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Eren T, Kuru CA, Harput G, Leblebicioglu G. Case-based report of graded motor imagery experience in traumatic brachial plexus injury: The art of moving without moving. J Hand Ther 2024; 37:161-169. [PMID: 37586989 DOI: 10.1016/j.jht.2023.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 05/09/2023] [Accepted: 05/15/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND We reported a 24-year-old woman who sustained multiple upper limb injuries after a traffic accident in March 2017. She sustained a C7-T1 brachial plexus injury and radial nerve injury on the left side diagnosed in November 2017. The patient underwent radial nerve reconstruction. The patient began her comprehensive therapy program in January 2018. PURPOSE To describe the use of graded motor imagery (GMI) and outcomes after traumatic brachial plexus palsy. We presented changes in electromyographic (EMG) activity of target muscles during task execution and functional status following 10-session GMI therapy. STUDY DESIGN Case report. METHODS The program included 4 sessions of motor imagery and 6 sessions of a combination of motor imagery and mirror therapy. RESULTS The patient successfully participated in the program with reported improvements in EMG activity, functional status, emotional well-being, and body awareness. CONCLUSIONS GMI therapy appears to have peripheral motor effects, including altered surface EMG activity and contributes to a favorable outcome in the functional level of the affected arm. An improved emotional state and awareness of the affected hand could have a positive effect on function. Future long-term randomized controlled trials are needed to investigate the cumulative peripheral effects of treatment of graded motor imagery and the effects of variables mediating its effects on functional performance in patients with nerve injury.
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Affiliation(s)
- Tuba Eren
- Beykent University, Faculty of Health Sciences, Istanbul, Turkey
| | - Cigdem Ayhan Kuru
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Ankara, Turkey.
| | - Gulcan Harput
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Ankara, Turkey
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2
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Yanagisawa T, Fukuma R, Seymour B, Tanaka M, Yamashita O, Hosomi K, Kishima H, Kamitani Y, Saitoh Y. Neurofeedback Training without Explicit Phantom Hand Movements and Hand-Like Visual Feedback to Modulate Pain: A Randomized Crossover Feasibility Trial. THE JOURNAL OF PAIN 2022; 23:2080-2091. [PMID: 35932992 DOI: 10.1016/j.jpain.2022.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 06/25/2022] [Accepted: 07/20/2022] [Indexed: 01/04/2023]
Abstract
Phantom limb pain is attributed to abnormal sensorimotor cortical representations, although the causal relationship between phantom limb pain and sensorimotor cortical representations suffers from the potentially confounding effects of phantom hand movements. We developed neurofeedback training to change sensorimotor cortical representations without explicit phantom hand movements or hand-like visual feedback. We tested the feasibility of neurofeedback training in fourteen patients with phantom limb pain. Neurofeedback training was performed in a single-blind, randomized, crossover trial using two decoders constructed using motor cortical currents measured during phantom hand movements; the motor cortical currents contralateral or ipsilateral to the phantom hand (contralateral and ipsilateral training) were estimated from magnetoencephalograms. Patients were instructed to control the size of a disk, which was proportional to the decoding results, but to not move their phantom hands or other body parts. The pain assessed by the visual analogue scale was significantly greater after contralateral training than after ipsilateral training. Classification accuracy of phantom hand movements significantly increased only after contralateral training. These results suggested that the proposed neurofeedback training changed phantom hand representation and modulated pain without explicit phantom hand movements or hand-like visual feedback, thus showing the relation between the phantom hand representations and pain. PERSPECTIVE: Our work demonstrates the feasibility of using neurofeedback training to change phantom hand representation and modulate pain perception without explicit phantom hand movements and hand-like visual feedback. The results enhance the mechanistic understanding of certain treatments, such as mirror therapy, that change the sensorimotor cortical representation.
