1
|
Maggio MG, Naro A, De Luca R, Latella D, Balletta T, Caccamo L, Pioggia G, Bruschetta D, Calabrò RS. Body Representation in Patients with Severe Spinal Cord Injury: A Pilot Study on the Promising Role of Powered Exoskeleton for Gait Training. J Pers Med 2022; 12:jpm12040619. [PMID: 35455735 PMCID: PMC9030625 DOI: 10.3390/jpm12040619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 04/05/2022] [Accepted: 04/08/2022] [Indexed: 12/15/2022] Open
Abstract
Patients with spinal cord injury (SCI) complain of changes in body representation, potentially leading to negative physical and psychological consequences. The purpose of our study is to evaluate the effects of robotic training with the Ekso-GT on body representation (BR) and on the quality of life in patients with SCI. The trial was designed as a pilot, assessor-blinded study. Forty-two inpatients with a diagnosis of SCI, classified as either American Spinal Cord Injury Association Impairment Scale (AIS), were enrolled in this study and randomized into either a control (CG: n = 21) or an experimental (EG: n = 21) group. Patients in the EG received rehabilitation training with the Ekso-GT device, whereas the CG patients were trained with conventional physical therapy (CPT), which consisted of physical and occupational therapy and psychological support. We considered as a primary outcome the modified Body Uneasiness Test (MBUT), focusing on three specific subscales on the patient’s perception of BR, i.e., the Global Severity Index (MBUT-GSI), which is an indicator of body suffering; the Positive Symptom Distress Index (MBUT-PSDI) that expresses an individual’s psychological distress; and the Lower Limb MBUT (MBUT-LL), which indicates the subject’s perception of their thighs/legs. The Short-Form-12 Health Status Questionnaire (SF12) and the Beck’s Depression Inventory (BDI) were used as secondary outcomes to evaluate the effect of the training on the quality of life and the psychological status. Non-parametric statistical analysis showed that the effect of the two treatments was significantly different on MBUT (BR), SF-12 (quality of life), and, partially, BDI (mood). Particularly, patients belonging to the EG achieved a major improvement in nearly all test scores compared to those in the CG. Our data suggest that the Ekso-GT training could be helpful in achieving positive changes in BR in patients with chronic SCI, especially in reducing psychological distress (PSDI) and thigh/leg perception (MBUT-LL) with an overall improvement in quality of life (SF-12).
Collapse
Affiliation(s)
- Maria Grazia Maggio
- Department of Biomedical and Biotechnological Science, University of Catania, 95123 Catania, Italy;
| | - Antonino Naro
- AOU Policlinico “G. Martino”, 98125 Messina, Italy; (A.N.); (D.B.)
| | - Rosaria De Luca
- IRCCS Centro Neurolesi “Bonino Pulejo”, 98121 Messina, Italy; (R.D.L.); (D.L.); (T.B.)
| | - Desiree Latella
- IRCCS Centro Neurolesi “Bonino Pulejo”, 98121 Messina, Italy; (R.D.L.); (D.L.); (T.B.)
| | - Tina Balletta
- IRCCS Centro Neurolesi “Bonino Pulejo”, 98121 Messina, Italy; (R.D.L.); (D.L.); (T.B.)
| | - Lory Caccamo
- Neuropsychology Unit, University of Padua, 35121 Padua, Italy;
| | - Giovanni Pioggia
- Institute for Biomedical Research and Innovation, National Research Council of Italy (IRIB-CNR), 98164 Messina, Italy;
| | | | - Rocco Salvatore Calabrò
- IRCCS Centro Neurolesi “Bonino Pulejo”, 98121 Messina, Italy; (R.D.L.); (D.L.); (T.B.)
- Correspondence: ; Tel.: +39-090-6012-3850
| |
Collapse
|
2
|
Forte G, Leemhuis E, Favieri F, Casagrande M, Giannini AM, De Gennaro L, Pazzaglia M. Exoskeletons for Mobility after Spinal Cord Injury: A Personalized Embodied Approach. J Pers Med 2022; 12:jpm12030380. [PMID: 35330380 PMCID: PMC8954494 DOI: 10.3390/jpm12030380] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/24/2022] [Accepted: 02/28/2022] [Indexed: 02/05/2023] Open
Abstract
Endowed with inherent flexibility, wearable robotic technologies are powerful devices that are known to extend bodily functionality to assist people with spinal cord injuries (SCIs). However, rather than considering the specific psychological and other physiological needs of their users, these devices are specifically designed to compensate for motor impairment. This could partially explain why they still cannot be adopted as an everyday solution, as only a small number of patients use lower-limb exoskeletons. It remains uncertain how these devices can be appropriately embedded in mental representations of the body. From this perspective, we aimed to highlight the homeostatic role of autonomic and interoceptive signals and their possible integration in a personalized experience of exoskeleton overground walking. To ensure personalized user-centered robotic technologies, optimal robotic devices should be designed and adjusted according to the patient's condition. We discuss how embodied approaches could emerge as a means of overcoming the hesitancy toward wearable robots.
Collapse
Affiliation(s)
- Giuseppe Forte
- Dipartimento di Psicologia, “Sapienza” Università di Roma, Via dei Marsi 78, 00185 Rome, Italy; (E.L.); (A.M.G.); (L.D.G.); (M.P.)
- Body and Action Lab, IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy
- Correspondence: (G.F.); (F.F.)
| | - Erik Leemhuis
- Dipartimento di Psicologia, “Sapienza” Università di Roma, Via dei Marsi 78, 00185 Rome, Italy; (E.L.); (A.M.G.); (L.D.G.); (M.P.)
- Body and Action Lab, IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy
| | - Francesca Favieri
- Dipartimento di Psicologia, “Sapienza” Università di Roma, Via dei Marsi 78, 00185 Rome, Italy; (E.L.); (A.M.G.); (L.D.G.); (M.P.)
- Body and Action Lab, IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy
- Correspondence: (G.F.); (F.F.)
| | - Maria Casagrande
- Dipartimento di Psicologia Dinamica, Clinica e Salute, Università di Rome “Sapienza”, Via Degli Apuli 1, 00185 Rome, Italy;
| | - Anna Maria Giannini
- Dipartimento di Psicologia, “Sapienza” Università di Roma, Via dei Marsi 78, 00185 Rome, Italy; (E.L.); (A.M.G.); (L.D.G.); (M.P.)
| | - Luigi De Gennaro
- Dipartimento di Psicologia, “Sapienza” Università di Roma, Via dei Marsi 78, 00185 Rome, Italy; (E.L.); (A.M.G.); (L.D.G.); (M.P.)
- Body and Action Lab, IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy
| | - Mariella Pazzaglia
- Dipartimento di Psicologia, “Sapienza” Università di Roma, Via dei Marsi 78, 00185 Rome, Italy; (E.L.); (A.M.G.); (L.D.G.); (M.P.)
- Body and Action Lab, IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy
| |
Collapse
|
3
|
Vastano R, Costantini M, Widerstrom-Noga E. Maladaptive reorganization following SCI: The role of body representation and multisensory integration. Prog Neurobiol 2021; 208:102179. [PMID: 34600947 DOI: 10.1016/j.pneurobio.2021.102179] [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: 02/15/2021] [Revised: 09/08/2021] [Accepted: 09/24/2021] [Indexed: 10/20/2022]
Abstract
In this review we focus on maladaptive brain reorganization after spinal cord injury (SCI), including the development of neuropathic pain, and its relationship with impairments in body representation and multisensory integration. We will discuss the implications of altered sensorimotor interactions after SCI with and without neuropathic pain and possible deficits in multisensory integration and body representation. Within this framework we will examine published research findings focused on the use of bodily illusions to manipulate multisensory body representation to induce analgesic effects in heterogeneous chronic pain populations and in SCI-related neuropathic pain. We propose that the development and intensification of neuropathic pain after SCI is partly dependent on brain reorganization associated with dysfunctional multisensory integration processes and distorted body representation. We conclude this review by suggesting future research avenues that may lead to a better understanding of the complex mechanisms underlying the sense of the body after SCI, with a focus on cortical changes.
