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Perception and Sensation for Amputees: a Research Study

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Introduction

The process that involves our bodies gathering information from the environment and sending it to the brain is referred to as sensation. Senses possessed by human beings are responsible for the transmission of the massive amounts of information that is sent to the mind. There are volumes of information that is usually transmitted such as temperature, the smell of food, presence lights, people conversing and a distant copter flying. All this information cannot be availed in the brains were it not for sensory abilities that people have. However, it is clear that people do not sense all the information around them as they lack the features to help. Notably, people are only able to sense what they can, and that explains why some aspects of the environment remain unnoted. On the other hand, perception is the process that involves interpretation of the information that the brain can receive through senses. The way people understand the environment is what makes a significant difference between humans and other animals. Equally, the way one person can view a colleague is different from one individual to another. The variation in perception usually is noted because of the different abilities that people possess. A person who has an arm or part of it removed is referred to as an amputee. Equally, the process of removing a limb of an individual can be referred to as amputation. Amputation can happen in different ways, which include removal by trauma, illness or a probable surgery. The main aim of the research is to establish how sensation and perception happen for amputees. Phantom limb pain (PLP) is the pain that is assumed to originate from body parts that no longer exist. However, the research aims at establishing the source of the pain and how it can be perceived.

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Research Summaries

Bolognini, N., Olgiati, E., Maravita, A., Ferraro, F., & Fregni, F. (2013). Motor and parietal cortex stimulation for phantom limb pain and sensations. PAIN®, 154(8), 1274-1280.

In the article, the author has well explained PLP as a neuropathic syndrome that majorly originates from the pain of an amputated limb. According to the author, PLP can lead to chronic and very painful sensations, which may have been influenced by maladaptive plasticity. The main aim of the study as explained by the author is to establish the cause of the phantom limb pain that amputees experience. Further, the research aimed at performing empirical experiments to determine when the pain is likely to be felt. On the other hand, the article has well-used methodology to establish the validity of the clinical presentation that is given regarding PLP.

The first step in the article is stimulation, which uses eight amputees who were right-handed before amputation as participants. The participants were recruited from a population, which included both outpatient and inpatient amputees. The eight patients were selected from the neurological rehab unit. The author of the article highlights clearly that a brain stimulator, which is invasive can be able to reduce the effects of PLP. As much as the experiments conducted were sham, the results indicate a significant correlation (Bolognini, Olgiati, Maravita, Ferraro & Fregni, 2013).

Notably, the author of the article asserts that pain felt and perceived to be coming from the amputated limp originates from the spinal cord. Sensory neurons are responsible for sending impulses to the brain after one has sensed. To some people, pain can be better with time, while in some, it can be so hard to control. Additionally, the findings indicate that at times, people who are amputated feel as if the limb is existing. The feeling is referred to as phantom limb sensation as referred to by the article. There are two types of pains, which are felt including residual and the PLP.

Finn, S. B., Perry, B. N., Clasing, J. E., Walters, L. S., Jarzombek, S. L., Curran, S., ... & Pasquina, P. F. (2017). A randomized, controlled trial of mirror therapy for upper extremity phantom limb pain in male amputees. Frontiers in neurology, 8, 267.

The primary objective of the article is to establish the fact that PLP can be prevalent at the post-amputation level than it can at an earlier stage. In the article, fifteen participants were chosen to take part in a study. Amputees included military people who were frontier participants. There were two types of experiments that were being carried out. The first one was the one that underwent through mirror therapy, while the second one involved a control experiment. The research was carried out at two medical centers namely Walter Reed and Brooke Army. The participants were advised to carry out their assigned therapy for at least 15 minutes each day (Finn et al., 2017). This would go on for five days a week in four weeks. The article asserts that a visual analog scale was used to measure the extent of the pain to the male amputees. Further, participants under the control experiment were put under therapy for four weeks and produced the same results.

Results indicated that the therapy assigned to people reduced the pain that is felt. After the therapy, the participants were allowed to take a survey involving an assessment. Further, the visual analog scale (VAS) was used to measure the extent that the pain was being felt by the participants daily. Surprisingly, the study carried out established that the daily therapy reduces the pain that they undergo in regular episodes. It can be used efficiently as established by the experiments performed on the male amputees. The article outlines that the participants selected had used various treatment drugs, which had failed. Additionally, there was a significant correlation between the therapy and the effect that is felt daily. With the therapy, the pain reduces daily to the extent of making them prefer carrying out the exercise daily. The article has supported previous work on the same topic by asserting that the effects are similar on both upper and lower extremity amputees.

