The prevalence of phantom limb experience in amputees.

Reviewed the records of 716 amputees who utilized Canadian prosthetic facilities to determine the prevalence of phantom limb pain or sensation and the possible influence of demographic variables on their presence. The prevalence of phantom pain (62.4%) and phantom sensation (84.1%) tended to confirm recent surveys in other nationalities. Years since amputation was the only variable found to influence the report of either pain or sensation. Ss who lost their limbs prior to 1960 reported significantly more pain (73.3%) than Ss who lost their limbs after 1976 (51.1%). There was also a slight tendency for older Ss to report phantom limb pain more often than younger Ss. Findings suggest that the incidence of phantom limb pain is declining. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Healthy youth development as a model for youth health promotion. A review

To explore the possible mechanisms of phantom limb discomfort after amputation, three amputees with phantom limb pain were studied. This study examined the change of regional cerebral blood flow using technetium-99m hexamethylpropyleneamine oxime-single photon emission computerized tomography, which was arranged at the time of severe phantom limb discomfort and after the discomfort subsided or was completely relieved. Nine representative transverse slices parallel to the orbitomeatal line were selected for quantification. The cortical ribbon (2-cm thickness) was equally subdivided into 12 symmetrical pairs of sector regions of interest in each slice. The irregularly shaped regions of interest were drawn manually around the right thalamus and basal ganglion and then mirrored to the left thalamus and basal ganglion. The contralateral to ipsilateral ratio of regional cerebral blood flow for each area was calculated. The intensity of phantom limb pain was evaluated on a 0 to 10 visual analog scale. In Cases 1 and 2, the contralateral to ipsilateral regional cerebral blood flow ratios of multiple areas of the frontal, temporal, or parietal lobes were increased at the time of more severe phantom limb pain, and the ratios were normalized or even decreased when the phantom limb pain subsided. In Case 3, increased contralateral to ipsilateral regional cerebral blood flow ratios were also found over the frontal, temporal, and parietal lobe. However, most of the increased regional cerebral blood flow ratios of regions of interest in the first study persisted in the follow-up study. Also, the regional cerebral blood flow ratios of greater number of regions of interest of the same gyrus and new gyrus were increased. There was no significant right-left difference of regional cerebral blood flow over bilateral thalami and basal ganglia in all three cases. The results suggested that phantom limb pain might be associated with cortical activation involving the frontal, temporal, or parietal cortex, and it may imply the possibility of the existence of an ascending polysynaptic pathway that conveys the uncomfortable phantom limb sensation to the cerebral cortex. These findings may also indicate that reorganization of the cortical blood flow occurs in amputees. However, it is still difficult to conclude that the changes in regional cerebral blood flow were attributable directly to pain. With no comparison group of amputees and because of the small number of cases, it is hard to generalize about cerebrocortical involvement in phantom pain, and it is possible that the findings represent a normal phenomenon seen after 'amputation. Another possibility is that the findings represent increased arousal caused by pain rather than an intrinsic pain pathway. Further study is worthwhile.     

Psychological distress in workers with traumatic upper or lower limb amputations following industrial injuries.

Objective: To determine whether individuals with traumatic upper limb amputations would report more symptoms of posttraumatic stress disorder (PTSD) and depression than individuals with traumatic lower limb amputations. Study Design: Retrospective file review. Setting: CARF-accredited outpatient rehabilitation center. Participants: Thirty workers with unilateral upper limb amputations and 25 workers with unilateral lower limb amputations. Main Outcome Measures: Presence or absence of depression, symptoms of PTSD, and pain. Results: The upper limb group had a higher frequency of depression and symptoms of PTSD than the lower limb group. The 2 groups did not differ with respect to pain complaints. Conclusion: More so than injuries to the lower limbs, upper limb injuries may render individuals vulnerable to PTSD and depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Extended and telescoped phantom limbs in unilateral amputees.

