Rubber hand illusion induced by touching the face ipsilaterally to a deprived hand: evidence for plastic "somatotopic" remapping in tetraplegics

How pain and body representations transform each other: A narrative review

Pain, as a multidimensional and subjective experience, intertwines with various aspects of body representation, involving sensory, affective and motivational components. This review explores the bidirectional relationship between pain and body representations, emphasizing the impact of the sense of ownership on pain perception, the transformative impact of pain on motor imagery, the effects associated with vicarious pain perception on body representations and the role of pain in the maintenance of body representations in specific clinical conditions. Literature indicates complex interactions between pain and body representations, with the sense of ownership inducing analgesic effects in some cases and hyperalgesia in others, contingent upon factors such as the appearance of the affected limb. Pain sensations inform the body on which actions might be executed without harm, and which are potentially dangerous. This information impacts on motor imagery too, showing reduced motor imagery and increased reaction times in tasks where motor imagery involves the painful body parts. Finally, contrary to the conventional view, according to which pain impairs body representation, evidence suggests that pain can serve as an informative somatosensory index, preserving or even enhancing the representation of the absent or affected body parts. This bidirectional relationship highlights the dynamic and multifaceted nature of the interplay between pain and body representations, offering insights into the adaptive nature of the central nervous system in response to perceived bodily states.

Individual Differences in Bodily Self-Consciousness and Its Neural Basis

Bodily self-consciousness (BSC), a subject of interdisciplinary interest, refers to the awareness of one's bodily states. Previous studies have noted the existence of individual differences in BSC, while neglecting the underlying factors and neural basis of such individual differences. Considering that BSC relied on integration from both internal and external self-relevant information, we here review previous findings on individual differences in BSC through a three-level-self model, which includes interoceptive, exteroceptive, and mental self-processing. The data show that cross-level factors influenced individual differences in BSC, involving internal bodily signal perceptibility, multisensory processing principles, personal traits shaped by environment, and interaction modes that integrate multiple levels of self-processing. Furthermore, in interoceptive processing, regions like the anterior cingulate cortex and insula show correlations with different perceptions of internal sensations. For exteroception, the parietal lobe integrates sensory inputs, coordinating various BSC responses. Mental self-processing modulates differences in BSC through areas like the medial prefrontal cortex. For interactions between multiple levels of self-processing, regions like the intraparietal sulcus involve individual differences in BSC. We propose that diverse experiences of BSC can be attributed to different levels of self-processing, which moderates one's perception of their body. Overall, considering individual differences in BSC is worth amalgamating diverse methodologies for the diagnosis and treatment of some diseases.

Topographic mapping of the sensorimotor qualities of empathic reactivity: A psychophysiological study in people with spinal cord injuries

The experience of empathy for pain is underpinned by sensorimotor and affective dimensions which, although interconnected, are at least in part behaviorally and neurally distinct. Spinal cord injuries (SCI) induce a massive, below-lesion level, sensorimotor body-brain disconnection. This condition may make it possible to test whether sensorimotor deprivation alters specific dimensions of empathic reactivity to observed pain. To explore this issue, we asked SCI people with paraplegia and healthy controls to observe videos of painful or neutral stimuli administered to a hand (intact) or a foot (deafferented). The stimuli were displayed by means of a virtual reality set-up and seen from a first person (1PP) or third person (3PP) visual perspective. A number of measures were recorded ranging from explicit behaviors like explicit verbal reports on the videos, to implicit measures of muscular activity (like EMG from the corrugator and zygomatic muscles that may represent a proxy of sensorimotor empathy) and of autonomic reactivity (like the electrodermal response and Respiratory Sinus Arrhythmia that may represent a general proxy of affective empathy). While no across group differences in explicit verbal reports about the pain stimuli were found, SCI people exhibited reduced facial muscle reactivity to the stimuli applied to the foot (but not the hand) seen from the 1PP. Tellingly, the corrugator activity correlated with SCI participants' neuropathic pain. There were no across group differences in autonomic reactivity suggesting that SCI lesions may affect sensorimotor dimensions connected to empathy for pain.

