scholarly journals Cognitive Training Improves Disconnected Limbs’ Mental Representation and Peripersonal Space after Spinal Cord Injury

2021 ◽  
Vol 18 (18) ◽  
pp. 9589
Author(s):  
Valentina Moro ◽  
Michela Corbella ◽  
Silvio Ionta ◽  
Federico Ferrari ◽  
Michele Scandola
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Mental Representation ◽  
Body Representation ◽  
Peripersonal Space ◽  
Physical Rehabilitation ◽  
Lower Limbs ◽  
Body Parts ◽  
Rehabilitation Programs ◽  
Cord Injury

Paraplegia following spinal cord injury (SCI) affects the mental representation and peripersonal space of the paralysed body parts (i.e., lower limbs). Physical rehabilitation programs can improve these aspects, but the benefits are mostly partial and short-lasting. These limits could be due to the absence of trainings focused on SCI-induced cognitive deficits combined with traditional physical rehabilitation. To test this hypothesis, we assessed in 15 SCI-individuals the effects of adding cognitive recovery protocols (motor imagery–MI) to standard physical rehabilitation programs (Motor+MI training) on mental body representations and space representations, with respect to physical rehabilitation alone (control training). Each training comprised at least eight sessions administered over two weeks. The status of participants' mental body representation and peripersonal space was assessed at three time points: before the training (T0), after the training (T1), and in a follow-up assessment one month later (T2). The Motor+MI training induced short-term recovery of peripersonal space that however did not persist at T2. Body representation showed a slower neuroplastic recovery at T2, without differences between Motor and the Motor+MI. These results show that body and space representations are plastic after lesions, and open new rehabilitation perspectives.

scholarly journals Spinal cord injury affects the interplay between visual and sensorimotor representations of the body

2016 ◽  
Vol 6 (1) ◽  
Author(s):  
Silvio Ionta ◽  
Michael Villiger ◽  
Catherine R Jutzeler ◽  
Patrick Freund ◽  
Armin Curt ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Relative Weight ◽  
Body Representation ◽  
The Body ◽  
Lower Limbs ◽  
Whole Body ◽  
Body Parts ◽  
Postural Changes ◽  
Cord Injury

Abstract The brain integrates multiple sensory inputs, including somatosensory and visual inputs, to produce a representation of the body. Spinal cord injury (SCI) interrupts the communication between brain and body and the effects of this deafferentation on body representation are poorly understood. We investigated whether the relative weight of somatosensory and visual frames of reference for body representation is altered in individuals with incomplete or complete SCI (affecting lower limbs’ somatosensation), with respect to controls. To study the influence of afferent somatosensory information on body representation, participants verbally judged the laterality of rotated images of feet, hands and whole-bodies (mental rotation task) in two different postures (participants’ body parts were hidden from view). We found that (i) complete SCI disrupts the influence of postural changes on the representation of the deafferented body parts (feet, but not hands) and (ii) regardless of posture, whole-body representation progressively deteriorates proportionally to SCI completeness. These results demonstrate that the cortical representation of the body is dynamic, responsive and adaptable to contingent conditions, in that the role of somatosensation is altered and partially compensated with a change in the relative weight of somatosensory versus visual bodily representations.

scholarly journals Embodying their own wheelchair modifies extrapersonal space perception in people with spinal cord injury

2019 ◽  
Author(s):  
Michele Scandola ◽  
Gaetano Tieri ◽  
Renato Avesani ◽  
Massimo Brambilla ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Reaction Times ◽  
Space Perception ◽  
Body Representation ◽  
The Body ◽  
Lower Limbs ◽  
Space Representation ◽  
Body Parts ◽  
Extrapersonal Space ◽  
Cord Injury

Despite the many links between body representation, acting and perceiving the environment, no research has to date explored whether specific tool embodiment in conditions of sensorimotor deprivation influences extrapersonal space perception. We tested 20 spinal cord injured (SCI) individuals to investigate whether specific wheelchair embodiment interacts with extrapersonal space representation. As a measure of wheelchair embodiment, we used a Body View Enhancement Task in which participants (either sitting in their own wheelchair or in one which they had never used before) were asked to respond promptly to flashing lights presented on their above- and below-lesion body parts. Similar or slower reaction times (RT) to stimuli on the body and wheelchair indicate, respectively, the presence or absence of tool embodiment. The RTs showed that the participants embodied their own wheelchair but not the other one. Moreover, they coded their deprived lower limbs as external objects and, when not in their own wheelchair, also showed disownership of their intact upper limbs. To measure extrapersonal space perception, we used a novel, ad-hoc designed paradigm in which the participants were asked to observe a 3D scenario by means of immersive virtual reality and estimate the distance of a flag positioned on a ramp. In healthy subjects, errors in estimation increased as the distance increased, suggesting that they mentally represent the physical distance. The same occurred with the SCI participants, but only when they were in their own wheelchair. The results demonstrate for the first time that tool-embodiment modifies extrapersonal space estimations.