Collapse
Affiliation(s)
- Roberta Vastano
- University of Miami, Department of Neurological Surgery, The Miami Project to Cure Paralysis, Miami, FL, USA.
| | - Marcello Costantini
- Department of Psychological, Health and Territorial Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy; Institute for Advanced Biomedical Technologies, ITAB, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy.
| | - Eva Widerstrom-Noga
- University of Miami, Department of Neurological Surgery, The Miami Project to Cure Paralysis, Miami, FL, USA.
| |
Collapse
|
4
|
De Martino ML, De Bartolo M, Leemhuis E, Pazzaglia M. Rebuilding Body-Brain Interaction from the Vagal Network in Spinal Cord Injuries. Brain Sci 2021; 11:brainsci11081084. [PMID: 34439702 PMCID: PMC8391959 DOI: 10.3390/brainsci11081084] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 08/12/2021] [Accepted: 08/15/2021] [Indexed: 12/12/2022] Open
Abstract
Spinal cord injuries (SCIs) exert devastating effects on body awareness, leading to the disruption of the transmission of sensory and motor inputs. Researchers have attempted to improve perceived body awareness post-SCI by intervening at the multisensory level, with the integration of somatic sensory and motor signals. However, the contributions of interoceptive-visceral inputs, particularly the potential interaction of motor and interoceptive signals, remain largely unaddressed. The present perspective aims to shed light on the use of interoceptive signals as a significant resource for patients with SCI to experience a complete sense of body awareness. First, we describe interoceptive signals as a significant obstacle preventing such patients from experiencing body awareness. Second, we discuss the multi-level mechanisms associated with the homeostatic stability of the body, which creates a unified, coherent experience of one's self and one's body, including real-time updates. Body awareness can be enhanced by targeting the vagus nerve function by, for example, applying transcutaneous vagus nerve stimulation. This perspective offers a potentially useful insight for researchers and healthcare professionals, allowing them to be better equipped in SCI therapy. This will lead to improved sensory motor and interoceptive signals, a decreased likelihood of developing deafferentation pain, and the successful implementation of modern robotic technologies.
Collapse
Affiliation(s)
- Maria Luisa De Martino
- Department of Psychology, Sapienza University of Rome, Via dei Marsi 78, 00185 Rome, Italy; (M.L.D.M.); (M.D.B.); (E.L.)
- Body and Action Lab, IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy
| | - Mina De Bartolo
- Department of Psychology, Sapienza University of Rome, Via dei Marsi 78, 00185 Rome, Italy; (M.L.D.M.); (M.D.B.); (E.L.)
| | - Erik Leemhuis
- Department of Psychology, Sapienza University of Rome, Via dei Marsi 78, 00185 Rome, Italy; (M.L.D.M.); (M.D.B.); (E.L.)
- Body and Action Lab, IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy
| | - Mariella Pazzaglia
- Department of Psychology, Sapienza University of Rome, Via dei Marsi 78, 00185 Rome, Italy; (M.L.D.M.); (M.D.B.); (E.L.)
- Body and Action Lab, IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy
- Correspondence: ; Tel.: +39-6-49917633
| |
Collapse
|
5
|
Leemhuis E, De Gennaro L, Pazzaglia M. Disconnected Body Representation: Neuroplasticity Following Spinal Cord Injury. J Clin Med 2019; 8:jcm8122144. [PMID: 31817187 PMCID: PMC6947607 DOI: 10.3390/jcm8122144] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 12/02/2019] [Accepted: 12/02/2019] [Indexed: 02/05/2023] Open
Abstract
Neuroplastic changes in somatotopic organization within the motor and somatosensory systems have long been observed. The interruption of afferent and efferent brain–body pathways promotes extensive cortical reorganization. Changes are majorly related to the typical homuncular organization of sensorimotor areas and specific “somatotopic interferences”. Recent findings revealed a relevant peripheral contribution to the plasticity of body representation in addition to the role of sensorimotor cortices. Here, we review the ways in which structures and brain mechanisms react to missing or critically altered sensory and motor peripheral signals. We suggest that these plastic events are: (i) variably affected across multiple timescales, (ii) age-dependent, (iii) strongly related to altered perceptual sensations during and after remapping of the deafferented peripheral area, and (iv) may contribute to the appearance of secondary pathological conditions, such as allodynia, hyperalgesia, and neuropathic pain. Understanding the considerable complexity of plastic reorganization processes will be a fundamental step in the formulation of theoretical and clinical models useful for maximizing rehabilitation programs and resulting recovery.
Collapse
Affiliation(s)
- Erik Leemhuis
- Department of Psychology, University of Rome “La Sapienza”, Via dei Marsi 78, 00185 Rome, Italy;
- Istituto di Ricovero e Cura a Carattere Scientifico Fondazione Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy
- Correspondence: (E.L.); (M.P.)
| | - Luigi De Gennaro
- Department of Psychology, University of Rome “La Sapienza”, Via dei Marsi 78, 00185 Rome, Italy;
- Istituto di Ricovero e Cura a Carattere Scientifico Fondazione Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy
| | - Mariella Pazzaglia
- Department of Psychology, University of Rome “La Sapienza”, Via dei Marsi 78, 00185 Rome, Italy;
- Istituto di Ricovero e Cura a Carattere Scientifico Fondazione Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy
- Correspondence: (E.L.); (M.P.)
| |
Collapse
|
6
|
Molteni F, Gasperini G, Cannaviello G, Guanziroli E. Exoskeleton and End-Effector Robots for Upper and Lower Limbs Rehabilitation: Narrative Review. PM R 2019; 10:S174-S188. [PMID: 30269804 DOI: 10.1016/j.pmrj.2018.06.005] [Citation(s) in RCA: 86] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 06/05/2018] [Accepted: 06/10/2018] [Indexed: 10/28/2022]
Abstract
Recovery of upper and lower limbs function is essential to reach independence in daily activities in patients with upper motor neuron syndrome (UMNS). Rehabilitation can provide a guide for motor recovery influencing the neurobiology of neuronal plasticity providing controlled, repetitive, and variable patterns. Increasing therapy dosage, intensity, number of repetition, execution of task-oriented exercises, and combining top-down and bottom-up approaches can promote plasticity and functional recovery. Robotic exoskeletons for upper and lower limbs, based on the principle of motor learning, have been introduced in neurorehabilitation. In this narrative review, we provide an overview of literature published on exoskeleton devices for upper and lower limb rehabilitation in patients with UMNS; we summarized the available current research evidence and outlined the new challenges that neurorehabilitation and bioengineering will have to face in the upcoming years. Robotic treatment should be considered a rehabilitation tool useful to generate a more complex, controlled multisensory stimulation of the patient and useful to modify the plasticity of neural connections through the experience of movement. Efficacy and efficiency of robotic treatment should be defined starting from intensity, complexity, and specificity of the robotic exercise, that are related to human-robot interaction in terms of motion, emotion, motivation, meaning of the task, feedback from the exoskeleton, and fine motion assistance. Duration of a single session, global period of the treatment, and the timing for beginning of robotic treatment are still open questions. There is the need to evaluate and individualize the treatment according to patient's characteristics. Robotic devices for upper and lower limbs open a window to define therapeutic modalities as possible beneficial drug, able to boost biological, neurobiological, and epigenetic changes in central nervous system. We need to implement large and innovative research programs to answer these issues in the near future.