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

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

Facilitation of imitative movement in patients with chronic hemiplegia triggered by illusory ownership

The sense of body ownership, the feeling that one's body belongs to oneself, is a crucial subjective conscious experience of one's body. Recent methodological advances regarding crossmodal illusions have provided novel insights into how multisensory interactions shape human perception and cognition, underpinning conscious experience, particularly alteration of body ownership. Moreover, in post-stroke rehabilitation, encouraging the use of the paretic limb in daily life is considered vital, as a settled sense of ownership and attentional engagement toward the paralyzed body part may promote increased frequency of its use and prevent learned nonuse. Therefore, in addition to traditional methods, novel interventions using neurorehabilitation techniques that induce self-body recognition are needed. This study investigated whether the illusory experience of a patient's ownership alterations of their paretic hand facilitates the enhancement in the range of motion of succeeding imitation movements. An experiment combining a modified version of the rubber hand illusion with imitation training was conducted with chronic hemiplegia. A larger imitation movement of the paretic hand was observed in the illusion-induced condition, indicating that the feeling of ownership toward the observed limb promotes the induction of intrinsic potential for motor performance. This training, using subjective experience, may help develop new post-stroke rehabilitation interventions.

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

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

Temporal judgments of actions following unilateral brain damage

Sense of time is a complex construct, and its neural correlates remain to date in most part unknown. To complicate the frame, physical attributes of the stimulus, such as its intensity or movement, influence temporal perception. Although previous studies have shown that time perception can be compromised after a brain lesion, the evidence on the role of the left and right hemispheres are meager. In two experiments, the study explores the ability of temporal estimation of multi-second actions and non-biological movements in 33 patients suffering from unilateral brain lesion. Furthermore, the modulatory role of induced embodiment processes is investigated. The results reveal a joint contribution of the two hemispheres depending not only on different durations but also on the presence of actions. Indeed, the left hemisphere damaged patients find it difficult to estimate 4500 ms or longer durations, while the right hemisphere damaged patients fail in 3000 ms durations. Furthermore, the former fail when a biological action is shown, while the latter fail in non-biological movement. Embodiment processes have a modulatory effect only after right hemisphere lesions. Among neuropsychological variables, only spatial neglect influences estimation of non-biological movement.

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

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

Bodily Illusions and Motor Imagery in Fibromyalgia

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

Rethinking the Body in the Brain after Spinal Cord Injury

Spinal cord injuries (SCI) are disruptive neurological events that severly affect the body leading to the interruption of sensorimotor and autonomic pathways. Recent research highlighted SCI-related alterations extend beyond than the expected network, involving most of the central nervous system and goes far beyond primary sensorimotor cortices. The present perspective offers an alternative, useful way to interpret conflicting findings by focusing on the deafferented and deefferented body as the central object of interest. After an introduction to the main processes involved in reorganization according to SCI, we will focus separately on the body regions of the head, upper limbs, and lower limbs in complete, incomplete, and deafferent SCI participants. On one hand, the imprinting of the body’s spatial organization is entrenched in the brain such that its representation likely lasts for the entire lifetime of patients, independent of the severity of the SCI. However, neural activity is extremely adaptable, even over short time scales, and is modulated by changing conditions or different compensative strategies. Therefore, a better understanding of both aspects is an invaluable clinical resource for rehabilitation and the successful use of modern robotic technologies.

Neural mechanisms underlying the Rubber Hand Illusion: A systematic review of related neurophysiological studies

INTRODUCTION

Many researchers took advantage of the well-established rubber hand illusion (RHI) paradigm to explore the link between the sense of body ownership and the different brain structures and networks. Here, we aimed to review the studies that have investigated this phenomenon by means of neurophysiological techniques.

METHODS

The MEDLINE, accessed by Pubmed and EMBASE electronic databases, was searched using the medical subject headings: "Rubber hand illusion" AND "Transcranial magnetic stimulation (TMS)" OR "Evoked potentials (EP)" OR "Event related potentials (ERP)" OR "Electroencephalography (EEG)".

RESULTS

Transcranial magnetic stimulation studies revealed a significant excitability drop in primary motor cortex hand circuits accompanying the disembodiment of the real hand during the RHI experience and that the perceived ownership over the rubber hand is associated with normal parietal-motor communication. Moreover, TMS provided causal evidence that the extrastriate body area is involved in the RHI and subsequently in body representation, while neuromodulation of ventral premotor area and the inferior parietal lobe did not result in an enhancement of embodiment. EP and ERP studies suggest that pre-existing body representations may affect larger stages of tactile processing and support predictive coding models of the functional architecture of multisensory integration in bodily perceptual experience. High-frequency oscillations on EEG play a role in the integrative processing of stimuli across modalities, and EEG activity in γ band activity in the parietal area reflects the visuotactile integration process. EEG studies also revealed that RHI is associated with the neural circuits underlying motor control and that premotor areas play a crucial role in mediating illusory body ownership.