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Affiliation(s)
- Takufumi Yanagisawa
- Osaka University, Institute for Advanced Co-Creation Studies, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan; Osaka University Graduate School of Medicine, Department of Neurosurgery, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan; ATR Computational Neuroscience Laboratories, Department of Neuroinformatics, 2-2-2 Hikaridai, Seika-cho, Kyoto 619-0288, Japan.
| | - Ryohei Fukuma
- Osaka University, Institute for Advanced Co-Creation Studies, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan; Osaka University Graduate School of Medicine, Department of Neurosurgery, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan; ATR Computational Neuroscience Laboratories, Department of Neuroinformatics, 2-2-2 Hikaridai, Seika-cho, Kyoto 619-0288, Japan
| | - Ben Seymour
- University of Oxford, Institute of Biomedical Engineering, Department of Engineering Science, Old Road Campus Research Building, Oxford OX3 7DQ, UK; National Institute for Information and Communications Technology, Center for Information and Neural Networks, 1-3 Suita, Osaka 565-0871, Japan
| | - Masataka Tanaka
- Osaka University Graduate School of Medicine, Department of Neurosurgery, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Okito Yamashita
- RIKEN Center for Advanced Intelligence Project, Nihonbashi 1-chome Mitsui Building, 15th floor, 1-4-1 Nihonbashi, Chuo-ku, Tokyo 103-0027, Japan; ATR Neural Information Analysis Laboratories, Department of Computational Brain Imaging, 2-2-2 Hikaridai, Seika-cho, Kyoto 619-0288, Japan
| | - Koichi Hosomi
- Osaka University Graduate School of Medicine, Department of Neurosurgery, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan; Osaka University Graduate School of Medicine, Department of Neuromodulation and Neurosurgery, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Haruhiko Kishima
- Osaka University Graduate School of Medicine, Department of Neurosurgery, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Yukiyasu Kamitani
- ATR Computational Neuroscience Laboratories, Department of Neuroinformatics, 2-2-2 Hikaridai, Seika-cho, Kyoto 619-0288, Japan; Kyoto University, Graduate School of Informatics, Yoshidahonmachi, Sakyoku, Kyoto, Kyoto 606-8501, Japan
| | - Youichi Saitoh
- Osaka University Graduate School of Medicine, Department of Neurosurgery, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan; Osaka University Graduate School of Medicine, Department of Neuromodulation and Neurosurgery, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
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3
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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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4
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Osumi M, Shimizu D, Nishi Y, Morioka S. Electrical stimulation of referred sensation area alleviates phantom limb pain. Restor Neurol Neurosci 2021; 39:101-110. [PMID: 33682735 DOI: 10.3233/rnn-201132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Patients with brachial plexus avulsion (BPA) usually experience phantom sensations and phantom limb pain (PLP) in the deafferented limb. It has been suggested that evoking the sensation of touch in the deafferented limb by stimulating referred sensation areas (RSAs) on the cheek or shoulder might alleviate PLP. However, feasible rehabilitation techniques using this approach have not been reported. OBJECTIVE The present study sought to examine the analgesic effects of simple electrical stimulation of RSAs in BPA patients with PLP. METHODS Study 1: Electrical stimulation of RSAs for 60 minutes was conducted for six BPA patients suffering from PLP to examine short-term analgesic effects. Study 2: A single case design experiment was conducted with two BPA patients to investigate whether electrical stimulation of RSAs was more effective for alleviating PLP than control electrical stimulation (electrical stimulation of sites on side opposite to the RSAs), and to elucidate the long-term effects of electrical stimulation of RSAs. RESULTS Study 1: Electrical stimulation of RSAs evoked phantom touch sensations in the deafferented limb, and significantly alleviated PLP (p < 0.05). Study 2: PLP was alleviated more after electrical stimulation on RSAs compared with control electrical stimulation (p < 0.05). However, the analgesic effects of electrical stimulation on RSAs were observed only in the short term, not in the long term (p > 0.05). CONCLUSIONS Electrical stimulation of RSAs not only evoked phantom touch sensation but also alleviated PLP in the short term. The results indicate that electrical stimulation of RSAs may provide a useful practical rehabilitation technique for PLP. Future studies will be required to clarify the mechanisms underlying immediate PLP alleviation via electrical stimulation of RSAs.
