Research Paper Assignment on Phantom Limbs

Phantom limbs

  1. Introduction

The phantom limb phenomenon presents problems to psychologists; these include the determination of the self, the qualities of the experiences, the nature of knowledge and reality. These problems have existed for many years and have been debated for long, in recent years many psychologists have tried to evade from them, but it is now evident that psychologists cannot hide from them if they want to have efficient information about the phantom limb syndrome. In consideration of these facts, this study will analyze the concept of phantom limbs by using research articles, it will explain the medical, psychological, treatment methods of the phantom limbs, two research articles will be analyzed, and the findings summarized in order to determine their relevance in psychology today.

  • Review of an article
  • Description of phantom limbs

In their article PHANTOM LIMB SYNDROME: a REVIEW, Lama and Kanazi (200) contends that the phantom limb is experienced after the amputation of a limb or the destruction of its sensory roots. Patients can experience sensations that are painful or otherwise in a limb that does not exist (Chahine and Kanazi 345).  The article explains that, some of the patients can feel that their limb is present; they are even able to describe the posture in which it is held and does some tasks (Chahine and Kanazi 345). For example, patients can continue to feel a wedding ring on a finger that has been amputated (Chahine and Kanazi 346). One of the major causal factors of the phantom limb is a complete break of the spinal cord that often results to a phantom body, right below the level of the break. It is possible for phantom bodies to occur after a person has undergone a surgery experience. One of the most astonishing features of the condition is the reality that it presents to the person. The examination of the phantom limb has resulted to four major conclusions, namely;

  1. The experience of the phantom limb has reality in it; this is because a similar brain process that underlies the body experiences when it is intact causes it.
  2. The neural networks in the brain are in charge of generating the qualities of the experiences that originate from the body, the inputs that are in the body can trigger or even modulate the outputs that are in the network, but are not significant for any qualities of the experiences.
  3. The body experience contains a unitary integrated quality that  that has the quality of the self which contends  that the body is uniquely one’s own and not that of any other individual
  4. The neural networks, which that underlie the experience of the body self are genetically determined and they can be modified through the sensory experiences.
  5. Medical perspective of disorder

The phantom limb has been commonly described as Neuropathic. It is widely assumed that it is related to the damage of the central and the peripheral neurons, however, this pain is common after a person arm, or leg has been amputated. This can happen after surgical removal of some body parts, for example, breasts and tongue (Chahine and Kanazi 346). The lesions that are found in the peripheral nerves can cause the phantom limb syndrome. This disorder is likely to occur among older children; however, studies based on questionnaires are difficult for children. Despite the fact that the phantom sensations seem to occur in people who are born without any limbs, it is rare to experience pain in the missing limbs (Chahine and Kanazi 346). The long-term cause of the sensations is not known, several researchers have reported declines in the number of patients who are affected over several years.

Many studies indicate that 80-100% of the amputees do not have painful phantom experiences. The reported incidences of the phantom limb pain are between 60-80% during the postoperative periods. 30% of the people that have amputations have reported the feeling of telescoping, this is the retraction of the phantom towards the residual limb, and in most of the cases, and it includes the disappearance of the phantom into the limb (Chahine and Kanazi 347). This may be accompanied by shrinking limbs. For a long, time, the concept of telescoping was assumed to be an adaptive process that negatively associated with the phantom limb pain. The latest evidence has shown that the process of telescoping is positively related to the phantom limb pain

The anecdotal evidence in the human amputees contends that the spinal mechanism has a role to play when it comes to the phantom limb pain, for example, during the spinal anesthesia, phantom pains have been reported by the patients who had never experienced phantom pain. The experimental data in the human amputees is not sufficient; however, the evidence of animals’ experiments is based on the   models of the partial nerve injury (Chahine and Kanazi 346). The increased activities of the peripheral non-receptors result in changes in the synaptic structure that is located on the dorsal horn of the spinal cord. This activity produces increased excitability of dorsal horn neurons, the reduction of the inhibitory processes and the structural changes that are located at the central nerve endings of the primary sensory neurons. Central sensitization is mediated through NMDA receptors. In this process, the possible mechanisms are that the low threshold afferents are functionally connected to the ascending spinal projection neurons that carry (Chahine and Kanazi 347).

The spinal changes that are related to the phantom limb, mainly involve the brainstem, the thalamus and the cortex.

After a limb is amputated nodules form at the severed nerve endings, they produce unusual impulses that cause the Phantom Limb sensation. Another possible explanation is found in the spinal cord itself and the observed abnormal signaling of the spinal cord Neurons. Melzack proposed a theory that suggested that, the reduction in the input that results from the decreased peripheral sensations following amputations results to inhibition at both the spinal level and the cortical level. Specific changes in spinal cord are been established.

