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The phantom limb and the mirror box therapy

The phantom limb and the mirror box therapy

July 19, 2024

The Ghost member , introduced term Silas Weir Mitchell in 1872, refers to a syndrome suffered by some people who have lost an arm, a leg or an organ and who continue to experience the sensations of amputated limbs. Patients who suffer from this syndrome, feel as if they are making a gesture, feel itching or intense pain.

The brain and the body

According to the neurologist Brain center and cognition from the University of California at San Diego, Vilayanur S. Ramachandran Nearly 70 percent of amputees continue to experience intermittent pain in the limb lost even decades after being amputated, producing devastating consequences in the lives of patients who suffer.


Unfortunately, for many years, the treatment had been ineffective because its biological bases were not clear enough . The sensations of the phantom limb may appear immediately after the amputation of the limb or late, but the pain usually appears in the first week of postamputation. It usually evolves with a reduction in both frequency and pain crises, but sometimes the pain may persist for years. In addition, it should be noted that the phantom limb syndrome can cause psychological disorders such as depression, anxiety or stress in those who suffer it.

Why is phantom limb syndrome?

There are several theories that try to explain the cause of the phantom limb. Not long ago a simple and univocal relationship between injury and pain was posed, but a current of recent thought has placed the genesis of the phantom limb in the brain since the cognitive and affective spheres intervene.


The investigations of Ronald Melzack resulted in the neuromatrix theory , in which the diffusion of pain and the transmission of pain by the organism is attributed to a complex system involving various areas of the central and peripheral nervous system, autonomic nervous system and endocrine system, directly influenced by various psychological factors, emotional, genetic and social. This theory explains that we can feel sensations of pain in the organism caused from our interior, that is from our own organism, and through this system we can make these sensations increase, modify or decrease at a certain moment. If this matrix is ​​activated in the absence of peripheral sensory information (amputated limb) it would produce the sensation of having a limb present after the loss.


Another line of research is that of the scientist Ramachandran , that in his book "Ghosts of the brain ", Gives an amazing explanation. A patient with a phantom limb complained of itching on the lost hand. Dr. Ramachandran, with a cotton swab for the ears, scratched the patient on the face, relieving the itching of his hand. What is the explanation to this? The explanation is found in the Penfield's Homunculus . In the 1950s, Penfield and Rasmussen demonstrated the existence of a cortical map of bodily representation in two aspects: motor and somatosensory.

East Neurological map has some particular characteristics: each part of the body is represented according to its sensorimotor importance (for example: the lips or hands have more cortical representation than the trunk, that is why they are more sensitive), that is, one thing is the body and another the representation of the body in the brain. If a person loses a leg, an arm or an organ, their representation in Penfield's homunculus stops receiving information from that effector, but then that area of ​​the map can be invaded by the adjacent representation. In the case of the amputated hand, the adjacent representation is that of the face. In this way, the stimulation on the face can make a hand feel (ghost).

Therapy with the mirror box (Mirror Box)

This seems to demonstrate the plasticity of the brain, but what about the pain of the phantom limb? Most patients, after an accident, are left with a useless and painful arm. After the amputation of the limb, the pain usually persists. Ramachandran think that the basis of this phenomenon is found in learned paralysis , because the phantom limb also lacks mobility and the brain is fixed on the idea of ​​an arm without movement. For this, the neurologist invented the mirror box.

The mirror box is a box with a mirror in the center, when the patient introduces the arm without amputating, he can see the reflection of his arm in the mirror. Upon seeing his arm, he feels that the limb is present despite being amputated.The patient then moves the arm, and through the use of the retr visual feedback and by eliminating potentially painful positions, Get feedback to the brain and relieve the pain you feel. Sometimes, even the ghost member disappears.


How using a mirror can relieve phantom pain (July 2024).


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