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Affiliation(s)
- Michihiro Osumi
- Graduate School of Health Science, Kio University, Nara, Japan.,Neurorehabilitation Research Center, Kio University, Nara, Japan
| | - Daisuke Shimizu
- School of Rehabilitation, Hyogo University of Health Sciences, Kobe, Japan
| | - Yuki Nishi
- Graduate School of Health Science, Kio University, Nara, Japan.,Neurorehabilitation Research Center, Kio University, Nara, Japan
| | - Shu Morioka
- Graduate School of Health Science, Kio University, Nara, Japan.,Neurorehabilitation Research Center, Kio University, Nara, Japan
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5
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Li C, Liu SY, Pi W, Zhang PX. Cortical plasticity and nerve regeneration after peripheral nerve injury. Neural Regen Res 2021; 16:1518-1523. [PMID: 33433465 PMCID: PMC8323687 DOI: 10.4103/1673-5374.303008] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
With the development of neuroscience, substantial advances have been achieved in peripheral nerve regeneration over the past decades. However, peripheral nerve injury remains a critical public health problem because of the subsequent impairment or absence of sensorimotor function. Uncomfortable complications of peripheral nerve injury, such as chronic pain, can also cause problems for families and society. A number of studies have demonstrated that the proper functioning of the nervous system depends not only on a complete connection from the central nervous system to the surrounding targets at an anatomical level, but also on the continuous bilateral communication between the two. After peripheral nerve injury, the interruption of afferent and efferent signals can cause complex pathophysiological changes, including neurochemical alterations, modifications in the adaptability of excitatory and inhibitory neurons, and the reorganization of somatosensory and motor regions. This review discusses the close relationship between the cerebral cortex and peripheral nerves. We also focus on common therapies for peripheral nerve injury and summarize their potential mechanisms in relation to cortical plasticity. It has been suggested that cortical plasticity may be important for improving functional recovery after peripheral nerve damage. Further understanding of the potential common mechanisms between cortical reorganization and nerve injury will help to elucidate the pathophysiological processes of nerve injury, and may allow for the reduction of adverse consequences during peripheral nerve injury recovery. We also review the role that regulating reorganization mechanisms plays in functional recovery, and conclude with a suggestion to target cortical plasticity along with therapeutic interventions to promote peripheral nerve injury recovery.
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Affiliation(s)
- Ci Li
- Department of Orthopedics and Trauma, Peking University People's Hospital; Key Laboratory of Trauma and Neural Regeneration, Peking University, Beijing, China
| | - Song-Yang Liu
- Department of Orthopedics and Trauma, Peking University People's Hospital; Key Laboratory of Trauma and Neural Regeneration, Peking University, Beijing, China
| | - Wei Pi
- Department of Orthopedics and Trauma, Peking University People's Hospital; Key Laboratory of Trauma and Neural Regeneration, Peking University, Beijing, China
| | - Pei-Xun Zhang
- Department of Orthopedics and Trauma, Peking University People's Hospital; Key Laboratory of Trauma and Neural Regeneration, Peking University; National Center for Trauma Medicine, Beijing, China
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6
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Neuropathic Pain Related to Peripheral Neuropathies According to the IASP Grading System Criteria. Brain Sci 2020; 11:brainsci11010001. [PMID: 33374929 PMCID: PMC7821938 DOI: 10.3390/brainsci11010001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 12/16/2020] [Accepted: 12/17/2020] [Indexed: 12/26/2022] Open
Abstract
Neuropathic pain is defined as pain caused by a lesion or disease of the somatosensory system. Neuropathic pain represents a broad category of pain conditions, common complications of peripheral neuropathies, which are characterized by a combination of positive symptoms, including paresthesia and/or dysesthesia and sensory deficits in the painful area. In the present paper, we aimed to assess neuropathic pain frequency and clinical characteristics of peripheral neuropathies due to different aetiologies according to grading system criteria of the International Association for the Study of Pain for a definitive diagnosis of neuropathic pain. Epidemiological studies applying these criteria have been conducted in patients with diabetes, brachial plexus injury, and other traumatic nerve injuries. Neuropathic pain was diagnosed in 37–42% of patients with diabetic peripheral neuropathy, 56% of patients with brachial plexus injury, and 22% of patients with intercostobrachial neuropathy. The most frequent neuropathic pain type was ongoing pain (described as burning or pressing), followed by paroxysmal pain (electric shock-like sensations) and allodynia (pain evoked by brushing and pressure). By providing information on the frequency, clinical signs, and variables associated with neuropathic pain due to different aetiologies, these studies contribute to improving the clinical management of this condition.