Collapse
Affiliation(s)
- Franco Molteni
- Valduce Hospital "Villa Beretta" Rehabilitation Center, Costa Masnaga, Italy(∗)
| | - Giulio Gasperini
- Valduce Hospital "Villa Beretta" Rehabilitation Center, Costa Masnaga, Italy(†)
| | | | - Eleonora Guanziroli
- Valduce Hospital "Villa Beretta" Rehabilitation Center, Via N. Sauro 17, Costa Masnaga, Italy(§).
| |
Collapse
|
7
|
Embodying their own wheelchair modifies extrapersonal space perception in people with spinal cord injury. Exp Brain Res 2019; 237:2621-2632. [DOI: 10.1007/s00221-019-05618-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 07/31/2019] [Indexed: 01/06/2023]
|
8
|
Scivoletto G, Galli G, Torre M, Molinari M, Pazzaglia M. The Overlooked Outcome Measure for Spinal Cord Injury: Use of Assistive Devices. Front Neurol 2019; 10:272. [PMID: 30967836 PMCID: PMC6438886 DOI: 10.3389/fneur.2019.00272] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 02/28/2019] [Indexed: 12/12/2022] Open
Abstract
Although several outcome measures are used to assess various areas of interest regarding spinal cord injuries (SCIs), little is known about the frequency of their use, and the ways in which they transform shared knowledge into implemented practices. Herein, 800 professionals from the International Spinal Cord Society, especially trained for caring in patients with SCI, were invited to respond to an Internet survey collecting information on the use of standardized measures in daily clinical practices. We asked both clinicians and researchers with different areas of interest about their use of functional outcome measures, and, in particular, which scales they habitually use to assess various aspects of clinical practice and rehabilitation. We selected a set of rating scales, which were validated for measuring SCIs (http://www.scireproject.com/outcome-measures). The results show that the areas of interest assessed by most of the participants were neurological status, upper limb, lower limb gait, pain, spasticity, self-care, and daily living. The most widely used rating scales were the spinal cord independence measure, the functional independence measure and the International Standards for Neurological Classification of Spinal Cord Injury. Instead, the majority of respondents did not evaluate the use of assistive technology. Despite the availability of several outcome scales, the practice of evaluating SCIs with standardized measures for assistive technologies and wheelchair mobility is still not widespread, even though it is a high priority in the rehabilitation of SCI patients. The results emphasize the need for a more thorough knowledge and use of outcome scales, thus improving the quality of assistive device evaluation.
Collapse
Affiliation(s)
- Giorgio Scivoletto
- Spinal Cord Unit, IRCCS Fondazione Santa Lucia, Rome, Italy.,Spinal Rehabilitation Lab, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Giulia Galli
- Spinal Cord Unit, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Monica Torre
- Spinal Cord Unit, IRCCS Fondazione Santa Lucia, Rome, Italy.,Spinal Rehabilitation Lab, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Marco Molinari
- Spinal Cord Unit, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Mariella Pazzaglia
- Spinal Cord Unit, IRCCS Fondazione Santa Lucia, Rome, Italy.,Department of Psychology, La Sapienza University of Rome, Rome, Italy
| |
Collapse
|
9
|
Graczyk EL, Gill A, Tyler DJ, Resnik LJ. The benefits of sensation on the experience of a hand: A qualitative case series. PLoS One 2019; 14:e0211469. [PMID: 30703163 PMCID: PMC6355013 DOI: 10.1371/journal.pone.0211469] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 01/15/2019] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The experience of upper limb loss involves loss of both functional capabilities and the sensory connection of a hand. Research studies to restore sensation to persons with upper limb loss with neural interfaces typically measure outcomes through standardized functional tests or quantitative surveys. However, these types of metrics cannot fully capture the personal experience of living with limb loss or the impact of sensory restoration on this experience. Qualitative studies can demonstrate the viewpoints and priorities of specific persons or groups and reveal the underlying conceptual structure of various aspects of their experiences. METHODS AND FINDINGS Following a home use trial of a neural-connected, sensory-enabled prosthesis, two persons with upper limb loss were interviewed about their experiences using the sensory restoration system in unsupervised, unconstrained settings. We used grounded theory methodology to examine their experiences, perspectives, and opinions about the sensory restoration system. We then developed a model to describe the impact of sensation on the experience of a hand for persons with upper limb loss. CONCLUSIONS The experience of sensation was complex and included concepts such as the naturalness of the experience, sensation modality, and the usefulness of the sensory information. Sensation was critical for outcome acceptance, and contributed to prosthesis embodiment, confidence, reduced focus and attention for using the prosthesis, and social interactions. Embodiment, confidence, and social interactions were also key determinants of outcome acceptance. This model provides a unified framework to study and understand the impact of sensation on the experience of limb loss and to understand outcome acceptance following upper limb loss more broadly.
Collapse
Affiliation(s)
- Emily L. Graczyk
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, United States of America
- Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio, United States of America
| | - Anisha Gill
- Providence Veterans Affairs Medical Center, Providence, Rhode Island, United States of America
| | - Dustin J. Tyler
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, United States of America
- Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio, United States of America
| | - Linda J. Resnik
- Providence Veterans Affairs Medical Center, Providence, Rhode Island, United States of America
- Department of Health Services, Policy, and Practice, Brown University, Providence, Rhode Island, United States of America
| |
Collapse
|
10
|
Scarpina F, Cau N, Cimolin V, Galli M, Priano L, Mauro A. Defective Tool Embodiment in Body Representation of Individuals Affected by Parkinson's Disease: A Preliminary Study. Front Psychol 2019; 9:2489. [PMID: 30666219 PMCID: PMC6330277 DOI: 10.3389/fpsyg.2018.02489] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 11/22/2018] [Indexed: 12/27/2022] Open
Abstract
When efficiently used for action, tools become part of the body, with effect on the spatial-temporal movement parameters and body size perception. Until now, no previous investigation has been reported about tool embodiment in Parkinson’s disease (PD), which is a neurological disease characterized by several sensory and motor symptoms affecting body and action. We enrolled 14 individuals affected by PD and 18 healthy individuals as controls. We studied the spatial-temporal parameters on self-paced free pointing movement task, via an optoelectronic system, before and after a short training in which a 27-cm long rod was used to point toward a far target. Moreover, we investigated changes in estimation of arm length through the Tactile Estimation Task. After the tool-use training, controls showed changes in spatial-temporal parameters: they were slower to perform movements and reported a higher value of deceleration than the baseline. However, such a difference did not emerge in the PD individuals. In the Tactile Discrimination Task, no difference emerged before and after the tool-use training in both groups. Our results were suggestive of possible difficulties of the tool embodiment process in PD. We discussed our results in relation to aberrant multisensory integration as well as in terms of the effect of PD sensory and motor symptoms on body schema plasticity. The present study points at a novel way to conceive PD sensory motor signs and symptoms in terms of their effect on individuals’ body representation.