The incidence of extended (same length) and telescoped phantom limbs was studied by interview in 239 adult unilateral amputees, above and below elbow and knee (AE, BE, AK, BK). Differences were analyzed by nonparametric statistics. Conclusions were as follows: (a) AEs reported the greatest, and BKs the smallest proportions of shortened phantoms; (b) BE and AK groups were approximately similar; (c) telescoped phantoms of proximal amputations were mainly partly telescoped—of distal amputations, fully telescoped; (d) phantom presence, persistence, strength, shortness, and tactile pressure sensitivity were positively related, paralleling the cephalocaudad principle; (e) limb image (established by cortical and learning factors); and (f) intensity of stump cues (dependent on the cephalocaudad gradient, etiology, and sensitization by amputation), affect perception of phantom length and related sensations. (18 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Phantom sensations generated by thalamic microstimulation

Many amputees have a sense of their missing 'phantom' limb. Amputation can alter the representation of the body's surface in the cerebral cortex and thalamus, but it is unclear how these changes relate to such phantom sensations. One possibility is that, in amputees who experience phantom sensations, the region of the thalamus that originally represented the missing limb remains functional and can give rise to phantom sensations even when some thalamic 'limb' neurons begin to respond to stimulation of other body regions. Here we use microelectrode recording and microstimulation during functional stereotactic mapping of the ventrocaudal thalamus in amputees to determine both the responses of the neurons to stimulation of the skin and the perceptual effects of electrical activation of these neurons. Thalamic mapping revealed an unusually large thalamic stump representation, consistent with the findings from animal experiments. We also found that thalamic stimulation in amputees with a phantom limb could evoke phantom sensations, including pain, even in regions containing neurons responsive to tactile stimulation of the stump. These findings support the hypothesis that the thalamic representation of the amputated limb remains functional in amputees with phantoms.     

Microelectrode recordings from transected nerves in amputees with phantom limb pain

Intraneural microelectrode recordings were made from the nerve supplying the phantom area in two patients suffering from phantom limb pain. Spontaneous activity was prominent in both cutaneous and muscle fascicle of the nerves. Tapping the neuromata which accentuated the phantom limb pain, induced afferent discharges with both short and long latencies, the latter from fibres with a conduction velocity of only 0.5 m/sec. Blocking the neuromata with lidocaine completely abolished the tap-induced afferent discharges and the tap-induced accentuation of the phantom pain. The spontaneous pain was, however, unchanged, as was the spontaneous activity recorded.     

Noise-driven neuroplasticity in self-organizing feature maps: a neurocomputational model of phantom limbs

The term "phantom limb" denotes the sensation that an extremity is present although it has been lost. A number of clinical features and recent findings of cortical map plasticity after destruction of afferent pathways (deafferentation) suggest that phantom limbs are caused by large-scale cortical reorganization processes. However, in paraplegics, who also suffer from cortical deafferentation, phantom sensations rarely develop, and if they do, they are weak, lacking in detail, and delayed, occurring after months. This has been taken to suggest a non-cortical genesis of phantom limbs. This article proposes a biologically plausible minimal neural network model to solve this apparent puzzle. Deafferentation was simulated in trained self-organizing feature maps. Reorganization was found to be directed by input noise. According to the model, the production of input noise by the deafferented primary sensory neuron promotes cortical reorganization in amputees. No such noise is generated or conducted to the cortex in paraplegics.     

"Extended and telescoped phantom limbs in unilateral amputees": Erratum.

Reports an error in the original article by Samuel A. Weiss and Sidney Fishman (Journal of Abnormal & Social Psychology, 1963, Vol 66[5], 489-497). A correction is provided to a sentence on page 491, in column 1, paragraph 2, line 3. (The following abstract of this article originally appeared in record 1964-02937-001.)The incidence of extended (same length) and telescoped phantom limbs was studied by interview in 239 adult unilateral amputees, above and below elbow and knee (AE, BE, AK, BK). Differences were analyzed by nonparametric statistics. Conclusions were as follows: (a) AEs reported the greatest, and BKs the smallest proportions of shortened phantoms; (b) BE and AK groups were approximately similar; (c) telescoped phantoms of proximal amputations were mainly partly telescoped--of distal amputations, fully telescoped; (d) phantom presence, persistence, strength, shortness, and tactile pressure sensitivity were positively related, paralleling the cephalocaudad principle; (e) limb image (established by cortical and learning factors); and (f) intensity of stump cues (dependent on the cephalocaudad gradient, etiology, and sensitization by amputation), affect perception of phantom length and related sensations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Increased cardiovascular disease mortality rates in traumatic lower limb amputees