CONCLUSION

Neurophysiological studies shed new light on our understanding of the different aspects that contribute to the formation of a coherent self-awareness in humans.

Impact of visuomotor feedback on the embodiment of virtual hands detached from the body

It has been shown that mere observation of body discontinuity leads to diminished body ownership. However, the impact of body discontinuity has mainly been investigated in conditions where participants observe a collocated static virtual body from a first-person perspective. This study explores the influence of body discountinuity on the sense of embodiment, when rich visuomotor correlations between a real and an artificial virtual body are established. In two experiments, we evaluated body ownership and motor performance, when participants interacted in virtual reality either using virtual hands connected or disconnected from a body. We found that even under the presence of congruent visuomotor feedback, mere observation of body discontinuity resulted in diminished embodiment. Contradictory evidence was found in relation to motor performance, where further research is needed to understand the role of visual body discontinuity in motor tasks. Preliminary findings on physiological reactions to a threat were also assessed, indicating that body visual discontinuity does not differently impact threat-related skin conductance responses. The present results are in accordance with past evidence showing that body discontinuity negatively impacts embodiment. However, further research is needed to understand the influence of visuomotor feedback and body morphological congruency on motor performance and threat-related physiological reactions.

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

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

Anosognosia for limb and bucco-facial apraxia as inferred from the recognition of gestural errors

Anosognosia is a multifaceted syndrome characterized by a lack of awareness of motor, cognitive, or emotional deficits. While most studies have focused on basic motor disorders such as hemiplegia, only recently, the issue of whether anosognosia also concerns higher-order motor disorders like apraxia has been addressed. Here, we explore the existence of a specific form of anosognosia for apraxia in forty patients with uni-hemispheric vascular lesions. The patients were requested to imitate actions involving upper limb or bucco-facial body parts and then judge their performance. Successively, they were also asked to observe video recordings of the same actions performed by themselves or by other patients and judge the accuracy of the displayed actions. The comparison of participants versus examiner judgement and between error recognition of others' versus self's actions was considered as an index of awareness deficit for the online and offline conditions, respectively. Evidence was found that awareness deficits occurred both immediately after action execution (online anosognosia) and in the video recording task (offline anosognosia). Moreover, bucco-facial and limb apraxic patients were specifically unaware of their errors in bucco-facial and limb actions, respectively, indicating for the first time a topographical organization of the syndrome. Our approach allowed us to distinguish awareness deficits from more general disorders in error recognition; indeed, anosognosic patients were able to identify errors when the same action was executed by another patient but not when the video showed their own actions. Finally, we provide evidence that anosognosia for apraxia might be associated with frontal cortical and subcortical networks.

The Embodiment of Objects: Review, Analysis, and Future Directions

Here we offer a thorough review of the empirical literature on the conditions under which an object, such as a tool or a prosthetic (whether real or virtual), can be experienced as being in some sense a part or extension of one's body. We discuss this literature both from the standpoint of the apparent malleability of our body representations, and also from within the framework of radical embodied cognition, which understands the phenomenon to result not from an alteration to a representation, but rather from the achievement of a certain kind of sensory/motor coupling. We highlight both the tensions between these frameworks, and also areas where they can productively complement one another for future research.

Anticipation of wheelchair and rollerblade actions in spinal cord injured people, rollerbladers, and physiotherapists

Embodied Cognition Theories (ECT) postulate that higher-order cognition is heavily influenced by sensorimotor signals. We explored the active role of somatosensory afferents and motor efferents in modulating the perception of actions in people who have suffered a massive body-brain disconnection because of spinal cord injury (SCI), which leads to sensory-motor loss below the lesion. We assessed whether the habitual use of a wheelchair enhances the capacity to anticipate the endings of tool-related actions, with respect to actions that have become impossible. In a Temporal Occlusion task, three groups of participants (paraplegics, rollerbladers and physiotherapists) observed two sets of videos depicting an actor who attempted to climb onto a platform using a wheelchair or rollerblades. Three different outcomes were possible, namely: a) success (the actor went up the step); b) fail (the actor stopped before the step without going up) and c) fall (the actor fell without going up). Each video set comprised 5 different durations increasing in complexity: in the shortest (600ms) only preparatory body movements were shown and in the longest (3000ms) the complete action was shown. The participants were requested to anticipate the outcome (success, fail, fall). The main result showed that the SCI group performed better with the wheelchair videos and poorer with rollerblade videos than both groups, even if the physiotherapists group never used rollerblades. In line with the ECT, this suggests that the action anticipation skills are not only influenced by motor expertise, but also by motor connection.