Trevelyan, E., Turner, W., & Robinson, N. (2015). Perceptions of phantom limb pain in lower limb amputees and its effect on quality of life: a qualitative study. British Journal of Pain, 10(2), 70-77

The article looks into phantom limb pain (PLP) with a view to finding out if the educational needs of amputees are being met. From interviews carried out on the amputees, the authors are seeking an understanding of the quality of life lived and if they are satisfied by the information provided to them on PLP. The research was carried out at the Inpatient Amputee Rehabilitation Unit and two other units in London. In the sample, 15 amputees were considered due to the time and resources available. They all were above 18 years with lower limb amputation greater than a toe. This selection was made by the physiotherapists that were approached by the researchers relying on the information availed regarding the study. The research method employed here was an interview that was semi-structure between the researcher and the participant, and it was audio recorded. Each interview lasted for at least one hour.

Key findings from the study were a positive affirmation that PLP affected their way of life with eleven confirming depression, illogical acting and being withdrawn (Trevelyan, Turner & Robinson, 2015). They also confirmed it being tiring and wearing. Four participants also reported to have accepted the condition and were coping with it well. During pain, they contained it through massage, rubbing or hitting the stamp gently. They agreed to the fact that there was lack of access to doctors and adequate information. In conclusion the study reinforced the fact that phantom limb syndrome was affecting the quality of life for the amputees and there is a need for more research into it to enable those affected to have the right information and know how to deal with it. It's in turn can help clinicians during therapeutic encounters with the amputees on sensation and perception.

Rayegani, S., Aryanmehr, A., Soroosh, M., & Baghbani, M. (2010). Phantom Pain, Phantom Sensation, and Spine Pain in Bilateral Lower Limb Amputees: Results of a National Survey of Iraq-Iran War Victimsʼ Health Status. JPO Journal Of Prosthetics And Orthotics, 22(3), 162-165.

Iraq versus Iran war that lasted for eight years since 1980 and the unrest that followed caused a lot of deaths and injuries. From this article more than eleven thousand people had their limbs amputated. The researchers carried out this study to find out the characteristics of phantom limb sensation and pain, spine pain and evaluate their relevance to various levels of amputations. Janbazan Medical and Engineering Research center invited amputees and upon getting their go-ahead for the exercise they were assessed and examined by three physiatrists. They also completed a detailed questionnaire. A total of 335 individuals participated with 97.6 percent being men and all were married. Their age ranged between 18 and 70 years. They all were victims of war and war-related activities since 1980 to 2006 (Rayegani, Aryanmehr, Soroosh & Baghbani, 2010).

The research method utilized here was a questionnaire that had details of the different types of phantom sensations that the amputees described. Pain that they experienced was also rated numerically from 1 to 10 with zero being no pain at all. The majority reported that they had had back pain within the past four weeks and precisely the lower back. The study found out that 83% of the amputees in the study experienced phantom sensation though less than 17% experienced annoying sensation. The study concluded that phantom limb sensation and pain was prevalent. Perception helps to make sense of our sensations, and from the research, its evident that the sensations experienced are affecting the amputee’s lives. The neurological implications as a result of this sensations create discomfort, and there is need to be keen when dealing with these patients. The article recommends an additional study to understand the severe phantom pain.

Diers, M., Christmann, C., Koeppe, C., Ruf, M., & Flor, H. (2010). Mirrored, imagined and executed movements differentially activate sensorimotor cortex in amputees with and without phantom limb pain. Pain, 149(2), 296-304.

The researchers carried out a study to understand whether the mirrored movements of an intact limb can provide important information to the cortical representation district that used to get instruction from the now missing limb. Participants included upper limb amputees who were fourteen in number with a mean age of 54 (Diers, Christmann, Koeppe, Ruf & Flor, 2010). They all consented to the study and approval received from the local authority. The experiments entailed three parts which included executed movements, mirrored movements, and imagined movements. All these movements both actual and imagined were externally paced by a metronome. These three experiments provided different results as expected. The executed movement activated the primary motor and somatosensory cortex. The mirror movements activated the cortex more than the executed movement. The imagine movement had no significant activation differences.