Collapse
Affiliation(s)
- Federica Scarpina
- Istituto Auxologico Italiano, IRCCS, Divisione di Neurologia e Neuroriabilitazione, Ospedale San Giuseppe, Piancavallo (VCO), Italy
| | - Nicola Cau
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Veronica Cimolin
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Manuela Galli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy.,IRCCS San Raffaele Pisana, Tosinvest Sanità Roma, Rome, Italy
| | - Lorenzo Priano
- Istituto Auxologico Italiano, IRCCS, Divisione di Neurologia e Neuroriabilitazione, Ospedale San Giuseppe, Piancavallo (VCO), Italy.,Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
| | - Alessandro Mauro
- Istituto Auxologico Italiano, IRCCS, Divisione di Neurologia e Neuroriabilitazione, Ospedale San Giuseppe, Piancavallo (VCO), Italy.,Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
| |
Collapse
|
11
|
Shokur S, Donati ARC, Campos DSF, Gitti C, Bao G, Fischer D, Almeida S, Braga VAS, Augusto P, Petty C, Alho EJL, Lebedev M, Song AW, Nicolelis MAL. Training with brain-machine interfaces, visuo-tactile feedback and assisted locomotion improves sensorimotor, visceral, and psychological signs in chronic paraplegic patients. PLoS One 2018; 13:e0206464. [PMID: 30496189 PMCID: PMC6264837 DOI: 10.1371/journal.pone.0206464] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 10/12/2018] [Indexed: 01/05/2023] Open
Abstract
Spinal cord injury (SCI) induces severe deficiencies in sensory-motor and autonomic functions and has a significant negative impact on patients' quality of life. There is currently no systematic rehabilitation technique assuring recovery of the neurological impairments caused by a complete SCI. Here, we report significant clinical improvement in a group of seven chronic SCI patients (six AIS A, one AIS B) following a 28-month, multi-step protocol that combined training with non-invasive brain-machine interfaces, visuo-tactile feedback and assisted locomotion. All patients recovered significant levels of nociceptive sensation below their original SCI (up to 16 dermatomes, average 11 dermatomes), voluntary motor functions (lower-limbs muscle contractions plus multi-joint movements) and partial sensory function for several modalities (proprioception, tactile, pressure, vibration). Patients also recovered partial intestinal, urinary and sexual functions. By the end of the protocol, all patients had their AIS classification upgraded (six from AIS A to C, one from B to C). These improvements translated into significant changes in the patients' quality of life as measured by standardized psychological instruments. Reexamination of one patient that discontinued the protocol after 12 months of training showed that the 16-month break resulted in neurological stagnation and no reclassification. We suggest that our neurorehabilitation protocol, based uniquely on non-invasive technology (therefore necessitating no surgical operation), can become a promising therapy for patients diagnosed with severe paraplegia (AIS A, B), even at the chronic phase of their lesion.
Collapse
Affiliation(s)
- Solaiman Shokur
- Neurorehabilitation Laboratory, Associação Alberto Santos Dumont para Apoio à Pesquisa (AASDAP), São Paulo, Brazil
| | - Ana R. C. Donati
- Neurorehabilitation Laboratory, Associação Alberto Santos Dumont para Apoio à Pesquisa (AASDAP), São Paulo, Brazil
- Associação de Assistência à Criança Deficiente (AACD), São Paulo, Brazil
| | - Debora S. F. Campos
- Neurorehabilitation Laboratory, Associação Alberto Santos Dumont para Apoio à Pesquisa (AASDAP), São Paulo, Brazil
| | - Claudia Gitti
- Associação de Assistência à Criança Deficiente (AACD), São Paulo, Brazil
| | - Guillaume Bao
- Neurorehabilitation Laboratory, Associação Alberto Santos Dumont para Apoio à Pesquisa (AASDAP), São Paulo, Brazil
| | - Dora Fischer
- Neurorehabilitation Laboratory, Associação Alberto Santos Dumont para Apoio à Pesquisa (AASDAP), São Paulo, Brazil
- Associação de Assistência à Criança Deficiente (AACD), São Paulo, Brazil
| | - Sabrina Almeida
- Neurorehabilitation Laboratory, Associação Alberto Santos Dumont para Apoio à Pesquisa (AASDAP), São Paulo, Brazil
- Associação de Assistência à Criança Deficiente (AACD), São Paulo, Brazil
| | - Vania A. S. Braga
- Neurorehabilitation Laboratory, Associação Alberto Santos Dumont para Apoio à Pesquisa (AASDAP), São Paulo, Brazil
| | - Patricia Augusto
- Neurorehabilitation Laboratory, Associação Alberto Santos Dumont para Apoio à Pesquisa (AASDAP), São Paulo, Brazil
| | - Chris Petty
- Brain Imaging and Analysis Center, Duke Univ Medical Center, Durham, NC, United States of America
| | - Eduardo J. L. Alho
- Neurorehabilitation Laboratory, Associação Alberto Santos Dumont para Apoio à Pesquisa (AASDAP), São Paulo, Brazil
- Department of Neurosurgery, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Mikhail Lebedev
- Department of Neurobiology, Duke University Medical Center, Durham, NC, United States of America
- Duke Center for Neuroengineering, Duke University, Durham, NC, United States of America
| | - Allen W. Song
- Brain Imaging and Analysis Center, Duke Univ Medical Center, Durham, NC, United States of America
| | - Miguel A. L. Nicolelis
- Neurorehabilitation Laboratory, Associação Alberto Santos Dumont para Apoio à Pesquisa (AASDAP), São Paulo, Brazil
- Department of Neurobiology, Duke University Medical Center, Durham, NC, United States of America
- Duke Center for Neuroengineering, Duke University, Durham, NC, United States of America
- Department of Biomedical Engineering, Duke University, Durham, NC, United States of America
- Department of Neurology, Duke University, Durham, NC, United States of America
- Department of Neurosurgery, Duke University, Durham, NC, United States of America
- Department of Psychology and Neuroscience, Duke University, Durham, NC, United States of America
- Edmond and Lily Safra International Institute of Neuroscience, Macaíba, Brazil
| |
Collapse
|
12
|
Embodying functionally relevant action sounds in patients with spinal cord injury. Sci Rep 2018; 8:15641. [PMID: 30353071 PMCID: PMC6199269 DOI: 10.1038/s41598-018-34133-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 10/06/2018] [Indexed: 02/06/2023] Open
Abstract
Growing evidence indicates that perceptual-motor codes may be associated with and influenced by actual bodily states. Following a spinal cord injury (SCI), for example, individuals exhibit reduced visual sensitivity to biological motion. However, a dearth of direct evidence exists about whether profound alterations in sensorimotor traffic between the body and brain influence audio-motor representations. We tested 20 wheelchair-bound individuals with lower skeletal-level SCI who were unable to feel and move their lower limbs, but have retained upper limb function. In a two-choice, matching-to-sample auditory discrimination task, the participants were asked to determine which of two action sounds matched a sample action sound presented previously. We tested aural discrimination ability using sounds that arose from wheelchair, upper limb, lower limb, and animal actions. Our results indicate that an inability to move the lower limbs did not lead to impairment in the discrimination of lower limb-related action sounds in SCI patients. Importantly, patients with SCI discriminated wheelchair sounds more quickly than individuals with comparable auditory experience (i.e. physical therapists) and inexperienced, able-bodied subjects. Audio-motor associations appear to be modified and enhanced to incorporate external salient tools that now represent extensions of their body schemas.
Collapse
|
13
|
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.
Collapse
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
| |
Collapse
|
14
|
Pazzaglia M, Haggard P, Scivoletto G, Molinari M, Lenggenhager B. Pain and somatic sensation are transiently normalized by illusory body ownership in a patient with spinal cord injury. Restor Neurol Neurosci 2018; 34:603-13. [PMID: 27080071 DOI: 10.3233/rnn-150611] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE Spinal cord injury (SCI), a profound impairment of sensorimotor functions, is often associated with pain related phenomena, including mechanical allodynia, a condition in which non-painful tactile sensation is perceived as pain. Pain and somatic sensation are undeniable markers of normal bodily awareness. However, the mechanism by which they are integrated into a coherent sense of the bodily self remains largely unclear. In this study, we investigated the effect of high-level multisensory manipulation on subjective experiences of pain, touch, and body-ownership. METHODS We administered visuo-tactile stimulation based on the rubber hand illusion. In a longitudinal study, we compared the strength of the illusion in a male with SCI, who initially had lost somatosensation in all his fingers, but a few months later reported signs of tactile allodynia restricted to the left C6-dermatome. RESULTS After the restoration of some somatosensation, even if it were painful, synchronous but not asynchronous visuo-tactile stimulation induced body illusion. Previously painful stimuli were temporarily perceived as less painful, and the patient further regained tactile sensations in adjacent numb areas. CONCLUSIONS The sensations of touch and pain are mutually influenced and inextricably linked to a coherent representation of one's own body. Multisensory manipulations affecting the perception and representation of the body might thus offer a powerful opportunity to mitigate nociceptive and somatic abnormalities.