Body ownership increases the interference between observed and executed movements

When we successfully achieve willed actions, the feeling that our moving body parts belong to the self (i.e., body ownership) is barely required. However, how and to what extent the awareness of our own body contributes to the neurocognitive processes subserving actions is still debated. Here we capitalized on immersive virtual reality in order to examine whether and how body ownership influences motor performance (and, secondly, if it modulates the feeling of voluntariness). Healthy participants saw a virtual body either from a first or a third person perspective. In both conditions, they had to draw continuously straight vertical lines while seeing the virtual arm doing the same action (i.e., drawing lines) or deviating from them (i.e., drawing ellipses). Results showed that when there was a mismatch between the intended and the seen movements (i.e., participants had to draw lines but the avatar drew ellipses), motor performance was strongly "attracted" towards the seen (rather than the performed) movement when the avatar's body part was perceived as own (i.e., first person perspective). In support of previous studies, here we provide direct behavioral evidence that the feeling of body ownership modulates the interference of seen movements to the performed movements.

Action Shapes the Sense of Body Ownership Across Human Development

In this study we investigated, both in childhood and adulthood, the role of action in promoting and shaping the sense of body ownership, which is traditionally viewed as dependent on multisensory integration. By means of a novel action-based version of the rubber hand illusion (RHI), in which participants could actively self-stroke the rubber hand, with (Version 1) or without visual feedback (Version 2) of their own actions, we showed that self-generated actions promote the emergence of a sense of ownership over the rubber hand in children, while it interferes with the embodiment of the rubber hand in adults. When the movement is missing (Version 3, i.e., mere view of the rubber hand being stroked concurrently with one's own hand), the pattern of results is reversed, with adults showing embodiment of the rubber hand, but children lacking to do so. Our novel findings reveal a dynamic and plastic contribution of the motor system to the emergence of a coherent bodily self, suggesting that the development of the sense of body ownership is shaped by motor experience, rather than being purely sensory.

Losing my hand. Body ownership attenuation after virtual lesion of the primary motor cortex

A fundamental component of the self-awareness is the sensation that we are acting with our own body. Thus, a coherent sense of self implies the existence of a tight link between the sense of body ownership and the motor system. Here, we investigated this issue by taking advantage of a well-known experimental manipulation of body ownership, i.e., the rubber hand illusion (RHI), during which the subjects perceive a fake hand as part of their own body. To test the effect of the motor system down-regulation on the RHI susceptibility, we designed a sham-controlled study, where the primary motor cortex (M1) excitability was modulated by off-line low-frequency repetitive transcranial magnetic stimulation (rTMS). After rTMS (real or sham), subjects underwent the RHI either on the right hand, contralateral to the inhibited hemisphere (Experiment 1), or on the left hand, ipsilateral to the inhibited hemisphere (Experiment 2). Only in Experiment 1, the procedure strengthened the illusory experience, as proved by a significant increase, in rTMS compared to Sham, of both subjective (Embodiment/Disembodiment Questionnaires) and objective (Proprioceptive Drift) RHI measures. This evidence demonstrates that, when the M1 activity is down-regulated, the sense of body ownership is attenuated and the subjects become more prone to incorporate an alien body part. This, in turn, supports the existence of a mutual interaction between the sense of body ownership and the motor system, shedding new light on the construction of a coherent sense of self as an acting body.

