Mirror therapy for phantom limb pain: Brain changes and the role of body representation

被引:225
作者
Foell, J. [1 ,2 ]
Bekrater-Bodmann, R. [1 ]
Diers, M. [1 ]
Flor, H. [1 ]
机构
[1] Heidelberg Univ, Med Fac Mannheim, Cent Inst Mental Hlth, Dept Cognit & Clin Neurosci, Mannheim, Germany
[2] Florida State Univ, Dept Psychol, Tallahassee, FL 32306 USA
关键词
CORTICAL REORGANIZATION; SOMATOSENSORY CORTEX; VISUAL FEEDBACK; NEURAL BASIS; AMPUTEES; MOTOR; HAND; AMPUTATION; MOVEMENTS; ILLUSION;
D O I
10.1002/j.1532-2149.2013.00433.x
中图分类号
R614 [麻醉学];
学科分类号
100217 [麻醉学];
摘要
Background Phantom limb pain (PLP) is a common consequence of amputation and is difficult to treat. Mirror therapy (MT), a procedure utilizing the visual recreation of movement of a lost limb by moving the intact limb in front of a mirror, has been shown to be effective in reducing PLP. However, the neural correlates of this effect are not known. Methods We investigated the effects of daily mirror training over 4 weeks in 13 chronic PLP patients after unilateral arm amputation. Eleven participants performed hand and lip movements during a functional magnetic resonance imaging (fMRI) measurement before and after MT. The location of neural activity in primary somatosensory cortex during these tasks was used to assess brain changes related to treatment. Results The treatment caused a significant reduction of PLP (average decrease of 27%). Treatment effects were predicted by a telescopic distortion of the phantom, with those patients who experienced a telescope profiting less from treatment. fMRI data analyses revealed a relationship between change in pain after MT and a reversal of dysfunctional cortical reorganization in primary somatosensory cortex. Pain reduction after mirror training was also related to a decrease of activity in the inferior parietal cortex (IPC). Conclusions Experienced body appearance seems to be an important predictor of mirror treatment effectiveness. Maladaptive changes in cortical organization are reversed during mirror treatment, which also alters activity in the IPC, a region involved in painful perceptions and in the perceived relatedness to an observed limb.
引用
收藏
页码:729 / 739
页数:11
相关论文
共 44 条
[1]
Illusory Hand Ownership Induced by an MRI Compatible Immersive Virtual Reality Device [J].
Bach, F. ;
Cakmak, H. ;
Maass, H. ;
Bekrater-Bodmann, R. ;
Foell, J. ;
Diers, M. ;
Trojan, J. ;
Fuchs, X. ;
Flor, H. .
BIOMEDICAL ENGINEERING-BIOMEDIZINISCHE TECHNIK, 2012, 57 :718-720
[2]
The perceptual and neuronal stability of the rubber hand illusion across contexts and over time [J].
Bekrater-Bodmann, Robin ;
Foell, Jens ;
Diers, Martin ;
Flor, Herta .
BRAIN RESEARCH, 2012, 1452 :130-139
[3]
Birbaumer N, 1997, J NEUROSCI, V17, P5503
[4]
Increased motor control of a phantom leg in humans results from the visual feedback of a virtual leg [J].
Brodie, EE ;
Whyte, A ;
Waller, B .
NEUROSCIENCE LETTERS, 2003, 341 (02) :167-169
[5]
Altered resting state attentional networks in diabetic neuropathic pain [J].
Cauda, F. ;
D'Agata, F. ;
Sacco, K. ;
Duca, S. ;
Cocito, D. ;
Paolasso, I. ;
Isoardo, G. ;
Geminiani, G. .
JOURNAL OF NEUROLOGY NEUROSURGERY AND PSYCHIATRY, 2010, 81 (07) :806-811
[6]
Mirror therapy for phantom limb pain [J].
Chan, Brenda L. ;
Witt, Richard ;
Charrow, Alexandra P. ;
Magee, Amanda ;
Howard, Robin ;
Pasquina, Paul F. ;
Heilman, Kenneth M. ;
Tsao, Jack W. .
NEW ENGLAND JOURNAL OF MEDICINE, 2007, 357 (21) :2206-2207
[7]
HOME-BASED SELF-DELIVERED MIRROR THERAPY FOR PHANTOM PAIN: A PILOT STUDY [J].
Darnall, Beth D. ;
Li, Hong .
JOURNAL OF REHABILITATION MEDICINE, 2012, 44 (03) :254-260
[8]
Mirrored, imagined and executed movements differentially activate sensorimotor cortex in amputees with and without phantom limb pain [J].
Diers, Martin ;
Christmann, Christoph ;
Koeppe, Caroline ;
Ruf, Matthias ;
Flor, Herta .
PAIN, 2010, 149 (02) :296-304
[9]
Cortical processing of visceral and somatic stimulation: Differentiating pain intensity from unpleasantness [J].
Dunckley, P ;
Wise, RG ;
Aziz, Q ;
Painter, D ;
Brooks, J ;
Tracey, I ;
Chang, L .
NEUROSCIENCE, 2005, 133 (02) :533-542
[10]
EXTENSIVE REORGANIZATION OF THE SOMATOSENSORY CORTEX IN ADULT HUMANS AFTER NERVOUS-SYSTEM INJURY [J].
ELBERT, T ;
FLOR, H ;
BIRBAUMER, N ;
KNECHT, S ;
HAMPSON, S ;
LARBIG, W ;
TAUB, E .
NEUROREPORT, 1994, 5 (18) :2593-2597