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Your Amazing Brain. Phantom Limb Pain How can we help amputees to get rid of the pain they feel from their absent limb?. Today’s Taster Session in Psychology. The Phantom Limb Experiment. I can make you ‘own’ a rubber hand!. I need a willing volunteer to try out the Rubber Hand Experiment!

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Your amazing brain

Your Amazing Brain

Phantom Limb Pain

How can we help amputees to get rid of the pain they feel from their absent limb?


Your amazing brain

Today’s Taster Session in Psychology.


Your amazing brain

The Phantom Limb Experiment

I can make you ‘own’ a rubber hand!


Your amazing brain

I need a willing volunteer to try out the Rubber Hand Experiment!

Or, go to the next slide.


Your amazing brain

Video clip 1

(Horizon version of the Rubber Hand Experiment.)


Your amazing brain

It is estimated there are 100 Billion neurons in the human brain.

If we count every possible connection potential, it has been computed that there are more neuronal connections possible in one brain, than there are elementary particles in the entire universe!

We are only just beginning to unravel the structure and function of this amazing organ, which makes us human.


Your amazing brain

Proprioception

the ability to sense the position and location and orientation and movement of the body and its parts


Your amazing brain

Proprioception

a positive bio-feedback loop

The Somato-sensory Cortex is responsible for constantly seeking bio-feedback from the senses, to ensure we are in the optimum position.

...the ability to sense the position, location, orientation and movement of the body and its parts...


Your amazing brain

The visual cortex

Even though we know it is a rubber hand


Your amazing brain

Here, the brain registers the sensation on the rubber hand is actually happening to them, and react to the hammer as if they were about to be injured.

This is entirely involuntary


Your amazing brain

In one version of the rubber hand experiment, after a few minutes of stroking the rubber hand and their own left hand simultaneously, the person was asked to point to their LEFT hand.

They usually pointed to the rubber hand!


Your amazing brain

Proprioception is the collection of sensory registrations we use to know where our body is in time/space.

The somato-sensory cortex is responsible for collating these sensory inputs and is very hungry for input at all times, to keep us safe, upright etc.

That bio-feedback loop is constantly being updated


Your amazing brain

For proprioception to happen, the somato-sensory cortex is hungry for stimulation, all of the time.

So, in this experiment...


Your amazing brain

Contractures

Contractures often follow damage to the CNS ability to provide adequate positive bio-feedback from a limb, e.g. after trauma, arthritis or even cerebral palsy.

After a while, failing to get good bio-feedback from the hand – the CNS will keep sending out stronger and stronger messages seeking the sensory feedback and will often clench the hand into a fist, (desperately seeking the feedback it is used to getting), the tendons shorten through lack of use and the limb becomes locked in this position.

Contractures are painful and even with physiotherapy, that pain is hardly eased.

Many amputees experience a virtual contracture, from their phantom limb!


Your amazing brain

Many amputees experience debilitating pain and distress for years after their limb has been removed.

We have only had pain killers to offer them, until now. Most say these don’t help.

Amputees are at a high risk of PTSD, depression and suicide, if they suffer from PLP


Your amazing brain

Some amputees experience something even more strange.

A while after their amputation, they begin to get sensation from their absent limb.................on their FACE!

Dr V Ramachandran investigated this and suggested the brain had actually re-wired the nerves to get feedback via the facial muscles instead of the absent limb.

Can a brain RE-WIRE it’s neural pathways, after birth???


Your amazing brain

YES!

It’s called NEURAL PLASTICITY.

Brain cells (neurons) have an amazing capacity to move/re-locate and transform their function, in response to environmental demand.

In the case of brain damage, other neurons can (sometimes) take on the function of the damaged/missing neurons and thus

restore the function, at least partially.


Your amazing brain

An Oxford University study of 7 amputees with PLP, & 7 amputees without PLP & 7 healthy controls.

fMRI scans show clearly that the nearby sensory registration area for the FACE has been activated only in the amputees with PLP.

This is called MALADAPTIVE NEURAL PLASTICITY

The neurons are setting off others nearby.

PLP is worse in those who had greater pain, pre-amputation.


Your amazing brain

Can I create adaptive neural plasticity to provide false positive bio-feedback?

Could this re-wire the CNS to switch off the sensation of pain from the phantom limb?

Ramachandran is a very clever Psychologist, who suggested that if the brain can re-wire itself to receive feedback from the absent limb on the FACE.................it should therefore, be possible to use this neural plasticity in therapy, to treat the pain felt from a phantom limb.

It is, after all, phantom pain! The brain is registering a FALSE pain, due to lack of positive bio-feedback.

Can we give the brain some kind of bio-feedback and cause it to register that the phantom limb is actually there, and fine???


Your amazing brain

Mirror Box Therapy

This incredibly simple therapy came directly from Ramachandran’s thinking!

Use a mirror to create the illusory bio-feedback, showing the image of an apparently ‘healthy’ missing limb.

Gradually, flex and move the healthy (existing) limb, e.g. The LEFT leg shown here..... and create the apparent image that the absent (amputated RIGHT) leg is fine and working.

Fool the brain!

Switch off the pain!

Research shows improvement in PLP within an hour!

Regular sessions – PLP usually GOES altogether!


Your amazing brain

Thanks to Dr V Ramachandran!

  • Suitable for:

  • PLP

  • contractures of limbs

  • stroke damage to limbs

  • CRPS

A cheap and effective therapy for PLP, which almost always works.

Using the plasticity of the brain!


Your amazing brain

Video clip of Mirror Box Therapy to treat PLP

http://www.youtube.com/watch?v=YL_6OMPywnQ


Your amazing brain

But:

Not all doctors know about this yet!

And, even if they do, their patients may not believe them when they tell them the pain they feel is phantom, and originates IN THEIR BRAIN.

Check this out!


Your amazing brain

Mark Goddard, suffered nerve damage to his arm, after a serious motorbike crash in 1998.

The incurable CNS pain he has suffered since, eventually led him to lose patience with the doctors treating him.

In March 2014 he cut off his own hand at the wrist, with a home-made guillotine.


Your amazing brain

Mark had tried to cut his hand off with a knife before, but surgeons re-attached it.

This time, he burnt the amputated hand, in a bucket, so they couldn’t do that again.

Mr Goddard seems convinced this was the only way to rid himself of the pain he felt.

Doctors had refused to amputate, because they felt the problem was not in the hand itself, but in the brain.

Who was right?


Your amazing brain

Doctors have said they will now have to amputate his arm above the elbow, due to the nerve damage he inflicted upon himself, as a result of his botched self-amputation.

28 March 2014

  • “Father builds guillotine and chops off his own hand in bid to end years of agony after accident left him in pain but doctors did not help...and it still hurts”

  • Mark Goddard, 44, used an axe, some springs and a gate post to cut it off

  • Father-of-one from Devon says NHS has ignored his pleas for amputation

  • Ten days ago sliced off hand and burnt it in bucket to stop reattachment But pain he suffered remains and he has issued deadline for NHS surgery

  • 'I've told them that if nothing is done, I will take the arm off,' he said!

Of course his pain remains!

And, cutting off his arm will not solve the problem!


Your amazing brain

And the moral of this tale is....................................

Always listen to Psychologists!

We ROCK!


Your amazing brain

Get ready for September and more exciting episodes of:

The AS Level Psychology Show!

Using your excellent research skills, rearrange the information in the boxes on the sheet, to create a TIMELINE for Psychology, as an academic discipline.

Early

1900s

Present day

Bring to your first lesson and we’ll see how correct you were.


Your amazing brain

See you in September!

Come prepared!

To be dazzled by Psychology!


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