Mirror Box Training in Hemiplegic Stroke Patients Affects Body Representation

The brain integrates multisensory inputs coming from the body (i.e., proprioception, tactile sensations) and the world that surrounds it (e.g., visual information). In this way, it is possible to build supra-modal and coherent mental representations of our own body, in order to process sensory events and to plan movements and actions in space. Post-stroke acquired motor deficits affect the ability to move body parts and to interact with objects. This may, in turn, impair the brain representation of the affected body part, resulting in a further increase of disability and motor impairment. To the aim of improving any putative derangements of body representation induced by the motor deficit, here we used the Mirror Box (MB). MB is a rehabilitative tool aimed at restoring several pathological conditions where body representation is affected, including post-stroke motor impairments. In this setting, observing the reflection of the intact limb in the mirror, while the affected one is hidden behind the mirror, can exert a positive influence upon different clinical conditions from chronic pain to motor deficits. Such results are thought to be mediated by a process of embodiment of the mirror reflection, which would be integrated into the representation of the affected limb. A group of 45 post-stroke patients was tested before and after performing a MB motor training in two conditions, one with the mirror between the hands and one without it, so that patients could see their impaired limb directly. A forearm bisection task, specifically designed to measure the metric representation of the body (i.e., size), was used as dependent variable. Results showed that, at baseline, the forearm bisection is shifted proximally, compatibly with a shrink of the metric representation of the affected arm towards the shoulder. However, following the MB session bisection scores shifted distally, compatibly with a partial correction of the metric representation of that arm. The effects showed some variability with the laterality of the lesion and the duration of the illness. The present results call for a possible role of the MB as a tool for improving altered body representation following post-stroke motor impairments.

Virtual reality improves embodiment and neuropathic pain caused by spinal cord injury

Objective:

To investigate changes in body ownership and chronic neuropathic pain in patients with spinal cord injury (SCI) using multisensory own body illusions and virtual reality (VR).

Methods:

Twenty patients with SCI with paraplegia and 20 healthy control participants (HC) participated in 2 factorial, randomized, repeated-measures design studies. In the virtual leg illusion (VLI), we applied asynchronous or synchronous visuotactile stimulation to the participant's back (either immediately above the lesion level or at the shoulder) and to the virtual legs as seen on a VR head-mounted display. We tested the effect of the VLI on the sense of leg ownership (questionnaires) and on perceived neuropathic pain (visual analogue scale pain ratings). We compared illusory leg ownership with illusory global body ownership (induced in the full body illusion [FBI]), by applying asynchronous or synchronous visuotactile stimulation to the participant's back and the back of a virtual body as seen on a head-mounted display.

Results:

Our data show that patients with SCI are less sensitive to multisensory stimulations inducing illusory leg ownership (as compared to HC) and that leg ownership decreased with time since SCI. In contrast, we found no differences between groups in global body ownership as tested in the FBI. VLI and FBI were both associated with mild analgesia that was only during the VLI specific for synchronous visuotactile stimulation and the lower back position.

Conclusions:

The present findings show that VR exposure using multisensory stimulation differently affected leg vs body ownership, and is associated with mild analgesia with potential for SCI neurorehabilitation protocols.

The Moving Rubber Hand Illusion Reveals that Explicit Sense of Agency for Tapping Movements Is Preserved in Functional Movement Disorders

Functional movement disorders (FMD) are characterized by motor symptoms (e.g., tremor, gait disorder, and dystonia) that are not compatible with movement abnormalities related to a known organic cause. One key clinical feature of FMD is that motor symptoms are similar to voluntary movements but are subjectively experienced as involuntary by patients. This gap might be related to abnormal self-recognition of bodily action, which involves two main components: sense of agency and sense of body ownership. The aim of this study was to systematically investigate whether this function is altered in FMD, specifically focusing on the subjective feeling of agency, body ownership, and their interaction during normal voluntary movements. Patients with FMD (n = 21) and healthy controls (n = 21) underwent the moving Rubber Hand Illusion (mRHI), in which passive and active movements can differentially elicit agency, ownership or both. Explicit measures of agency and ownership were obtained via a questionnaire. Patients and controls showed a similar pattern of response: when the rubber hand was in a plausible posture, active movements elicited strong agency and ownership; implausible posture of the rubber hand abolished ownership but not agency; passive movements suppressed agency but not ownership. These findings suggest that explicit sense of agency and body ownership are preserved in FMD. The latter finding is shared by a previous study in FMD using a static version of the RHI, whereas the former appears to contrast with studies demonstrating altered implicit measures of agency (e.g., sensory attenuation). Our study extends previous findings by suggesting that in FMD: (i) the sense of body ownership is retained also when interacting with the motor system; (ii) the subjective experience of agency for voluntary tapping movements, as measured by means of mRHI, is preserved.

Dissociation between preserved body structural description and impaired body image following a pediatric spinal trauma

In adult patients, Spinal Cord Injury (SCI) may influence the mental Body Representation (BR). Currently, there is no evidence on the modulation of SCI on BR during early stages of cognitive development. Here, we investigated BR in a 3-year-old child with complete SCI. The patient was administered with a specific battery assessing different BR components. We found evidence for putative classical neuropsychological dissociation between a preserved topological map with impaired semantic knowledge of the body. This finding sheds new light on the impact of SCI on BR in childhood, as well as on the level of interdependence between BR's components..