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7
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Acupuncture Induces Reduction in Limbic-Cortical Feedback of a Neuralgia Rat Model: A Dynamic Causal Modeling Study. Neural Plast 2020; 2020:5052840. [PMID: 32148473 PMCID: PMC7023796 DOI: 10.1155/2020/5052840] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 01/02/2020] [Accepted: 01/10/2020] [Indexed: 11/17/2022] Open
Abstract
Background Neuropathic pain after brachial plexus avulsion remained prevalent and intractable currently. However, the neuroimaging study about neural mechanisms or etiology was limited and blurred. Objective This study is aimed at investigating the effect of electroacupuncture on effective connectivity and neural response in corticolimbic circuitries during implicit processing of nociceptive stimulus in rats with brachial plexus pain. Methods An fMRI scan was performed in a total of 16 rats with brachial plexus pain, which was equally distributed into the model group and the electroacupuncture group. The analysis of task-dependent data determined pain-related activation in each group. Based on those results, several regions including AMY, S1, and h were recruited as ROI in dynamic causal modeling (DCM) analysis comparing evidence for different neuronal hypotheses describing the propagation of noxious stimuli in regions of interest and horizontal comparison of effective connections between the model and electroacupuncture groups. Results In both groups, DCM revealed that noxious stimuli were most likely driven by the somatosensory cortex, with bidirectional propagation with the hypothalamus and amygdala and the interactions in them. Also, the 3-month intervention of acupuncture reduced effective connections of h-S1 and AMY-S1. Conclusions We showed an evidence that a full connection model within the brain network of brachial plexus pain and electroacupuncture intervention reduces effective connectivity from h and AMY to S1. Our study for the first time explored the relationship of involved brain regions with dynamic causal modeling. It provided novel evidence for the feature of the organization of the cortical-limbic network and the alteration caused by acupuncture.
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8
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Osumi M, Sano Y, Ichinose A, Wake N, Yozu A, Kumagaya SI, Kuniyoshi Y, Morioka S, Sumitani M. Direct evidence of EEG coherence in alleviating phantom limb pain by virtual referred sensation: Case report. Neurocase 2020; 26:55-59. [PMID: 31762364 DOI: 10.1080/13554794.2019.1696368] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Virtual reality (VR) systems have been integrated into rehabilitation techniques for phantom limb pain (PLP). In this case report, we used electroencephalography (EEG) to analyze corticocortical coherence between the bilateral sensorimotor cortices during vibrotactile stimulation in conjunction with VR rehabilitation in two PLP patients. As a result, we observed PLP alleviation and increased alpha wave coherence during VR rehabilitation when stimulation was delivered to the cheek and shoulder (referred sensation areas) of the affected side. Vibrotactile stimulation with VR rehabilitation may enhance the awareness and movement of the phantom hand.
