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Understanding Phantom Limbs

Heidi Francis

Dominican University of California

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Understanding Phantom Limbs

The brain has a seemingly limitless amount of capabilities. From the feelings of love,

addiction to substances or objects, shocking motor connections, and billions of neurons

connecting all throughout the body, we have made tremendous progress in research and variation

of causes and treatment. Despite the amount of progress, we have made, there is still a great

amount of uncertainty we have on disorders, conditions, and especially pain. In Phantoms in the

Brain by Ramachandran (1998, p. 23), the discussion of perceptual influence relating to the

external world is thoroughly talked about. In introducing phantom limbs, Ramachandran

discusses the term first being brought up after the Civil War from veterans who had lost limbs

from injuries not surgical at the time. From this knowledge we know that phantom limbs are not

a new phenomenon yet we are still trying to decipher their mystery. The understanding of

phantom limbs and phantom limb pain is reliant on the understanding of perception in

individuals and their environment.

In order to comprehend phantom limbs, it is important to acknowledge that patients may

have similarities but each case is usually found to be unique. The pain may differ from patient to

patient in terms of severity or cause. In fact, the cause of phantom limbs is researched and

discussed often because of the great amount of uncertainty. In the textbook Brain and Behavior

by Eagleman and Downar (2015 p. 107), it is mentioned that there is a common correlation of

phantom limb pain and changes in the cortex from the reorganization in the brain after an

amputation. This explains the common occurrence after the Civil War and the reports of other

areas having an effect from the phantom limb as well. Because researchers and doctors are not

experiencing nor can address the limb that is no longer there, it can be difficult to find an
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explanation. Ramachandran (1998, p.23) writes Many explanations for phantoms but not

necessarily proved right, it revolves around perception. There can be a possibility of damaged

nerve endings, the most popular theory, or there could be several other reasons such as a

remapping of the brain, trauma, or a false perception. Phantom limbs can be difficult for a patient

to grasp as well, they feel a body part that no longer is visible to anyone other than themselves.

Oftentimes with the phantom limbs comes a great deal of pain from several reported reasons

such as the inability for a patient to move it, the constant clenching of the phantom muscles, or

even just the feeling of the limb being gone. Ramachandran (1998, p. 50) explains that there are

many possibilities of the pain in PLP patients all possible from the remapping of the brain, scar

tissue, or even neural connectivity issues, but the pain is unique to each patient.

The primary treatment for phantom limbs is medication but there are therapies such as

mirror therapy that can use perception to relieve pain in the phantom limbs as well as the

phantom limbs themselves. As an experienced researcher on phantom limbs, Ramachandran

(1998 p. 52) writes that pain is one of the most poorly understood of all sensory experiences.

Pain, similar to the phantom limbs themselves is not necessarily present in appearance but rather

individually characterized. In looking into a specific research case of a seven-year-old boy with

phantom limb pain, a variety of treatments were used and success in the reduction of phantom

limb pain (Ramsey, Karlsen, Collier, 2017). In this case the boy had osteosarcoma and the limb

was not able to be saved. He received several rounds of chemotherapy treatment but after the

amputation there were residual physical and emotional effects. The patient was given standard

post-surgical medications but there was still a decrease in focus and conversing. These signs of

phantom limb pain as well as medication produced adverse effects resulted in the changing of
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medication dosages and mirror therapy. With home mirror therapy exercises, there were signs of

improvement in several areas including both emotional and physical after a two-week check in

period. Although there was improvement in the phantom limb pain there was still pain during

physically impacting effects. This case is a great example of the basics that someone

experiencing phantom limb pain may go through. Researchers comment that phantom limb pain

seems to have a strong link to the central nervous system and possibly the peripheral nervous

system. There is lots of research into phantom limb pain treatments but not systematic treatment

because cases can vary from patient to patient. The reliance on opioids, anticonvulsants, and

other prominent pharmacologic aids are primary. It was concluded mirror therapy has been

proven useful in many different cases but yields uncertainty (Ramsey, Karlsen, Collier, 2017).

This case shows that treatments may vary from patient to patient, especially with factors such as

age, history of abuse to substances, and mental stability.