Collapse
Affiliation(s)
- Mariella Pazzaglia
- Department of Psychology, University of Rome "La Sapienza, " Via dei Marsi, Rome, Italy.,IRCCS Santa Lucia Foundation, Via Ardeatina, Rome, Italy
| | - Patrick Haggard
- Institute of Cognitive Neuroscience, University College London, London, UK
| | | | - Marco Molinari
- IRCCS Santa Lucia Foundation, Via Ardeatina, Rome, Italy
| | - Bigna Lenggenhager
- Neuropsychology Unit, Department of Neurology, University Hospital Zurich, Switzerland
| |
Collapse
|
15
|
|
16
|
Paolucci T, Piccinini G, Iosa M, Piermattei C, De Angelis S, Zangrando F, Saraceni VM. The importance of trunk perception during brace treatment in moderate juvenile idiopathic scoliosis: What is the impact on self-image? J Back Musculoskelet Rehabil 2017; 30:203-210. [PMID: 27392847 DOI: 10.3233/bmr-160733] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The perception of body image and the deformity of the trunk in patients with adolescent idiopathic scoliosis (AIS) are a silver lining that has yet to be discussed in the relevant literature during brace rehabilitation treatment. OBJECTIVE To determine whether and how the use of the brace changes perception of the trunk in patients with AIS by the drawing test. METHODS We observed 32 subjects with AIS from our Rehabilitation outpatient clinic and divided them into the brace treatment (BG-16 subjects) and the non-brace treatment (CG-16 subjects). Trunk perception and quality of life were evaluated using the Trunk Appearance Perception Scale and Scoliosis Research Society-22 questionnaire, and the perception of one's back was measured by the drawing test. RESULTS Pain was lower in BG versus CG (p= 0.095). Satisfaction with the treatment was higher in BG than in CG (p= 0.002). Self-image did not differ significantly between the groups in terms of TAPS. Drawings of the most severe cases of scoliosis were made by the group without the brace. CONCLUSIONS The use of the brace corrects the function of the trunk and has a positive influence on its perception.
Collapse
Affiliation(s)
- Teresa Paolucci
- Complex Unit of Physical Medicine and Rehabilitation, Azienda Policlinico Umberto I, Rome, Italy
| | - Giulia Piccinini
- Complex Unit of Physical Medicine and Rehabilitation, Azienda Policlinico Umberto I, Rome, Italy
| | - Marco Iosa
- Clinical Laboratory of Experimental Neurorehabilitation, Santa Lucia Foundation, Rome, Italy
| | - Cristina Piermattei
- Complex Unit of Physical Medicine and Rehabilitation, Azienda Policlinico Umberto I, Rome, Italy
| | - Simona De Angelis
- Complex Unit of Physical Medicine and Rehabilitation, Azienda Policlinico Umberto I, Rome, Italy
| | - Federico Zangrando
- Complex Unit of Physical Medicine and Rehabilitation, Azienda Policlinico Umberto I, Rome, Italy
| | - Vincenzo Maria Saraceni
- Complex Unit of Physical Medicine and Rehabilitation, Azienda Policlinico Umberto I, Rome, Italy
| |
Collapse
|
17
|
Zantedeschi M, Pazzaglia M. Commentary: Non-invasive Brain Stimulation, a Tool to Revert Maladaptive Plasticity in Neuropathic Pain. Front Hum Neurosci 2016; 10:544. [PMID: 27833544 PMCID: PMC5081357 DOI: 10.3389/fnhum.2016.00544] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 10/13/2016] [Indexed: 12/18/2022] Open
Affiliation(s)
- Marta Zantedeschi
- Department of Psychology, University of Rome “La Sapienza”Rome, Italy
| | - Mariella Pazzaglia
- Department of Psychology, University of Rome “La Sapienza”Rome, Italy
- IRCCS Santa Lucia FoundationRome, Italy
| |
Collapse
|
18
|
Shokur S, Gallo S, Moioli RC, Donati ARC, Morya E, Bleuler H, Nicolelis MAL. Assimilation of virtual legs and perception of floor texture by complete paraplegic patients receiving artificial tactile feedback. Sci Rep 2016; 6:32293. [PMID: 27640345 PMCID: PMC5027552 DOI: 10.1038/srep32293] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 08/04/2016] [Indexed: 11/23/2022] Open
Abstract
Spinal cord injuries disrupt bidirectional communication between the patient’s brain and body. Here, we demonstrate a new approach for reproducing lower limb somatosensory feedback in paraplegics by remapping missing leg/foot tactile sensations onto the skin of patients’ forearms. A portable haptic display was tested in eight patients in a setup where the lower limbs were simulated using immersive virtual reality (VR). For six out of eight patients, the haptic display induced the realistic illusion of walking on three different types of floor surfaces: beach sand, a paved street or grass. Additionally, patients experienced the movements of the virtual legs during the swing phase or the sensation of the foot rolling on the floor while walking. Relying solely on this tactile feedback, patients reported the position of the avatar leg during virtual walking. Crossmodal interference between vision of the virtual legs and tactile feedback revealed that patients assimilated the virtual lower limbs as if they were their own legs. We propose that the addition of tactile feedback to neuroprosthetic devices is essential to restore a full lower limb perceptual experience in spinal cord injury (SCI) patients, and will ultimately, lead to a higher rate of prosthetic acceptance/use and a better level of motor proficiency.
Collapse
Affiliation(s)
- Solaiman Shokur
- Neurorehabilitation Laboratory, Associação Alberto Santos Dumont para Apoio à Pesquisa (AASDAP), São Paulo, Brazil
| | - Simone Gallo
- STI IMT, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Renan C Moioli
- Edmond and Lily Safra International Institute of Neuroscience, Santos Dumont Institute, Macaiba, Brazil.,Alberto Santos Dumont Education and Research Institute, São Paulo, Brazil
| | - Ana Rita C Donati
- Neurorehabilitation Laboratory, Associação Alberto Santos Dumont para Apoio à Pesquisa (AASDAP), São Paulo, Brazil.,Associação de Assistência à Criança Deficiente (AACD), São Paulo, Brazil
| | - Edgard Morya
- Edmond and Lily Safra International Institute of Neuroscience, Santos Dumont Institute, Macaiba, Brazil.,Alberto Santos Dumont Education and Research Institute, São Paulo, Brazil
| | - Hannes Bleuler
- STI IMT, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Miguel A L Nicolelis
- Neurorehabilitation Laboratory, Associação Alberto Santos Dumont para Apoio à Pesquisa (AASDAP), São Paulo, Brazil.,Edmond and Lily Safra International Institute of Neuroscience, Santos Dumont Institute, Macaiba, Brazil.,Alberto Santos Dumont Education and Research Institute, São Paulo, Brazil.,Department of Neurobiology, Duke University, Durham, NC, USA.,Department of Biomedical Engineering, Duke University, Durham, NC, USA.,Department of Psychology and Neuroscience, Duke University, Durham, NC, USA.,Center for Neuroengineering, Duke University, Durham, NC, USA
| |
Collapse
|
19
|
Pazzaglia M, Zantedeschi M. Plasticity and Awareness of Bodily Distortion. Neural Plast 2016; 2016:9834340. [PMID: 27630779 PMCID: PMC5007354 DOI: 10.1155/2016/9834340] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 07/20/2016] [Accepted: 08/01/2016] [Indexed: 12/26/2022] Open
Abstract
Knowledge of the body is filtered by perceptual information, recalibrated through predominantly innate stored information, and neurally mediated by direct sensory motor information. Despite multiple sources, the immediate prediction, construction, and evaluation of one's body are distorted. The origins of such distortions are unclear. In this review, we consider three possible sources of awareness that inform body distortion. First, the precision in the body metric may be based on the sight and positioning sense of a particular body segment. This view provides information on the dual nature of body representation, the reliability of a conscious body image, and implicit alterations in the metrics and positional correspondence of body parts. Second, body awareness may reflect an innate organizational experience of unity and continuity in the brain, with no strong isomorphism to body morphology. Third, body awareness may be based on efferent/afferent neural signals, suggesting that major body distortions may result from changes in neural sensorimotor experiences. All these views can be supported empirically, suggesting that body awareness is synthesized from multimodal integration and the temporal constancy of multiple body representations. For each of these views, we briefly discuss abnormalities and therapeutic strategies for correcting the bodily distortions in various clinical disorders.