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Affiliation(s)
- Michihiro Osumi
- Neurorehabilitation Research Center, Kio University, Nara, Japan
| | - Yuko Sano
- Intelligent Systems and Informatics Laboratory, Department of Mechano-Informatics, Graduate School of Information Science and Technology, The University of Tokyo, Tokyo, Japan
| | - Akimichi Ichinose
- Intelligent Systems and Informatics Laboratory, Department of Mechano-Informatics, Graduate School of Information Science and Technology, The University of Tokyo, Tokyo, Japan
| | - Naoki Wake
- Intelligent Systems and Informatics Laboratory, Department of Mechano-Informatics, Graduate School of Information Science and Technology, The University of Tokyo, Tokyo, Japan
| | - Arito Yozu
- Center of Medical Science, Ibaraki Prefectural University of Health Science, Tokyo, Japan
| | - Shin-Ichiro Kumagaya
- Research Center for Advanced Science and Technology, The University of Tokyo, Tokyo, Japan
| | - Yasuo Kuniyoshi
- Intelligent Systems and Informatics Laboratory, Department of Mechano-Informatics, Graduate School of Information Science and Technology, The University of Tokyo, Tokyo, Japan
| | - Shu Morioka
- Neurorehabilitation Research Center, Kio University, Nara, Japan
| | - Masahiko Sumitani
- Department of Pain and Palliative Medicine, The University of Tokyo Hospital, Tokyo, Japan
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Shen J, Huo BB, Hua XY, Zheng MX, Lu YC, Wu JJ, Shan CL, Xu JG. Cerebral 18F-FDG metabolism alteration in a neuropathic pain model following brachial plexus avulsion: A PET/CT study in rats. Brain Res 2019; 1712:132-138. [PMID: 30738025 DOI: 10.1016/j.brainres.2019.02.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 02/03/2019] [Accepted: 02/05/2019] [Indexed: 12/14/2022]
Abstract
The present study aimed to investigate cerebral metabolic changes in a neuropathic pain model following deafferentation. A total of 24 Sprague-Dawley rats were included for modeling of right brachial plexus avulsion (BPA) through the posterior approach. As nerve injury would cause central sensitization and facilitate pain sensitivity in other parts of the body, thermal withdrawal latency (TWL) of the intact forepaw was assessed to investigate the level of pain perception following BPA-induced neuropathic pain. [Fluorine-18]-fluoro-2-deoxy-d-glucose (18F-FDG) positron emission tomography (PET) was applied to the brain before and after brachial plexus avulsion to explore metabolic changes in neuropathic pain following deafferentation. The TWL of the left (intact) forepaw was significantly lower after BPA than that of baseline (p < 0.001). Using TWL as a covariate, standardized uptake values (SUVs) of 18F-FDG significantly increased in the ipsilateral dorsolateral thalamus and contralateral anterodorsal hippocampus after BPA. Conversely, SUVs in multiple brain regions decreased, including the contralateral somatosensory cortex, ipsilateral cingulate cortex, and ipsilateral temporal association cortex. The Pearson correlation analysis showed that the SUVs of the contralateral anterodorsal hippocampus and ipsilateral dorsolateral thalamus were negatively related to the TWL of the intact forepaw, whereas the SUVs in the contralateral somatosensory cortex and ipsilateral cingulate cortex were positively related to it (p < 0.05). These findings indicate that upregulation of metabolism in the anterodorsal hippocampus and dorsolateral thalamus and downregulation metabolism in the contralateral somatosensory cortex and ipsilateral cingulate cortex could be a unique pattern of metabolic changes for neuropathic pain following brachial plexus avulsion.