Decreased motor cortex excitability mirrors own hand disembodiment during the rubber hand illusion

During the rubber hand illusion (RHI), subjects experience an artificial hand as part of their own body, while the real hand is subject to a sort of 'disembodiment'. Can this altered belief about the body also affect physiological mechanisms involved in body-ownership, such as motor control? Here we ask whether the excitability of the motor pathways to the real (disembodied) hand are affected by the illusion. Our results show that the amplitude of the motor-evoked potentials recorded from the real hand is significantly reduced, with respect to baseline, when subjects in the synchronous (but not in the asynchronous) condition experience the fake hand as their own. This finding contributes to the theoretical understanding of the relationship between body-ownership and motor system, and provides the first physiological evidence that a significant drop in motor excitability in M1 hand circuits accompanies the disembodiment of the real hand during the RHI experience.

DOI:http://dx.doi.org/10.7554/eLife.14972.001

The feeling of body ownership — that the various parts of your body are all part of you — is something that we typically take for granted. However, brain damage can disrupt this sensation and leave individuals convinced that an arm or a leg is no longer their own. Even in healthy people, the ‘rubber hand illusion’ can temporarily produce a similar phenomenon. Individuals watch a lifelike rubber hand being touched while their own hand – which is hidden from view – is touched at the same time. This creates the feeling that the artificial hand has become part of their body, while their real hand is left in a ‘disembodied’ state.

How does the brain generate this illusory sense of ownership and accompanying sense of disembodiment? A person’s ability to move their body is thought to contribute to their feeling of body ownership. Therefore, della Gatta, Garbarini et al. asked whether the brain’s ability to move the real hand changes during the rubber hand illusion.

In the experiments, the region of the brain that controls hand movement was artificially stimulated in a number of volunteers. When an individual had been primed by the rubber hand illusion to perceive a fake hand as part of their own body, their brain was temporarily less able to activate the muscles of their real hand. This is as if the brain no longer considered the real hand as part of the body. Thus, the altered sense of body ownership experienced during the rubber hand illusion is not a bizarre fantasy, but corresponds to a physiological reaction that accompanies changes in brain activity.

The next step is to further define and quantify the relationship between the sense of body ownership and the control of body movement. Specifically, how does activity in the brain areas that control movement contribute to the sense of body ownership? And how do these brain regions communicate with one another to generate a sense of self?

DOI:http://dx.doi.org/10.7554/eLife.14972.002

The Role of Audio-Visual Feedback in a Thought-Based Control of a Humanoid Robot: A BCI Study in Healthy and Spinal Cord Injured People

The efficient control of our body and successful interaction with the environment are possible through the integration of multisensory information. Brain-computer interface (BCI) may allow people with sensorimotor disorders to actively interact in the world. In this study, visual information was paired with auditory feedback to improve the BCI control of a humanoid surrogate. Healthy and spinal cord injured (SCI) people were asked to embody a humanoid robot and complete a pick-and-place task by means of a visual evoked potentials BCI system. Participants observed the remote environment from the robot's perspective through a head mounted display. Human-footsteps and computer-beep sounds were used as synchronous/asynchronous auditory feedback. Healthy participants achieved better placing accuracy when listening to human footstep sounds relative to a computer-generated sound. SCI people demonstrated more difficulty in steering the robot during asynchronous auditory feedback conditions. Importantly, subjective reports highlighted that the BCI mask overlaying the display did not limit the observation of the scenario and the feeling of being in control of the robot. Overall, the data seem to suggest that sensorimotor-related information may improve the control of external devices. Further studies are required to understand how the contribution of residual sensory channels could improve the reliability of BCI systems.