Visuo-motor and interoceptive influences on peripersonal space representation following spinal cord injury.

2019 ◽  
Author(s):  
Michele Scandola ◽  
Salvatore Maria Aglioti ◽  
Carlo Alberto Arcangeli ◽  
Renato Avesani ◽  
Silvio Ionta ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Peripersonal Space ◽  
Space Representation ◽  
Body Parts ◽  
Short Term ◽  
Virtual Reality Technology ◽  
Passive Motion ◽  
Cord Injury ◽  
Interoceptive Sensitivity

Peripersonal space (PPS) representation is affected by information coming from body, as demonstrated by patients with spinal cord injury (SCI) in whom a body-brain disconnection leads to deafferentation and deefferentation of the below-lesion body parts. In particular, in paraplegic individuals whose lower limb sensory-motor functions are impaired or completely lost, the representation of PPS around the feet is reduced. However, passive motion can have short-term restorative effects. What remains unclear is the mechanisms underlying this recovery and in particular the contribution of visual and motor feedback and of interoception. Using virtual reality technology, we dissociated the motor and visual feedback during passive motion in paraplegics with complete and incomplete lesions and in healthy controls.Results show that in the case of paraplegics (even those with complete lesions), the presence of motor feedback is necessary for the recovery of PPS representation, both when the motor feedback is congruent and incongruent with the visual one. In contrast, visuo-motor incongruence leads to inhibition of the PPS representation in controls.There were no differences in sympathetic responses between the three groups. Nevertheless, in individuals with incomplete lesions, greater interoceptive sensitivity is associated with better representation of PPS around the feet in visuo-motor incongruent conditions.These results shed new light on the modulation of PPS representation, and demonstrates the importance of residual motor feedback and its integration with other bodily information in maintaining space representation.

scholarly journals Massive Edema of the Lower Limbs in Patients after Spinal Cord Injury—One Picture, Different Diagnoses

2021 ◽  
Vol 18 (8) ◽  
pp. 4219
Author(s):  
Magdalena Mackiewicz-Milewska ◽  
Małgorzata Cisowska-Adamiak ◽  
Katarzyna Sakwińska ◽  
Iwona Szymkuć-Bukowska ◽  
Iwona Głowacka-Mrotek
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Heterotopic Ossification ◽  
Lower Limb ◽  
Bone Fractures ◽  
Lower Limbs ◽  
University Hospital ◽  
Pain Sensation ◽  
Vein Thrombosis ◽  
Cord Injury

Diagnosis of the cause of massive edema of the lower limbs in patients after spinal cord injury (SCI) can be difficult because of loss of pain sensation, commonly occurring in this group of patients. This paper reviews several different pathologies that can lead to lower-limb edema and the associated diagnostic difficulties. We present four cases of patients with massive edemas of lower limbs at different times after SCI undergoing treatment in the Department of Rehabilitation, University Hospital in Bydgoszcz, Poland. All patients had a lack of pain sensation in the lower limbs and significantly elevated levels of D-dimer. In two cases, deep vein thrombosis (DVT) and intramuscular hematomas (IHs) were diagnosed. IHs were probably a consequence of antithrombotic treatments implemented due to the occurrence of DVT. Heterotopic ossification (HO) was diagnosed in a third case, and, in another patient, who was hospitalized for the longest period after injury, we found humeral bone fractures. Heterotopic ossification, intramuscular haematomas, and bone fractures of the lower limb can mimic DVT. Careful observation of the edema evolution is recommended, as the onset of new symptoms may indicate a different cause of edema from that initially established.

scholarly journals Bone changes in the lower limbs from participation in an FES rowing exercise program implemented within two years after traumatic spinal cord injury

2018 ◽  
Vol 43 (3) ◽  
pp. 306-314 ◽  
Author(s):  
Rebecca L. Lambach ◽  
Nicole E. Stafford ◽  
Julie A. Kolesar ◽  
B. Jenny Kiratli ◽  
Graham H. Creasey ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Exercise Program ◽  
Lower Limbs ◽  
Traumatic Spinal Cord Injury ◽  
Cord Injury ◽  
Bone Changes

scholarly journals Intercostal, ilioinguinal, and iliohypogastric nerve transfers for lower limb reinnervation after spinal cord injury: an anatomical feasibility and experimental study

