Abstract
ObjectiveWe investigated for the first time the presence of chronic changes in the functional organization of sensorimotor brain areas induced by prolonged training with a bidirectional hand prosthesis.MethodsA multimodal neurophysiological and neuroimaging evaluation of brain functional changes occurring during training in five consecutive amputees participating to experimental trials with robotic hands over a period of 10 years was carried out. In particular, modifications to the functional anatomy of sensorimotor brain areas under resting conditions were explored in order to check for eventual changes with respect to baseline.ResultsFull evidence is provided to demonstrate brain functional changes, and some of them in both the hemispheres and others restricted to the hemisphere contralateral to the amputation/prosthetic hand.ConclusionsThe study describes a unique experimental experience showing that brain reactions to the prolonged use of an artificial hand can be tracked for a tailored approach to a fully embedded artificial upper limb for future chronic uses in daily activities.
Highlights
The hand is a body segment of extraordinary importance as it is used to interact with the peri-personal environment in all the pivotal daily activities; its loss causes severe physical and psychological deficits.Hand amputation is followed by a cascade of plastic changes in motor and somatosensory pathways and relays in the “orphan” districts of the central nervous system (CNS) connected to the amputated part
Objective: We investigated for the first time the presence of chronic changes in the functional organization of sensorimotor brain areas induced by prolonged training with a bidirectional hand prosthesis
This study reports on a multimodal evaluation of cortical changes occurring during bidirectional hand prosthesis training of variable duration (4–36 weeks), in a series of 5 amputees over a period of 10 years
Summary
The hand is a body segment of extraordinary importance as it is used to interact with the peri-personal environment in all the pivotal daily activities; its loss causes severe physical and psychological deficits. Several recent experimental studies and observations in human amputees clearly demonstrated the persistence of a certain degree of functionality of the somatosensory and motor cortices corresponding to the amputated part, even several years following amputation (Granata et al, 2018; Makin, Filippini, et al, 2015; Makin et al, 2013; Makin, Scholz, Henderson Slater, Johansen-Berg, & Tracey, 2015; Raspopovic et al, 2014; Rossini et al, 2010) Both the cortical reorganization and the persistance of the original functional topography seem to contribute to the presence and severity of the phantom limb pain (PLP) (Flor et al, 1998; Flor et al, 1999; Vaso et al, 2014). Patient 5: 53-year-old female with left traumatic transradial (proximal third of the forearm) amputation that occurred 1 year and 6 months before the trial She suffered from mild phantom limb pain and very frequent nonpainful phantom sensation (score of around 4 on the VAS), mainly located on the ulnar side of the phantom hand.
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