We evaluated the 24-year mortality rates of male traumatic lower limb amputees (n = 201) of the Israeli army, wounded between 1948 and 1974 compared with a cohort sample representing the general population (n = 1,832). Mortality rates were significantly higher (21.9% vs 12.1%, p <0.001) in amputees than in controls. Cardiovascular disease (CVD) mortality was the main cause for this difference. The prevalence of selected risk factors for CVD was determined in 101 surviving amputees (aged 50 to 65 years) and a sample of the controls (n = 96) matched by age and ethnic origin. Amputees had higher plasma insulin levels (during fasting and in response to oral glucose loading) and increased blood coagulation activity. No differences were found in rates of current symptoms of ischemic heart disease or of cerebrovascular disease, obesity, hypertension, altered plasma lipoprotein profile, impaired physical activity, smoking, or nutritional habits. Traumatic lower limb amputees had increased mortality rates due to CVD. Surviving amputees had hyperinsulinemia, increased coagulability, and increased sympathetic and parasympathetic responses (described previously). These established CVD risk factors may explain the excess mortality due to CVD in traumatic amputees.     

Phantom limb pain and pain interference in adults with lower extremity amputation: The moderating effects of age.

Purpose/Objective: To determine whether the relationship between phantom limb pain severity and pain-related interference was moderated by age and to compare 2 theoretical perspectives used in the literature to account for age-related differences in the experience of chronic pain. Research Method/Design: Analysis of survey data provided by 375 adults with lower extremity amputations who reported phantom limb pain. Results: The relationship between phantom limb pain severity and pain-related interference was shown to be moderated by age (β = -.10, p     

Congenital constriction band syndrome. Pathophysiology and treatment

The clinical manifestations of 88 children with congenital constriction band syndrome involvement of the hand were reviewed. Seventy-five of these children had evidence of digital or limb amputations, with 235 upper limb amputations and 138 lower limb amputations. In the hand, digital amputations were most common in the index, middle, and ring fingers, whereas in the foot, amputations of the hallux were most often noted. Band indentation was often present at multiple levels. Proximal bands may be associated with neural compression. Syndactyly was invariably associated with a proximal interdigital sinus or cleft and was frequently associated with distal amputation. Examination of a 27-week gestation stillborn specimen having manifestations of congenital constriction band syndrome demonstrated the intrauterine biologic response to band constriction. The variable clinical manifestations of congenital constriction band syndrome can best be explained as the response of the growing, embryologically defined limb to intrauterine deformation or band-induced compression and ischemia.     

An innovative approach using film and creative writing to teach developmental concepts to pediatric nursing students

We have reviewed 75 amputees, 58 in the lower limb and 18 in the upper. Closed amputation was performed in 69 patients (92%) and an open procedure in six (8%). Wound infection occurred in six (8%) and one patient died from thromboembolism. Wound healing was normal in the remainder. The results of closed amputation in war conditions are very good, if performed within 6 hours of injury.     

Lower limb amputation. 1: indications and treatment

Lower limb amputation is performed predominantly to alleviate acute and chronic limb ischaemia caused by vascular disease, poorly controlled diabetes or, occasionally, infection. Atherosclerosis is the primary cause of chronic arterial ischaemia and the most common reason for amputation. The vascular nurse has an important role in reducing the need for amputation, by providing information on health promotion and illness prevention to patients with vascular insufficiency to halt progression to amputation. This is the first of four articles focusing on lower limb amputation. It examines the indications for lower limb amputation in detail, and briefly outlines other treatment options including revascularization techniques.     