2019 ◽  
Vol 30 (2) ◽  
pp. 268-278 ◽  
Author(s):  
Ahmed A. Toreih ◽  
Asser A. Sallam ◽  
Cherif M. Ibrahim ◽  
Ahmed I. Maaty ◽  
Mohsen M. Hassan
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Animal Studies ◽  
Femoral Nerve ◽  
Lower Limbs ◽  
Nerve Transfers ◽  
Promising Therapeutic Approach ◽  
Cord Injury ◽  
Significant Motor

OBJECTIVESpinal cord injury (SCI) has been investigated in various animal studies. One promising therapeutic approach involves the transfer of peripheral nerves originating above the level of injury into those originating below the level of injury. The purpose of the present study was to evaluate the feasibility of nerve transfers for reinnervation of lower limbs in patients suffering SCI to restore some hip and knee functions, enabling them to independently stand or even step forward with assistive devices and thus improve their quality of life.METHODSThe feasibility of transferring intercostal to gluteal nerves and the ilioinguinal and iliohypogastric nerves to femoral nerves was assessed in 5 cadavers. Then, lumbar cord hemitransection was performed below L1 in 20 dogs, followed by transfer of the 10th, 11th, and 12th intercostal and subcostal nerves to gluteal nerves and the ilioinguinal and iliohypogastric nerves to the femoral nerve in only 10 dogs (NT group). At 6 months, clinical and electrophysiological evaluations of the recipient nerves and their motor targets were performed.RESULTSThe donor nerves had sufficient length to reach the recipient nerves in a tension-free manner. At 6 months postoperatively, the mean conduction velocity of gluteal and femoral nerves, respectively, increased to 96.1% and 92.8% of the velocity in controls, and there was significant motor recovery of the quadriceps femoris and glutei.CONCLUSIONSIntercostal, ilioinguinal, and iliohypogastric nerves are suitable donors to transfer to the gluteal and femoral nerves after SCI to restore some hip and knee motor functions.

scholarly journals Walking with Neuropathic Pain: Paradoxical Shift from Burden to Support?

2015 ◽  
Vol 2015 ◽  
pp. 1-3 ◽  
Author(s):  
David J. Kopsky ◽  
Jan M. Keppel Hesselink ◽  
Roberto Casale
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Neuropathic Pain ◽  
Unusual Case ◽  
Body Schema ◽  
The Body ◽  
Sensory Loss ◽  
Pain Patient ◽  
Rehabilitation Programs ◽  
Cord Injury

Baclofen 5% cream can be used for the treatment of neuropathic pain. We describe an unusual case of a neuropathic pain patient with spinal cord injury. A 71-year-old woman with a partial spinal cord injury lesion at L4 complained of tingling, pins and needles, and burning in her legs. She scored her pain as 6 before adding baclofen 5% cream to her pain medication (pregabalin 450 mg, acetaminophen 3000 mg, and diclofenac 150 mg daily). One month later she experienced complete pain relief, though experienced increased difficulties in walking, leading to frequent falls. Her steadier walking without stumbling and falling was more important to her than pain reduction. Thus she decided to stop using baclofen. This unusual case report discusses two important issues that relate to pain medicine and rehabilitation in patients with painful spinal cord lesions: (1) the presence of wide areas of sensory loss “covered” by the presence of painful sensations and (2) pathological sensations that can be used and integrated in the body schema to create an improved spatiovisual orientation and thus mobility. Both these aspects have to be taken into account when treating pain and design rehabilitation programs.

scholarly journals Development of a Rehabilitation Game for Individuals With Spinal Cord Injury Using a User-Centered Design Process

2018 ◽  
Author(s):  
Stuart R. Fairhurst ◽  
Logan C. McCool ◽  
Kristin M. Scheel ◽  
Crystal L. Stien ◽  
Charlotte M. Brenteson ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Video Game ◽  
Perceived Exertion ◽  
Interactive Video ◽  
Spinal Cord Injuries ◽  
Lower Limbs ◽  
User Centered Design ◽  
Cord Injury ◽  
Interactive Video Game

The use of video games during exercise, exergaming, has been shown to increase energy expenditure without increasing perceived exertion [1]. This suggests that exergaming may be an effective way to engage a patient during rehabilitation and increase adherence to a rehabilitation regime. Existing exergame systems are designed with able bodied users in mind and often combine hand controlled game play while using lower limbs for aerobic exertion, making current systems inaccessible to individuals with spinal cord injuries and others without lower limb function. Our earlier work on increasing exercise accessibility includes developing an ergometer for supine use for patients who have recently had a flap procedure [2]. The goal of the present project was to create an engaging, interactive video game designed for use during arm ergometry by individuals with spinal cord injury (SCI) in either the supine or seated position.

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