targeted reinnervation (TR). EEG was recorded when stimulating the intact finger and the residual nerve. The experiment was repeated longitudinally through 2 years in a single subject. The missing finger representation changed back to a more normal pattern post-TR. Neural mechanisms underlying TR-induced sensory cortical remapping are discussed.
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Affiliation(s)
- Jun Yao
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, IL, USA
| | - Albert Chen
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, IL, USA ; Department of Biomedical Engineering, Northwestern University, IL, USA
| | - Todd Kuiken
- Department of Biomedical Engineering, Northwestern University, IL, USA ; Department of Physical Medicine and Rehabilitation, Northwestern University, IL, USA ; Center for Bionic Medicine, Rehabilitation Institute of Chicago, IL, USA
| | - Carolina Carmona
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, IL, USA
| | - Julius Dewald
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, IL, USA ; Department of Biomedical Engineering, Northwestern University, IL, USA ; Department of Physical Medicine and Rehabilitation, Northwestern University, IL, USA
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