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Affiliation(s)
- Jun Shen
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Bei-Bei Huo
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xu-Yun Hua
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China; Department of Trauma and Orthopedics, Yueyang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Mou-Xiong Zheng
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China; Department of Trauma and Orthopedics, Yueyang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ye-Chen Lu
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jia-Jia Wu
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Chun-Lei Shan
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China; Department of Rehabilitation Medicine, Yueyang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jian-Guang Xu
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China; Department of Rehabilitation Medicine, Yueyang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
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Pazzaglia M, Galli G, Lucci G, Scivoletto G, Molinari M, Haggard P. Phantom limb sensations in the ear of a patient with a brachial plexus lesion. Cortex 2018; 117:385-395. [PMID: 30293692 DOI: 10.1016/j.cortex.2018.08.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 06/22/2018] [Accepted: 08/25/2018] [Indexed: 12/18/2022]
Abstract
Referred phantom sensations are frequently reported following a peripheral injury. However, very few cases describe such sensations of the ear, and it remains unclear how the aural nerve territory can be remapped to one specific peripheral nerve region. We report on a patient with brachial plexus avulsion who underwent sensory testing and was asked to report the location of the stimulated site and any other sensations experienced. The patient spontaneously described the sensation of his arm being separate from his body. Despite visual input, he felt that his fist was closed, with his thumb pointing inward. Importantly, he felt clear and reproducible sensations from the affected arm when the ipsilateral ear was touched. These referred sensations were noted just 15 days after sustaining the injury. The arm nerve territory was systematically remapped to a specific aural nerve territory by applying both manual and electrical stimulation. Stimulation of the external ear, which is innervated by the vagus nerve, showed high spatial specificity for the dorsal and volar skin surfaces of the limb, and clearly delineated digits. Somatosensory-evoked potentials indicated that cortical adaptation in the somatosensory stream transferred a spatially organized map of the limb to the skin of the outer ear. This referral of sensations to the ear, as distinct from the face, provides evidence of highly specific topographical reorganization of the central nervous system following peripheral injury. Rapid map changes in the phantom sensation to the ear as a function of stimulation of vagus nerve suggest that the reorganization process can occur in cortex rather than in the brainstem.
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Affiliation(s)
- Mariella Pazzaglia
- Department of Psychology, University of Rome "La Sapienza", Rome, Italy; IRCCS Fondazione Santa Lucia, Rome, Italy.
| | | | - Giuliana Lucci
- Department of Psychology, University of Rome "La Sapienza", Rome, Italy
| | | | | | - Patrick Haggard
- Institute of Cognitive Neuroscience, University College London, London, UK
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11
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Ciaramitaro P, Padua L, Devigili G, Rota E, Tamburin S, Eleopra R, Cruccu G, Truini A. Prevalence of Neuropathic Pain in Patients with Traumatic Brachial Plexus Injury: A Multicenter Prospective Hospital-Based Study. PAIN MEDICINE 2018; 18:2428-2432. [PMID: 28340085 DOI: 10.1093/pm/pnw360] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objective Prevalence and clinical characteristics of neuropathic pain due to traumatic brachial plexus injury. Design Observational epidemiological study. Setting Hospital-based multicenter study. Subjects One hundred seven prospectively enrolled patients with brachial plexus injury. Methods All the patients underwent clinical examination and neurophysiological testing for a definitive diagnosis of the brachial plexus lesion. The DN4 questionnaire was used to identify neuropathic pain, and the Neuropathic Pain Symptom Inventory (NPSI) to evaluate the different symptoms of neuropathic pain. The SF36 questionnaire and the Beck Depression Inventory (BDI) were used to assess quality of life and mood disturbances in patients with neuropathic pain. Results Of the 107 enrolled patients, 74 had pain (69%); neuropathic pain, as assessed by means of the DN4, was identified in 60 (56%) of these patients. According to the NPSI, the most frequent and severe pain type was the spontaneous burning pain. Clinical and neurophysiological findings showed that pain is unrelated to age but is associated with the severity of peripheral nerve damage. The SF36 questionnaire and BDI showed that neuropathic pain impairs quality of life and causes depression. Conclusions Our study provides information on the prevalence, characteristics, and variables associated with neuropathic pain due to traumatic brachial plexus injuries that might provide a basis for improving the clinical management of this condition.