Collapse
Affiliation(s)
- Mariella Pazzaglia
- Department of Psychology, University of Rome “La Sapienza,” Via dei Marsi 78, 00185 Rome, Italy
- IRCCS Santa Lucia Foundation, Via Ardeatina 306, 00179 Rome, Italy
| | - Marta Zantedeschi
- Department of Psychology, University of Rome “La Sapienza,” Via dei Marsi 78, 00185 Rome, Italy
| |
Collapse
|
20
|
Wireless Cortical Brain-Machine Interface for Whole-Body Navigation in Primates. Sci Rep 2016; 6:22170. [PMID: 26938468 PMCID: PMC4776675 DOI: 10.1038/srep22170] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 02/09/2016] [Indexed: 11/08/2022] Open
Abstract
Several groups have developed brain-machine-interfaces (BMIs) that allow primates to use cortical activity to control artificial limbs. Yet, it remains unknown whether cortical ensembles could represent the kinematics of whole-body navigation and be used to operate a BMI that moves a wheelchair continuously in space. Here we show that rhesus monkeys can learn to navigate a robotic wheelchair, using their cortical activity as the main control signal. Two monkeys were chronically implanted with multichannel microelectrode arrays that allowed wireless recordings from ensembles of premotor and sensorimotor cortical neurons. Initially, while monkeys remained seated in the robotic wheelchair, passive navigation was employed to train a linear decoder to extract 2D wheelchair kinematics from cortical activity. Next, monkeys employed the wireless BMI to translate their cortical activity into the robotic wheelchair’s translational and rotational velocities. Over time, monkeys improved their ability to navigate the wheelchair toward the location of a grape reward. The navigation was enacted by populations of cortical neurons tuned to whole-body displacement. During practice with the apparatus, we also noticed the presence of a cortical representation of the distance to reward location. These results demonstrate that intracranial BMIs could restore whole-body mobility to severely paralyzed patients in the future.
Collapse
|
21
|
Pazzaglia M, Molinari M. The re-embodiment of bodies, tools, and worlds after spinal cord injury: An intricate picture: Reply to comments on "The embodiment of assistive devices-From wheelchair to exoskeleton". Phys Life Rev 2016; 16:191-4. [PMID: 26917254 DOI: 10.1016/j.plrev.2016.02.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 02/05/2016] [Indexed: 01/10/2023]
Affiliation(s)
- Mariella Pazzaglia
- Department of Psychology, University of Rome 'La Sapienza', Via dei Marsi 78, 00185 Rome, Italy.
| | - Marco Molinari
- IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy
| |
Collapse
|
22
|
Martel M, Cardinali L, Roy AC, Farnè A. Tool-use: An open window into body representation and its plasticity. Cogn Neuropsychol 2016; 33:82-101. [PMID: 27315277 PMCID: PMC4975077 DOI: 10.1080/02643294.2016.1167678] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Revised: 02/13/2016] [Accepted: 03/15/2016] [Indexed: 10/28/2022]
Abstract
Over the last decades, scientists have questioned the origin of the exquisite human mastery of tools. Seminal studies in monkeys, healthy participants and brain-damaged patients have primarily focused on the plastic changes that tool-use induces on spatial representations. More recently, we focused on the modifications tool-use must exert on the sensorimotor system and highlighted plastic changes at the level of the body representation used by the brain to control our movements, i.e., the Body Schema. Evidence is emerging for tool-use to affect also more visually and conceptually based representations of the body, such as the Body Image. Here we offer a critical review of the way different tool-use paradigms have been, and should be, used to try disentangling the critical features that are responsible for tool incorporation into different body representations. We will conclude that tool-use may offer a very valuable means to investigate high-order body representations and their plasticity.
Collapse
Affiliation(s)
- Marie Martel
- Laboratoire Dynamique du Langage, CNRS UMR 5596, Lyon69007, France
- University of Lyon, Lyon69000, France
| | - Lucilla Cardinali
- The Brain and Mind Institute, University of Western Ontario, London, ON, Canada
| | - Alice C. Roy
- Laboratoire Dynamique du Langage, CNRS UMR 5596, Lyon69007, France
- University of Lyon, Lyon69000, France
| | - Alessandro Farnè
- University of Lyon, Lyon69000, France
- Integrative Multisensory Perception Action & Cognition team (ImpAct), Lyon Neuroscience Research Center, INSERM U1028, CNRS UMR5292, Lyon69000, France
- Hospices Civils de Lyon, Mouvement et Handicap & Neuro-immersion, Lyon69000, France
| |
Collapse
|
23
|
Ferrara M, Tempesta D, De Gennaro L. Do exoskeletons dream of plastic sleep?: Comment on "The embodiment of assistive devices-from wheelchair to exoskeleton" by M. Pazzaglia and M. Molinari. Phys Life Rev 2015; 16:178-80. [PMID: 26708356 DOI: 10.1016/j.plrev.2015.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 12/09/2015] [Indexed: 02/05/2023]
Affiliation(s)
- Michele Ferrara
- Department of Life, Health and Environmental Sciences, University of L'Aquila, P.le S. Tommasi 1, 67010 Coppito (L'Aquila), Italy.
| | - Daniela Tempesta
- Department of Life, Health and Environmental Sciences, University of L'Aquila, P.le S. Tommasi 1, 67010 Coppito (L'Aquila), Italy
| | - Luigi De Gennaro
- Department of Psychology, Sapienza University of Rome, Via dei Marsi 78, 00185 Rome, Italy
| |
Collapse
|
24
|
Pazzaglia M, Molinari M. The embodiment of assistive devices-from wheelchair to exoskeleton. Phys Life Rev 2015; 16:163-75. [PMID: 26708357 DOI: 10.1016/j.plrev.2015.11.006] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 11/24/2015] [Indexed: 01/18/2023]
Abstract
Spinal cord injuries (SCIs) place a heavy burden on the healthcare system and have a high personal impact and marked socio-economic consequences. Clinically, no absolute cure for these conditions exists. However, in recent years, there has been an increased focus on new robotic technologies that can change the frame we think about the prognosis for recovery and for treating some functions of the body affected after SCIs. This review has two goals. The first is to assess the possibility of the embodiment of functional assistive tools after traumatic disruption of the neural pathways between the brain and the body. To this end, we will examine how altered sensorimotor information modulates the sense of the body in SCI. The second goal is to map the phenomenological experience of using external tools that typically extend the potential of the body physically impaired by SCI. More specifically, we will focus on the difference between the perception of one's physically augmented and non-augmented affected body based on observable and measurable behaviors. We discuss potential clinical benefits of enhanced embodiment of the external objects by way of multisensory interventions. This review argues that the future evolution of human robotic technologies will require adopting an embodied approach, taking advantage of brain plasticity to allow bionic limbs to be mapped within the neural circuits of physically impaired individuals.