  • Psychological perspective

There is assumption that the phantom limb is related to the unresolved grief over the loss of the limb. Many experts contend that it might be a psychosomatic manifestation of the of the pre morbid personality. Ideas that phantom limbs are inside a patient’s head are still prevalent beliefs. These beliefs can result in large divergence of the reported incidences and prevalence of phantom disorder. The empirical studies that have been carried out on the psychological characteristics of the patients who suffer from the phantom limb and controls indicate that these patients tend to have a normal psychological profile.

People who suffer from the phantom limb exhibit higher than the normal levels of the psychological and emotional distress. Other forms of psychopathology are evident in many individuals who suffer from this disorder. The occurrence of the phantom limb pain and the psychological disturbance has resulted in three conclusions, in one the psychological disturbance is seen as a consequence of pain.

The Phantom limb disorder can be triggered by the psychological factors; the article contends that there is a close relationship between stress and the onset of the phantom limb pain. This is probably mediated by the activities that take place in the sympathetic nervous systems and the increase of the muscle tension. The cognitive factors also play a big role when it comes to the modulation of the phantom limb pain. The patients that do not have the coping strategies and have fear for the worst are more affected by the experiences of the phantom limb; they report more interference than the patients who have the power to cope well with their problems. Before the process of amputation take place, the psychological variables are predictive of the phantom limb pain. The patients who have less support before the amputation takes place tend to have more phantom limb pain. The somatosensory cortex has been known to be involved in the pain process; it may be significant for the sensory discriminating features of the pain experience. There have been reports that the syndrome was abolished after the removal of primary somatosensory cortex.

  • Treatments
  • Preemptive analgesia

                  In the past, the general approach to the postoperative pain management is to treat pain whenever it occurs. It is widely recognized that the trauma to the nervous tissues and the bone may result in long lasting changes in the central neural functions that amplify the postoperative pain and the need for the analgesics (Chahine and Kanazi 347). If epidural anesthesia is started before the surgery period, the incidence of the phantom limb can be decreased.

  • Neuro-stimulation and behavioral modifications

                    According to the findings of the cortical reorganizations in many amputees, attempts have been made for the purpose of changing the cortical reorganization to impact the phantom limb. Animal studies have indicated that, the extensive behavioral relevant stimulation of a body results in the expansion of its stimulation zone. The plasticity of the neurons can then be utilized for the purpose of addressing the   reorganization in the somatic sensory cortex (Chahine and Kanazi 347).

  • Behavior modification

                   One study showed patients being trained to discriminate electrical stimuli that were applied to the stump for two hours a day for a period of two weeks. The process that is commonly known as the behavioral relevant stimulation decreased the phantom limb pain. Ramachandran used a mirror for the purpose of training the patient with the phantom limb pain to move the phantom and reduce the phantom limb pain. A mirror was put in a box; the patient inserted his/her intact arm and the arm that has a phantom (Chahine and Kanazi 348). The patient was asked to look at the mirror image of the intact arm; it was perceived that this was the intact arm in the location where the amputated arm used to be. The patients were asked to make symmetric movements by using both the intact and the phantom hands; this suggested a real movement of the lost arm to the brain. The procedure was used in reestablishing control over the phantom and the reduction of the phantom limb pain in some, but not all the patients in the anecdotal study.

  • Description of two research articles
  • Research done by articles
  • Article 1: Synesthesia in phantom limbs induced with Mirrors

V S Ramachandran together with Rogers Ramachandran wrote the above research article. The authors contend that although there are no experimental studies on the effects of the visual inputs on the phantom sensations, it is possible to introduce an inexpensive new device in the form of a box. They use the box for the purposes of resurrecting the phantom so that they can study inter sensory effects. In the research, a mirror is placed vertically on the table, the mirror reflection of the patient intact hand, which is superimposed on the felt position of the phantom (Ramachandran and Ramachandran 377). The researchers used this procedure on ten patients and the following results were found; in six of the patients, when the normal hand was moved, so that the phantom was perceived to move in the mirror, it was felt to move, this implied the fact that kinesthetic sensations emerged in the phantom. A repeated practice resulted in the disappearance of the phantom; this resulted in the hands becoming telescoped into the stump near the shoulder.

By using optical tricks and impossible postures, for example, the extreme hypertension of the fingers-could be induced visually in the phantom (Ramachandran and Ramachandran 377). In one instance, this happens as a transient painful tag in phantom. Five of the patients underwent painful involuntary spasm in the phantom hand, in four of them. The pain was relieved when the mirror was used for the purpose of facilitating the ‘opening’ of the phantom hand. In three of the patients, touching the normal hand resulted in precisely localizes touch sensations in the phantom hand. Interestingly, this referral was pronounced when their patients observed their phantom being touched in the mirror. In the fourth patient, the referral took place if they saw their phantom being touched; a curious form of synesthesia.