The study brought forth crucial results.it revealed that seeing one’s own hand in the mirror leads to activity in the brain part responsible for the specific function for the amputated limb similar to the actual one. As such previous mirror boxes used to decrease cramps, the sensation of pain and touch in the phantom limbs. But as a result of this study, sensational pain can be reduced as a result of visual feedback which results in cortical rearrangement in the brain. Additionally, in case of conflict of information with other senses visual always takes precedence over the others. From the study sensation and perception have been covered extensively with the conclusion indicating a strong correlation between the two. Seeing the hand in the mirror eventually impacted on the phantom limb pain. This, in turn, seems to support the information that the phantom pain is a result of conflicting information being transmitted that over time and with adequate therapy will subside.

Trevelyan, E., Turner, W., & Robinson, N. (2015). Exploring the experience of phantom limb syndrome and acceptability of acupuncture intervention to lower limb amputees. Integrative Medicine Research, 4(1), 110.

The research was carried out in view of the fact that Phantom limb syndrome is a chronic post-surgery (amputation) complication. Additionally, using the normal recommended medicine does not help in managing this condition. As such the study also sort to find out if Acupuncture, a drug that has been highly effective in controlling and dealing with other inveterate pain conditions, can be used to treat Phantom limb pain. A sample size of fifteen persons who had been amputated within a span of one to three months was considered. All had one or both of there low limbs amputated. They also had to have had an experience with Phantom Pain syndrome and were willing to consider Acupuncture as a treatment.

From the study, crucial analysis results were generated. All the participants alluded to the fact that they suffered prior to amputation and after losing a limb. They also indicated the fact that they had accepted living with a phantom though it made life unbearable. Acupuncture was also accepted though there were few concerns raised regarding its effectiveness and side effects. As such other than the research adding to the knowledge pool of the Phantom Limb Syndrome it also found out that amputees are bequeathing to try complementary medicine to contain the condition hence the acceptance of Acupuncture (Trevelyan, Turner & Robinson, 2015). From the study it is clear that the sensation from PLS is such a bother judging from what the participants are willing to do. The study also brings to light the fact that the syndrome begun much earlier before the amputation itself and the perception that it’s a creation of the mind or due to miscommunication by nerves may be untrue.

Course Connections

As already noted, there is a great correlation between the effects that are felt and therapy. The main aim of the research is to establish whether PLP can be reduced. In the articles that have been reviewed above, amputated people can be put under therapy to reduce the pain. Sensation involves the detection of the pain though sensory neurons that are connected to the spinal cord as the primary central nervous system. The experiments that were conducted in the articles reviewed above support the fact that PLP can be controlled in some circumstances. Various features can be associated with the PLP including onset of pain immediately the part of the limb or the whole of it has been amputated. Further characteristics may include seasonality in the existence of the pain, meaning that the pain can disappear and come back. Additionally, the pain can be described as burning, throbbing and hurting. As compared to the research conducted out in the articles, there is a connection between the PLP that is under study in this research and the main discussion in the reports.

Phantom pain can be severe, and many amputated people are under rehabilitation. To help such people in the society, there is a need for such research procedures to be carried out and establish what has been done before and determine whether the argument is valid. Notably, there is a clear connection between the information presented in the articles and the course material that is being learned in class. The difference noted in the effects of the pain in the people who participated in the study is a clear indication that therapy is an essential factor in reducing the experience. However, there are some cases that the therapy does not seem to work correctly well.

The pain felt can be explained to originate due to the peripheral mechanism, which involves massive tissue injury including neural instigated pain. It disrupts transmission of impulses to the spinal cord through the sensory neurons. The spontaneous releases that are made cause pain to an individual. The pain arises sometimes, and one can feel like the amputated limb is still there. The abnormal activity, which is peripheral, results to the effect, however, once the spinal cord sends the signal to the brain, the effect is perceived as pain. Depending on various principles, there is some treatment therapy that victims can be assigned to, which can include pharmacological strategies and non-pharmacological ones.