Collapse
Affiliation(s)
- Mariella Pazzaglia
- Department of Psychology, University of Rome 'La Sapienza', Via dei Marsi 78, 00185 Rome, Italy; IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy.
| | - Marco Molinari
- IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy
| |
Collapse
|
25
|
Galli G, Lenggenhager B, Scivoletto G, Molinari M, Pazzaglia M. Don't look at my wheelchair! The plasticity of longlasting prejudice. MEDICAL EDUCATION 2015; 49:1239-1247. [PMID: 26611189 DOI: 10.1111/medu.12834] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 06/08/2015] [Accepted: 07/22/2015] [Indexed: 06/05/2023]
Abstract
CONTEXT Scientific research has consistently shown that prejudicial behaviour may contribute to discrimination and disparities in social groups. However, little is known about whether and how implicit assumptions and direct contact modulate the interaction and quality of professional interventions in education and health contexts. OBJECTIVES This study was designed to examine implicit and explicit attitudes towards wheelchair users. METHODS We investigated implicit and explicit attitudes towards wheelchair users in three different groups: patients with traumatic spinal cord injury (SCI); health professionals with intense contact with wheelchair users, and healthy participants without personal contact with wheelchair users. To assess the short-term plasticity of prejudices, we used a valid intervention that aims to change implicit attitudes through brief direct contact with a patient who uses a wheelchair in an ecologically valid real-life interaction. RESULTS We found that: (i) wheelchair users with SCI held positive explicit but negative implicit attitudes towards their novel in-group; (ii) the amount of experience with wheelchair users affected implicit attitudes among health professionals, and (iii) interacting with a patient with SCI who contradicts prejudices modulated implicit negative bias towards wheelchair users in healthy participants. CONCLUSIONS The use of a wheelchair immediately and profoundly affects how a person is perceived. However, our findings highlight the dynamic nature of perceptions of social identity, which are not only sensitive to personal beliefs, but also highly permeable to intergroup interactions. Having direct contact with people with disabilities might foster positive attitudes in multidisciplinary health care teams. Such interventions could be integrated into medical education programmes to successfully prevent or reduce hidden biases in a new generation of health professionals and to increase the general acceptance of disability in patients.
Collapse
Affiliation(s)
- Giulia Galli
- IRCCS (Istituto di Recovero e Cura a Carattere Scientifico [Research Hospital]) Santa Lucia Foundation, Rome, Italy
| | - Bigna Lenggenhager
- Neuropsychology Unit, Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - Giorgio Scivoletto
- IRCCS (Istituto di Recovero e Cura a Carattere Scientifico [Research Hospital]) Santa Lucia Foundation, Rome, Italy
| | - Marco Molinari
- IRCCS (Istituto di Recovero e Cura a Carattere Scientifico [Research Hospital]) Santa Lucia Foundation, Rome, Italy
| | - Mariella Pazzaglia
- IRCCS (Istituto di Recovero e Cura a Carattere Scientifico [Research Hospital]) Santa Lucia Foundation, Rome, Italy
- Department of Psychology, University of Rome 'La Sapienza', Rome, Italy
| |
Collapse
|
26
|
Galli G, Noel JP, Canzoneri E, Blanke O, Serino A. The wheelchair as a full-body tool extending the peripersonal space. Front Psychol 2015; 6:639. [PMID: 26042069 PMCID: PMC4435246 DOI: 10.3389/fpsyg.2015.00639] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 05/01/2015] [Indexed: 11/13/2022] Open
Abstract
Dedicated multisensory mechanisms in the brain represent peripersonal space (PPS), a limited portion of space immediately surrounding the body. Previous studies have illustrated the malleability of PPS representation through hand-object interaction, showing that tool use extends the limits of the hand-centered PPS. In the present study we investigated the effects of a special tool, the wheelchair, in extending the action possibilities of the whole body. We used a behavioral measure to quantify the extension of the PPS around the body before and after Active (Experiment 1) and Passive (Experiment 2) training with a wheelchair and when participants were blindfolded (Experiment 3). Results suggest that a wheelchair-mediated passive exploration of far space extended PPS representation. This effect was specifically related to the possibility of receiving information from the environment through vision, since no extension effect was found when participants were blindfolded. Surprisingly, the active motor training did not induce any modification in PPS representation, probably because the wheelchair maneuver was demanding for non-expert users and thus they may have prioritized processing of information from close to the wheelchair rather than at far spatial locations. Our results suggest that plasticity in PPS representation after tool use seems not to strictly depend on active use of the tool itself, but is triggered by simultaneous processing of information from the body and the space where the body acts in the environment, which is more extended in the case of wheelchair use. These results contribute to our understanding of the mechanisms underlying body-environment interaction for developing and improving applications of assistive technological devices in different clinical populations.
Collapse
Affiliation(s)
- Giulia Galli
- Istituto di Ricovero e Cura a Carattere Scientifico, Santa Lucia Foundation Rome, Italy ; Laboratory of Cognitive Neuroscience, Brain Mind Institute, École Polytechnique Fédérale de Lausanne Lausanne, Switzerland
| | - Jean Paul Noel
- Laboratory of Cognitive Neuroscience, Brain Mind Institute, École Polytechnique Fédérale de Lausanne Lausanne, Switzerland ; Center for Neuroprosthetics, School of Life Sciences, École Polytechnique Fédérale de Lausanne Lausanne, Switzerland ; Vanderbilt Brain Institute, Vanderbilt University Nashville, TN, USA
| | - Elisa Canzoneri
- Laboratory of Cognitive Neuroscience, Brain Mind Institute, École Polytechnique Fédérale de Lausanne Lausanne, Switzerland ; Center for Neuroprosthetics, School of Life Sciences, École Polytechnique Fédérale de Lausanne Lausanne, Switzerland
| | - Olaf Blanke
- Laboratory of Cognitive Neuroscience, Brain Mind Institute, École Polytechnique Fédérale de Lausanne Lausanne, Switzerland ; Center for Neuroprosthetics, School of Life Sciences, École Polytechnique Fédérale de Lausanne Lausanne, Switzerland ; Department of Neurology, University Hospital Geneva Geneva, Switzerland
| | - Andrea Serino
- Laboratory of Cognitive Neuroscience, Brain Mind Institute, École Polytechnique Fédérale de Lausanne Lausanne, Switzerland ; Center for Neuroprosthetics, School of Life Sciences, École Polytechnique Fédérale de Lausanne Lausanne, Switzerland
| |
Collapse
|
27
|
Lucci G, Pazzaglia M. Towards multiple interactions of inner and outer sensations in corporeal awareness. Front Hum Neurosci 2015; 9:163. [PMID: 25883564 PMCID: PMC4381648 DOI: 10.3389/fnhum.2015.00163] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 03/09/2015] [Indexed: 11/13/2022] Open
Abstract
Under normal circumstances, different inner- and outer-body sources are integrated to form coherent and accurate mental experiences of the state of the body, leading to the phenomenon of corporeal awareness. How these processes are affected by changes in inner and outer inputs to the body remains unclear. Here, we aim to present empirical evidence in which people with a massive sensory and motor disconnection may continue to experience feelings of general body state awareness without complete control of their inner and outer states. In these clinical populations, the activity of the neural structures subserving inner and outer body processing can be manipulated and tuned by means of body illusions that are usually based on multisensory stimulation. We suggest that a multisensory therapeutic approach could be adopted in the context of therapies for patients suffering from deafferentation and deefferentation. In this way, these individuals could regain a more complete feeling and control of the sensations they experience, which vary widely depending on their neurological condition.