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Affiliation(s)
- Palma Ciaramitaro
- Clinical Neurophysiology, Neuroscience Department, AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - Luca Padua
- Institute of Neurology, Catholic University, Rome, Italy.,Don Carlo Gnocchi Onlus Foundation, Italy
| | - Grazia Devigili
- AOU S. Maria della Misericordia, UOC Neurologia, Udine, Italy
| | - Eugenia Rota
- Presidio Ospedaliero di Piacenza, UOC Neurologia, Piacenza, Italy
| | - Stefano Tamburin
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Roberto Eleopra
- AOU S. Maria della Misericordia, UOC Neurologia, Udine, Italy
| | - Giorgio Cruccu
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Andrea Truini
- Department of Neurology and Psychiatry, Sapienza University, Rome, Italy
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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. MEG-BMI to Control Phantom Limb Pain. Neurol Med Chir (Tokyo) 2018; 58:327-333. [PMID: 29998936 PMCID: PMC6092605 DOI: 10.2176/nmc.st.2018-0099] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
A brachial plexus root avulsion (BPRA) causes intractable pain in the insensible affected hands. Such pain is partly due to phantom limb pain, which is neuropathic pain occurring after the amputation of a limb and partial or complete deafferentation. Previous studies suggested that the pain was attributable to maladaptive plasticity of the sensorimotor cortex. However, there is little evidence to demonstrate the causal links between the pain and the cortical representation, and how much cortical factors affect the pain. Here, we applied lesioning of the dorsal root entry zone (DREZotomy) and training with a brain–machine interface (BMI) based on real-time magnetoencephalography signals to reconstruct affected hand movements with a robotic hand. The DREZotomy successfully reduced the shooting pain after BPRA, but a part of the pain remained. The BMI training successfully induced some plastic changes in the sensorimotor representation of the phantom hand movements and helped control the remaining pain. When the patient tried to control the robotic hand by moving their phantom hand through association with the representation of the intact hand, this especially decreased the pain while decreasing the classification accuracy of the phantom hand movements. These results strongly suggested that pain after the BPRA was partly attributable to cortical representation of phantom hand movements and that the BMI training controlled the pain by inducing appropriate cortical reorganization. For the treatment of chronic pain, we need to know how to modulate the cortical representation by novel methods.
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Affiliation(s)
- Takufumi Yanagisawa
- Department of Neurosurgery, Osaka University Graduate School of Medicine.,Osaka University Institute for Advanced Co-Creation Studies.,Department of Neuroinformatics, ATR Computational Neuroscience Laboratories.,Division of Clinical Neuroengineering, Global Center for Medical Engineering and Informatics, Osaka University
| | - Ryohei Fukuma
- Department of Neurosurgery, Osaka University Graduate School of Medicine.,Department of Neuroinformatics, ATR Computational Neuroscience Laboratories
| | - Ben Seymour
- Computational and Biological Learning Laboratory, Department of Engineering, University of Cambridge.,Center for Information and Neural Networks, National Institute for Information and Communications Technology
| | - Koichi Hosomi
- Department of Neurosurgery, Osaka University Graduate School of Medicine.,Department of Neuromodulation and Neurosurgery, Osaka University Graduate School of Medicine
| | - Haruhiko Kishima
- Department of Neurosurgery, Osaka University Graduate School of Medicine
| | - Takeshi Shimizu
- Department of Neurosurgery, Osaka University Graduate School of Medicine.,Department of Neuromodulation and Neurosurgery, Osaka University Graduate School of Medicine
| | - Hiroshi Yokoi
- Department of Mechanical Engineering and Intelligent Systems, The University of Electro-Communications
| | - Masayuki Hirata
- Department of Neurosurgery, Osaka University Graduate School of Medicine.,Division of Clinical Neuroengineering, Global Center for Medical Engineering and Informatics, Osaka University
| | - Toshiki Yoshimine
- Department of Neurosurgery, Osaka University Graduate School of Medicine.,Division of Clinical Neuroengineering, Global Center for Medical Engineering and Informatics, Osaka University
| | - Yukiyasu Kamitani
- Department of Neuroinformatics, ATR Computational Neuroscience Laboratories.,Graduate School of Informatics, Kyoto University
| | - Youichi Saitoh
- Department of Neurosurgery, Osaka University Graduate School of Medicine.,Department of Neuromodulation and Neurosurgery, Osaka University Graduate School of Medicine
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13
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Russell HG, Tsao JW. Phantom Sensations Following Brachial Plexus Nerve Block: A Case Report. Front Neurol 2018; 9:436. [PMID: 29951033 PMCID: PMC6008534 DOI: 10.3389/fneur.2018.00436] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 05/24/2018] [Indexed: 11/13/2022] Open
Abstract
Following the administration of brachial plexus anesthesia for right thumb carpometacarpal arthroplasty with ligament reconstruction, a 54-year-old woman with all limbs intact developed phantom limb sensations, including the misperception of the placement of her right arm and frozen limb sensations in her fingers. Immobility of her fingers in a stacked position was experienced for ~3.5 days after surgery, and she described her phantom sensations as the hand experiencing "tingling" and feeling "heavy." While the onset of these phantom sensations occurred almost immediately after administration of brachial plexus anesthesia, they lasted for ~69 h after anesthesia wear off, suggesting that cortical effects from denervation resolves much more slowly than initial remapping, giving insight into the mechanisms behind phantom limb sensations that are often experienced by amputees.