Spinal cord lesions shrink peripersonal space around the feet, passive mobilization of paraplegic limbs restores it

Peripersonal space (PPS) is the space surrounding us within which we interact with objects. PPS may be modulated by actions (e.g. when using tools) or sense of ownership (e.g. over a rubber hand). Indeed, intense and/or prolonged use of a tool may induce a sense of ownership over it. Conversely, inducing ownership over a rubber hand may activate brain regions involved in motor control. However, the extent to which PPS is modulated by action-dependent or ownership-dependent mechanisms remains unclear. Here, we explored the PPS around the feet and the sense of ownership over lower limbs in people with Paraplegia following Complete spinal cord Lesions (PCL) and in healthy subjects. PCL people can move their upper body but have lost all sensory-motor functions in their lower body (e.g. lower limbs). We tested whether PPS alterations reflect the topographical representations of various body parts. We found that the PPS around the feet was impaired in PCL who however had a normal representation of the PPS around the hands. Significantly, passive mobilization of paraplegic limbs restored the PPS around the feet suggesting that activating action representations in PCL brings about short-term changes of PPS that may thus be more plastic than previously believed.

Motor imagery in spinal cord injured people is modulated by somatotopic coding, perspective taking, and post-lesional chronic pain

Motor imagery (MI) allows one to mentally represent an action without necessarily performing it. Importantly, however, MI is profoundly influenced by the ability to actually execute actions, as demonstrated by the impairment of this ability as a consequence of lesions in motor cortices, limb amputations, movement limiting chronic pain, and spinal cord injury. Understanding MI and its deficits in patients with motor limitations is fundamentally important as development of some brain-computer interfaces and daily life strategies for coping with motor disorders are based on this ability. We explored MI in a large sample of patients with spinal cord injury (SCI) using a comprehensive battery of questionnaires to assess the ability to imagine actions from a first-person or a third-person perspective and also imagine the proprioceptive components of actions. Moreover, we correlated MI skills with personality measures and clinical variables such as the level and completeness of the lesion and the presence of chronic pain. We found that the MI deficits (1) concerned the body parts affected by deafferentation and deefferentation, (2) were present in first- but not in third-person perspectives, and (3) were more altered in the presence of chronic pain. MI is thus closely related to bodily perceptions and representations. Every attempt to devise tools and trainings aimed at improving autonomy needs to consider the cognitive changes due to the body-brain disconnection.

Re-establishing the disrupted sensorimotor loop in deafferented and deefferented people: The case of spinal cord injuries

Acting efficiently in the world depends on the activity of motor and somatosensory systems, the integration of which is necessary for the proper functioning of the sensorimotor loop (SL). Profound alterations of SL functioning follow spinal cord injury (SCI), a condition that brings about a disconnection of the body from the brain. Such disconnection creates a substantial deprivation of somatosensorial inputs and motor outputs. Consequent somatic deficits and motor paralysis affect the body below the lesion level. A complete restoration of normal functions of the SL cannot be expected until basic neuroscience has found a way to re-establish the interrupted neural connectivity. Meanwhile, studies should focus on the development of technical solutions for dealing with the disruption of the sensorimotor loop. This review discusses the structural and functional adaptive reorganization of the brain after SCI, and the maladaptive mechanisms that impact on the processing of body related information, which alter motor imagery strategies and EEG signals. Studies that show how residual functions (e.g. face tactile sensitivity) may help people to restore a normal body image are also reviewed. Finally, data on how brain and residual body signals may be used to improve brain computer interface systems is discussed in relation to the issue of how such systems may help SCI people to re-enter the world and interact with objects and other individuals.

Are movements necessary for the sense of body ownership? Evidence from the rubber hand illusion in pure hemiplegic patients

A question still debated within cognitive neuroscience is whether signals present during actions significantly contribute to the emergence of human’s body ownership. In the present study, we aimed at answer this question by means of a neuropsychological approach. We administered the classical rubber hand illusion paradigm to a group of healthy participants and to a group of neurological patients affected by a complete left upper limb hemiplegia, but without any propriceptive/tactile deficits. The illusion strength was measured both subjectively (i.e., by a self-report questionnaire) and behaviorally (i.e., the location of one’s own hand is shifted towards the rubber hand). We aimed at examining whether, and to which extent, an enduring absence of movements related signals affects body ownership. Our results showed that patients displayed, respect to healthy participants, stronger illusory effects when the left (affected) hand was stimulated and no effects when the right (unaffected) hand was stimulated. In other words, hemiplegics had a weaker/more flexible sense of body ownership for the affected hand, but an enhanced/more rigid one for the healthy hand. Possible interpretations of such asymmetrical distribution of body ownership, as well as limits of our results, are discussed. Broadly speaking, our findings suggest that the alteration of the normal flow of signals present during movements impacts on human’s body ownership. This in turn, means that movements have a role per se in developing and maintaining a coherent body ownership.