Collapse
Affiliation(s)
- Giuliana Lucci
- IRCCS Fondazione Santa Lucia Rome, Italy ; Department of Psychology, University of Rome "La Sapienza" Rome, Italy
| | - Mariella Pazzaglia
- IRCCS Fondazione Santa Lucia Rome, Italy ; Department of Psychology, University of Rome "La Sapienza" Rome, Italy
| |
Collapse
|
28
|
Galli G, Pazzaglia M. Commentary on: "The body social: an enactive approach to the self". A tool for merging bodily and social self in immobile individuals. Front Psychol 2015; 6:305. [PMID: 25852619 PMCID: PMC4365544 DOI: 10.3389/fpsyg.2015.00305] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 03/03/2015] [Indexed: 11/30/2022] Open
Affiliation(s)
| | - Mariella Pazzaglia
- IRCCS Santa Lucia Foundation Rome, Italy ; Department of Psychology, University of Rome "La Sapienza," Rome, Italy
| |
Collapse
|
29
|
Merolla G, Dellabiancia F, Filippi MV, De Santis E, Alpi D, Magrini P, Porcellini G. Assessment of the ability of wheelchair subjects with spinal cord injury to perform a specific protocol of shoulder training: a pilot study. Muscles Ligaments Tendons J 2014; 4:165-176. [PMID: 25332931 PMCID: PMC4187595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND a regular program of exercises in subjects with spinal cord injury (SCI) can contribute to reduce the risk of upper extremities injuries. METHODS in this prospective laboratory study we tested the hypothesis that a training machine developed for able-body users is suitable for a shoulder training protocol in 11 paraplegic subjects with SCI. Overall subjects were assessed with the SCIM III, CS, DASH and standard shoulder examination. We set a protocol of shoulder exercises performed with a training machine. Overall subjects were able to perform the protocol but 2 did not complete the exercises n° 6 and 7. The position of the wheelchair during each exercise was recorded. Wheelchair position/loading level were significantly correlated with the protocol n° 2, 3 and 5 as well as BMI/loading level for the exercises n° 5 and 9 and age/loading level for the exercise n° 7. Clinical scores were neither correlated with loading nor with anthropometric data. RESULTS/CONCLUSIONS FROM THE ANALYSIS OF DATA COLLECTED IN THIS STUDY ARISED THAT: 1) the training machine needs some adjustments for paraplegic subjects, 2) the training protocol was appropriate except for the exercises needing a torso-rotation and 3) the template for wheelchair position may be a valid guide for an optimal paraplegic shoulder training.
Collapse
Affiliation(s)
- Giovanni Merolla
- Unit of Shoulder and Elbow Surgery, D. Cervesi Hospital, Cattolica, AUSL della Romagna Ambito Territoriale di Rimini, Italy
- Biomechanics laboratory “Marco Simoncelli”, D. Cervesi Hospital, Cattolica, della Romagna Ambito Territoriale di Rimini, Italy
| | - Fabio Dellabiancia
- Biomechanics laboratory “Marco Simoncelli”, D. Cervesi Hospital, Cattolica, della Romagna Ambito Territoriale di Rimini, Italy
| | - Maria Vittoria Filippi
- Service of Functional Recovery and Rehabilitation, AUSL della Romagna Ambito Territoriale di Rimini, Italy
| | - Elisa De Santis
- Biomechanics laboratory “Marco Simoncelli”, D. Cervesi Hospital, Cattolica, della Romagna Ambito Territoriale di Rimini, Italy
- ShoulderTeam Rehabilitative Office, Forlì, Italy
| | - Daniele Alpi
- Biomechanics laboratory “Marco Simoncelli”, D. Cervesi Hospital, Cattolica, della Romagna Ambito Territoriale di Rimini, Italy
| | - Paola Magrini
- Biomechanics laboratory “Marco Simoncelli”, D. Cervesi Hospital, Cattolica, della Romagna Ambito Territoriale di Rimini, Italy
| | - Giuseppe Porcellini
- Unit of Shoulder and Elbow Surgery, D. Cervesi Hospital, Cattolica, AUSL della Romagna Ambito Territoriale di Rimini, Italy
| |
Collapse
|
30
|
Expanding the primate body schema in sensorimotor cortex by virtual touches of an avatar. Proc Natl Acad Sci U S A 2013; 110:15121-6. [PMID: 23980141 DOI: 10.1073/pnas.1308459110] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The brain representation of the body, called the body schema, is susceptible to plasticity. For instance, subjects experiencing a rubber hand illusion develop a sense of ownership of a mannequin hand when they view it being touched while tactile stimuli are simultaneously applied to their own hand. Here, the cortical basis of such an embodiment was investigated through concurrent recordings from primary somatosensory (i.e., S1) and motor (i.e., M1) cortical neuronal ensembles while two monkeys observed an avatar arm being touched by a virtual ball. Following a period when virtual touches occurred synchronously with physical brushes of the monkeys' arms, neurons in S1 and M1 started to respond to virtual touches applied alone. Responses to virtual touch occurred 50 to 70 ms later than to physical touch, consistent with the involvement of polysynaptic pathways linking the visual cortex to S1 and M1. We propose that S1 and M1 contribute to the rubber hand illusion and that, by taking advantage of plasticity in these areas, patients may assimilate neuroprosthetic limbs as parts of their body schema.
Collapse
|
31
|
Dellabiancia F, Porcellini G, Merolla G. Instruments and techniques for the analysis of wheelchair propulsion and upper extremity involvement in patients with spinal cord injuries: current concept review. Muscles Ligaments Tendons J 2013; 3:150-156. [PMID: 24367774 PMCID: PMC3838323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The correct functionality of the upper limbs is an essential condition for the autonomy of people with disabilities, especially for those in wheelchair. In this review we focused on the biomechanics of wheelchair propulsion and we described the instrumental analysis of techniques for the acquisition of wheelchair propulsion.
Collapse
Affiliation(s)
- Fabio Dellabiancia
- Biomechanics Laboratory “Marco Simoncelli”, D. Cervesi Hospital, Cattolica, Rimini, Italy
| | - Giuseppe Porcellini
- Unit of Shoulder and Elbow Surgery, D. Cervesi Hospital, Cattolica, Rimini, Italy
| | - Giovanni Merolla
- Biomechanics Laboratory “Marco Simoncelli”, D. Cervesi Hospital, Cattolica, Rimini, Italy
- Unit of Shoulder and Elbow Surgery, D. Cervesi Hospital, Cattolica, Rimini, Italy
| |
Collapse
|
32
|
Lenggenhager B, Scivoletto G, Molinari M, Pazzaglia M. Restoring tactile awareness through the rubber hand illusion in cervical spinal cord injury. Neurorehabil Neural Repair 2013; 27:704-8. [PMID: 23757296 DOI: 10.1177/1545968313491009] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Bodily sensations are an important component of corporeal awareness. Spinal cord injury can leave affected body parts insentient and unmoving, leading to specific disturbances in the mental representation of one's own body and the sense of self. OBJECTIVE Here, we explored how illusions induced by multisensory stimulation influence immediate sensory signals and tactile awareness in patients with spinal cord injuries. METHODS The rubber hand illusion paradigm was applied to 2 patients with chronic and complete spinal cord injury of the sixth cervical spine, with severe somatosensory impairments in 2 of 5 fingers. RESULTS Both patients experienced a strong illusion of ownership of the rubber hand during synchronous, but not asynchronous, stroking. They also, spontaneously reported basic tactile sensations in their previously numb fingers. Tactile awareness from seeing the rubber hand was enhanced by progressively increasing the stimulation duration. CONCLUSIONS Multisensory illusions directly and specifically modulate the reemergence of sensory memories and enhance tactile sensation, despite (or as a result of) prior deafferentation. When sensory inputs are lost, and are later illusorily regained, the brain updates a coherent body image even several years after the body has become permanently unable to feel. This particular example of neural plasticity represents a significant opportunity to strengthen the sense of the self and the feelings of embodiment in patients with spinal cord injury.
Collapse
|