Parvovirus B19 quiescence during the course of human immunodeficiency virus infection in persons with hemophilia

One hundred and seventy patients with major lower limb amputation (MLLA) presenting to The National Prosthetic-Orthotic Centre (NPOC) in Khartoum over a 1-year period were studied. There were 141 males and 29 females giving a M:F ratio of 4.9: 1.0, with mean age of 37 years (range 5-72 years). Forty-one patients (24%) underwent amputation of diabetic septic foot, 30 patients (17.6%) underwent amputation as a result of trauma from road traffic accidents and Madura foot, and war injuries accounted for 29 amputations (17%). One hundred and eleven patients had below knee amputation (BKA), 52 had above knee amputation (AKA) and seven patients had Syme's amputation. Diabetic amputees had higher rate of revisional surgery compared with others because of sepsis and/or flap necrosis. Stump pain was reported by amputees with excessive scarring of the stump and those with undue prominence of bony ends. There are two types of prostheses provided by the NPOC for both BKA and AKA: the peg leg and the conventional prostheses. The Syme's amputees were fitted with either simple hoof or articulated prostheses with solid ankle cushion heel (SACH). The peg leg consists of a leather lined side bearing metal socket connected to a rocker base by side steels. It is used by the country natives as it suits different weather and job conditions, particularly farming, and it can be repaired locally. The urban population use the conventional prostheses which is lighter in weight, can be put on and taken off easily and is cosmetically acceptable. However, these prostheses are more expensive and require frequent repair or replacement. The functional outcome of patient's rehabilitation with the prostheses was significantly affected by the level and indication of amputation. Those with BKA and those amputated because of trauma or Madura foot experienced better functional outcome compared with the diabetics, independent of age. 50% of patients with the AKA and 19% of those with BKA reported poor functional outcome. Surgeons should be more involved with the long-term evaluation of functional outcome in such patients, to offer help if feasible and to modify their technique for future procedures.     

Spatio-temporal properties of the pattern of evoked phantom sensations in a left index amputee patient

In a left index finger amputee, appropriate stimulation of skin areas of the remnant left fingers or left lower face evoked veridical sensations as well as sensations localized to the phantom finger. Five months after the amputation, there was a systematic correspondence between positions of digital and facial stimuli and positions of stimuli felt on the phantom. More than 3 years after the amputation, orderly maps of the phantom index on the ipsilateral fingers were still detected. By contrast, poorly organized facial maps were present only contralaterally to the amputation. The maps on the remnant fingers are likely to acquire stability because they are systematically activated during manipulations performed with the mutilated hand. The disorganization of facial maps may be related to their irrelevance for behavioral control in everyday life conditions.     

Phantom limb experience in children and adults: Cognitive and affective contributions.

Reviews the literature on cognitive and affective processes that contribute to phantom limb (PL) experience in children and adults and challenges the view that psychologically or emotionally induced sensations or pain referred to the PL necessarily represent a psychopathological response to amputation. It is argued that thoughts and feelings may trigger sensations referred to the PL in psychologically healthy individuals and that the painful or painless PL is not a symptom of a psychological disorder. A model is presented that involves a sympathetic-efferent somatic-afferent cycle of activity initiated by higher brain centers involved in cognitive and affective processes to explain psychologically and emotionally triggered PL sensations. The experience of a PL is determined by a complex interaction of inputs from the periphery and widespread regions of the brain subserving sensory, affective and cognitive processes. (French abstract) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An unusual presentation of multiple congenital melanocytic nevi with a limb distribution

We report a newborn in whom multiple small congenital melanocytic nevi (MN) were noted on the right side involving the scapular area, shoulder, upper arm and forearm. Such a limb distribution of small congenital MN has never been reported in the literature.     

Glycine-glutamate interactions at the NMDA receptor: role of cysteine residues

The term "centrocentral anastomosis" is used to describe the end-to-end connection across interposed nerve grafts between paired fascicular groups of the proximal stump of a severed nerve. In 22 patients harboring a painful terminal neuroma following amputation of a lower limb (20 neuromas on the sciatic nerve and two on the peroneal nerve), a centrocentral anastomosis was performed on the end of the sectioned nerve to treat pain that had not improved with conventional conservative treatment. Follow-up review at 1 year revealed that the typical neuroma pain had disappeared in all cases, although sporadic diffuse pain persisted in four. Where previous phantom sensation was present, no change was observed. The results presented here are consistent with laboratory findings demonstrating the absence of neuroma formation after centrocentral anastomosis. Therefore, this technique is recommended for the treatment of painful amputation neuroma.