There are various senses that people possess, which may include gustation, olfaction, sight, vision, hearing, and equilibrium. Gustation is the sense to taste, and it is essential to the human body. Olfactory, on the other hand, implies smell, equilibrium refers to balance while hearing represent the ability to hear. Concerning the research summaries, amputees also sense various aspects of the environment with the help of such senses. For instance, in the articles, it is clear that sensory nerves are used to detect the changes in the environment and affect them. Without the senses, one cannot be able to detect important happenings in the surrounding, which shows how important it is for amputees to possess sensory abilities. Additionally, amputees use the sense of equilibrium to bring balance between the remaining limbs.

Pharmacological approaches to the disease may include opioids, tricyclic antidepressants, anticonvulsants, sodium channel blockers and receptor antagonists. On the other hand, non-pharmacological strategies that can be used include transcutaneous electrical nerve stimulation (TENS), mirror therapy, behavioral methods, surgical intervention and electroconvulsive therapy. As indicated by the methodology applied to perform various experiments in the articles, there is a great course connection between the two. In class, the whole concept of sensation and perception has been learnt. For instance, mirror therapy has been applied in performing experiments to ascertain the effect of the pain and whether the procedure can be able to reduce it. PLP is a condition that can be disturbing to the people involved as it can cause further problems. To control it, the approaches listed above are helpful as ascertained in the research that was conducted and presented in the articles. All groups that conducted the study asserted the fact that the condition does not only happen to people who have been amputated, it can also occur and may necessitate for surgery to amputate the limb.

Limitations and Future Implications

The research conducted by the authors of the articles represent private views as they are described as sham experiments. This forms a significant part of the limitations that are facing the assertions in the reports. Further, the fact that the methodology applied cannot be verifiable makes it hard for the research to convince many that it is the true picture of what is experienced. Second, some of the experiments performed in the articles do not have any financial or commercial obligations, and their validity is highly questionable. This fact is one limitation that has impacted the research negatively. Timing may have affected the credibility of the study as researchers did not spend a lot of time with the participants. As such, they resolved to rely on the information provided by the amputee. Also, prolonged engagement encourages openness which in turn result in more information. The sample used did not meet all the relevant requirements. Lack of women in the sample limited it to the opinion of only men instead of considering both genders. Third, in article 3, Participants were victims of war, and as such, they may have taken part in the study due to an opportunity to get medication and opinion of the psychiatrist and not a commitment to give an accurate and fair opinion on how they have been affected by Phantom Limb syndrome. Additionally, their social beliefs may have hindered them from providing all information required. The main limitation is the number of individuals considered in the different study movements. A human era may have led to a different result. Moreover, the duration that it took to train and monitor the participant was not adequate and may have given an idle opportunity for a participant to fake the result they wanted to be displayed. This can be noted from article four. Given the suffering associated with Phantom Limb Syndrome participants who as per the study were willing to go to any length may have accepted to participate just to access Acupuncture. Additionally, the number of individuals sampled was too small to be able to make a conclusive decision. Various implications can arise due to the studies that have been conducted. The therapies used such as mirror therapy can be used to reduce the effects of the PLP. In many circumstances, it serves as an alternative method where regular drug interventions are not readily available. Moreover, the research carried out can help add to the existing pool of information.

Conclusion

Most people who are under rehabilitation can use therapy to reduce the effect caused by the PLP. Sensation and perception in amputated people is a condition that can be hard to deal with. However, in the rehabilitation centers, the problem can be handled by use of various approaches, which include both pharmacological and non-pharmacological treatment procedures. Once therapy assigned to an individual is used correctly, there is a high likelihood that the effect of pain will reduce. The sensory nerves, the muscles involved and the spinal cord is all involved as mechanisms explaining the occurrence of a PLP. Various senses make up a complete sensory mechanism for the body. They include gustation, olfactory, sight, sense of hearing and importantly, equilibrium in the body. For instance, the senses coordinate well with each other to sustain and protect the life of a human being. Additionally, research has limitations, and whenever one is conducting one, they should take into consideration factors that influence the result. Further, samples that are used to take a study should be standard to provide the required results. People who are amputated sometimes feel as if the removed part is still existent and that the pain originates from the amputated limb. However, this is not true as the pain originates due to the sensitivity of the spinal cord.

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