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Touching the phantom limb, Ramachandran

  • Ramachandran, V. S., et al. (1995). "Touching the phantom limb." Nature 377(6549): 489-490.

by Laura Rathbone

This week we have been reading a 1995 piece by Dr Ramachandran exploring mirror therapy for people with persisting phantom limb pain and then a proof-of-concept piece by Dr (I.Am.) Stanton and team exploring visuotactile illusions in clinical application for persistent pain.

Below I share with you a few of my thoughts from the resources today.

When seeing is feeling

Dr Ramachandran has given us some really lovely work about phantom limb phenomena, but I love this correspondence piece because his excitement leaps off the page. If you've never read his work, this is a lovely first piece to be introduced to him through.

Here is a link to his wiki page:

Ramachandran is a neuroscientist that invented the mirror box as a therapy but oh so much more! He has developed some of the foundational work on mirror neurons as well as the concepts of sinesthesia, body-integrity disorder and somataparaphrenia.

Here is a person that is working to unify neuroscience with experience. A lofty goal!

TLDR: (Too long didn't read)

They took a group of 14 people with phantom limb pain and exposed them to mirror box therapy. The responses of the individuals are super exciting and interesting.

Mirror box therapy, if you haven't seen it, is when a mirror is placed where the phantom is and the mirror image of the limb is used as a proxy to create the phantom limb within the visual field.

A common experience for people with phantom limb pain is a feeling of un-relievable spasm in the phantom, people can give very clear descriptions of positions and angles that the phantom limb and digits are 'stuck' in. With the introduction to the mirror box, in four of the participants, these spasms were immediately relieved. (How cool is that?!?!?!)

Participants reported telescoping (a retraction of the phantom limb towards the stump) and the sensation of touch referred to the phantom from the in-tact limb. When the in-tact limb was submerged into a cold water bath with ice cubes, the sensation of the cubes referred to the phantom limb but not the pain experience or cold sensation, this may have something to do with a lack of nociceptive stimulation of the phantom, which may demonstrate that in the context of cold activation of the local nociceptors, precision for the generation of pain is weighted towards the peripheral mechanisms.

Ramachandran continues to pose that, whilst this referral of unilateral touch may exist usually, the unilateral sensory-discrimination of the other limb will over-power that of the contralateral. however, in the absence of that , the laterally referred sensations may well be "disinhibited or progressively strengthened".

Why do I get excited about this?

Well, not necessarily because it tells us about how to treat persisting pain, but because it raises questions about the 'feltness' of the body in ways that really challenge my truth and knowledge about the world and how I move through it which obviously makes me think about how it is for someone else to navigate this thing we call life and being human.

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