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Affiliation(s)
- Hannah G Russell
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Jack W Tsao
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, United States.,Children's Foundation Research Institute, Le Bonheur Children's Hospital, Memphis, TN, United States.,Department of Neurology, Memphis Veterans Affairs Medical Center, Memphis, TN, United States
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14
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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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15
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Osumi M, Ichinose A, Sumitani M, Wake N, Sano Y, Yozu A, Kumagaya S, Kuniyoshi Y, Morioka S. Restoring movement representation and alleviating phantom limb pain through short-term neurorehabilitation with a virtual reality system. Eur J Pain 2016; 21:140-147. [DOI: 10.1002/ejp.910] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2016] [Indexed: 11/07/2022]
Affiliation(s)
- M. Osumi
- Neurorehabilitation Research Center; Kio University; Nara Japan
| | - A. Ichinose
- Intelligent Systems and Informatics Laboratory; Department of Mechano-Informatics; Graduate School of Information Science and Technology; The University of Tokyo; Japan
| | - M. Sumitani
- Department of Pain and Palliative Medicine; The University of Tokyo Hospital; Japan
| | - N. Wake
- Intelligent Systems and Informatics Laboratory; Department of Mechano-Informatics; Graduate School of Information Science and Technology; The University of Tokyo; Japan
| | - Y. Sano
- Intelligent Systems and Informatics Laboratory; Department of Mechano-Informatics; Graduate School of Information Science and Technology; The University of Tokyo; Japan
| | - A. Yozu
- Department of Rehabilitation Medicine; Graduate School of Medicine; The University of Tokyo; Japan
| | - S. Kumagaya
- Research Center for Advanced Science and Technology; The University of Tokyo; Japan
| | - Y. Kuniyoshi
- Intelligent Systems and Informatics Laboratory; Department of Mechano-Informatics; Graduate School of Information Science and Technology; The University of Tokyo; Japan
| | - S. Morioka
- Neurorehabilitation Research Center; Kio University; Nara Japan
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16
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Tsao JW, Finn SB, Miller ME. Reversal of phantom pain and hand-to-face remapping after brachial plexus avulsion. Ann Clin Transl Neurol 2016; 3:463-4. [PMID: 27547774 PMCID: PMC4892000 DOI: 10.1002/acn3.316] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 04/15/2016] [Accepted: 04/18/2016] [Indexed: 11/23/2022] Open
Abstract
Following left brachial plexus avulsion, a 20‐year‐old man had phantom limb pain and remapping of sensation from his paralyzed hand onto his face. Mirror therapy (15 min daily, 5 days/week) led immediately to good movement of the phantom limb with decreased pain. Within 2 weeks following nerve graft surgery, remapping of hand sensation onto the face disappeared along with resolution of phantom limb pain. Mirror therapy coupled with nerve grafting may relieve phantom limb pain due to brachial plexus avulsion and reverse hand‐to‐face remapping, suggesting that both peripheral and central mechanisms mediate development of phantom limb pain and cortical reorganization/neuroplasticity after brachial plexus avulsion.
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Affiliation(s)
- Jack W Tsao
- Walter Reed National Military Medical Center Bethesda Maryland; Present address: University of Tennessee Health Science Center Memphis Tennessee
| | - Sacha B Finn
- Walter Reed National Military Medical Center Bethesda Maryland
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