  • Article 2: The perception of the Phantom Limbs

The article contends that almost every person who has a limb amputated will experience a phantom limb. According to the article a wide wealth of empirical evidence, that demonstrates the changes in the cortical topography. The main aim of the research was this with the clinical phenomenology of the phantom limbs. The authors argue that the advent of the noninvasive imaging techniques has made it possible to reorganize and demonstrates graphical reorganization in humans. The research shows that it is now possible to track the perceptual changes and the changes in the cortical topography in the individual patients. According to the article, the patients present a rich opportunity not only for the exploration of the neural plasticity in the adult human brain, but also for understanding the relationship between the activities of the sensory Neuron and the conscious experience.

  • Meaning of research
  • Article 1

The research suggests that there is a certain amount of human plasticity in the brain of the human being. For example, the precisely organized new paths, which bridge the two hemispheres, can emerge in less than three weeks (Ramachandran and Ramachandran 377). For this to happen, there must be a great deal of back and forth interactions that take place between the vision and touch so that the strictly modular, hierarchical model of the brain, that is in vogue can be replaced by a more dynamic and interactive model in which the reentrant signaling plays a major role (Ramachandran and Hirstein 1603).

Article 2

The research article shows that the referred sensations provide the proof for the changing cortical maps that take place in the brain. The research article is divided  in two parts, in one part the article discuss about the phenomenology of  the phantom limbs, in the second part, the article discusses about the new experiments that have been done on the animals and the human patients. The research attempts to link the experiments to the perceptual phenomena of the phantoms

  • Summary on why the topic was picked
  • Article 1

              The reason the authors picked the topic is because in the past medical profession have regarded the phantom limbs as enigmatic clinical curiosities. Only a few researchers have been committed to carrying psychophysical work on the patients. Through the topic, the authors attempt to explain why the phantom limbs illustrate certain important principles that underlie the functional organization and the plasticity of the normal human brain (Ramachandran and Ramachandran 378). Some patients who have phantom limbs experience movements in the phantom, for example, the phantom might attempt to find a blow or shake hands, many other patients report that their phantom is frozen; because the reason for this is obscure, the topic will carry out a careful investigation that will help answer some of these questions.

Article 2

The reason that the authors of the article pick the topic is to revise the conception of the effects of differentiation on the somatosensory maps. The research indicates that the sensory maps can change in the adult brain and they have been responsible for the growing interest of the growing phenomena of the phantom limbs (Ramachandran and Hirstein 1604). By taking the experiments collectively, the work that has been done on the humans and the patients creates a valuable experimental opportunity to investigate not only how the new connections emerge in adult human brain but also how the information from the different sensory module interacts.

  • How the articles enhanced understanding of perceptual psychology

a. Article 1

The article enhances perceptual psychology in that it looks at the process of the brain that underlies the human phenomena. By restoring the vivid illusory movements in the phantom using a mirror, the authors are able to show that the modules that are concerned with vision must interact to greater extents than was previously assumed. The findings in the article demonstrate that neural connections can have therapeutic implications for the purpose rehabilitation. A more general implication of the studies shows that people must give up the hierarchical modular view of the brain.

Article 2

The research in this article has helped in gaining insights about the functional organization of the normal human grain. As the article contends, it is possible to have an initial overshoot during re-mapping, so that the aberrant inputs from the hand skin in the cortical facial area is stronger than the input in the hand area and therefore can dominate the perception and masks the sensation that are in the hand (Ramachandran and Hirstein 1626).

  • Summary

The Phantom Limb syndrome is one of the oldest clinical concepts. It continues to have immense attention among the medical community and the researcher for many decades. Despite the major advancements that have been made in trying to understand the phenomenon, it is evident that a great deal of knowledge has not yet been clarified in terms of the pathogenesis and the treatment. Phantom limbs can be explained through medical plus psychological domains. Patients who suffer from the syndrome can receive treatment through various ways, the most common being behavior modification

Work cited

Chahine, Lama and Ghassan Kanazi. “Phantom Limb Syndrome: A Review.” MEJ ANESTH (2007): 345-355.

Ramachandran, V S and Rogers Ramachandran. “Synesthesia in Phantom limbs induced with mirrors.” Proc.R. Soc. Land B (2003): 377-386.

Ramachandran, V S and William Hirstein. “The Perception of the phantom Limbs: The DO Hebb lecture.” Brain (2005): 1603-1630.