Many different aspects of research are being conducted in order to mend any possible

misunderstandings between doctors and patients with phantom limbs. As we enter into a world

more advanced than before, there is a heightened ability of production and creativity in a variety

of fields. Interestingly enough, the upcoming technology has played a major role in phantom

limb research. In “Capturing the perceived phantom limb through virtual reality” (Rogers, Lau,

Huynh, Albertson, Beem, & Qian, 2016). The use of electronics intertwined within the solutions

to varying problems proves beneficial the majority of the time. Phantom limb perception was

tested with virtual reality in order to further the understanding of phantom limb positions

described by patients and contribute to the overall knowledge of phantom limbs. Further

understanding the pain of the patient and the perspective can aid researchers in finding solutions.
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Other forms of therapy such as mirror therapy and mirror box therapy have proven helpful for

patients suffering from phantom limb pain. Researchers predicted that virtual reality would be

able to help form a 3D model of the patient's perspective and overall provide a better positional

understanding for treatment. Having similar effects of mirror therapy, virtual reality works with

perception. The technology captures the positioning as best as it can and then with the models

created, patients were able to adjust them in order to fix any minor errors. Throughout this

research, more about phantom limbs as well as the Leap Motion technology was learned. The

model hand was not fully accurate with the perceived hand but this introduction into a new type

of integration of technology and phantom limb pain is extremely useful in the field. More

research and testing with technology needs to be followed but this research proves promising

because of the reasonable cost and successful results.

Not only is the proficiency of communication between patient and doctor vital but

understanding the motor aspects of phantom limbs helps widen the range of knowledge. In a

study named, “Psychophysical evaluation of the capability for phantom limb movement in

forearm amputees” (Kawashima & Mita, 2016), the attempt to measure movement capabilities

with those who suffered from phantom limbs was carried out. Phantom limb pain is very

common in amputees, but the understanding of it is still being greatly researched. In this study is

to introduce a measuring amount of psychophysical capability not just physically. Patients who

have had a limb amputated were asked to perform physical exercises with their phantom forearm

and then give feedback on the motion with a visual analog scale. The scale would be used to

measure a psychophysical profile per patient and would later be compared with the focus on

unilateral, bilateral, and bilateral experimental conditions. Twelve males that had an upper
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amputated limb were the participants. Each male was asked to move their phantom limb by itself

(unilateral), with a mirror (bilateral +), and without a mirror (bilateral -). After the movements

the scale was used to see how much the participant felt they could complete the movement. By

asking and understanding the perceived capability of those with phantom limb pain in terms of

movement can help the barrier of the limbs being phantom and perception in the brain. The

ability of possible movement of a phantom limb is important in treatment possibilities carried out

by researchers and doctors.

Perception and conscious intention can overlap in many areas. In order to grasp a more

in-depth view on the mechanisms in the brain that occur in phantom limbs, a study by Walsh,

Long, Haggard, (2015) was done to see how much voluntary control there is in phantom limbs.

In the study, one individual who has a phantom limb in their left arm is tested in inhibitions and

actions that are voluntary. This study looks into how a phantom limb phenomenon could work in

terms of control and perception of control. Participants were asked to make note of conscious

experiences and intention of actions. Using a clock and feedback of times they were asked to

identify certain times as well as free choice of intentional actions, juxtaposition of intention and

chance were identified. A second session took place after ten weeks, followed by several more

trial blocks and action only blocks. Using data from an EEG, areas linked with motor preparation

were found as well as a greater number of epochs rejected for the phantom hand than the

physical one. In the behavioral outcome, the physical hand had a greater reported inhibition than

the phantom limb. Overall it was concluded that the alpha and beta bonds are necessary in

voluntary motor preparation. Movement and actions are a main aspect for those with phantom

limbs but there because there is uncertainty in the willingness, other aspects of riding the
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phantom limb become more complicated. Ramachandran (1998, p. 57) writes that involuntary

and voluntary movements can occur because the brain will continue to send signals to the area of

the missing limb which is one explanation for the feelings and intentions actions of those with

phantom limbs

Perception is a unique topic; there is an unconscious and conscious awareness.

Ramachandran (1998 p. 58) states that “Your own body is a phantom,” which is a valid yet

thought-provoking set of words. The book discusses the overall implications that perception can

have on one's body, feelings, and relationship to others but if we become aware of the perception

that our brain tries to fool us then how can we still be fooled. The Eagleman and Downar text

(2015, p. 107) also supports the idea of perception having the most influence, writing that

phantom limbs show the significance of perception and the power of the brain, despite physical

or emotional contributing factors. In order to fully understand phantom limbs, one may need a

heavy background of research in the area but even with the studies done on movement and

voluntary behaviors, perception seems to be the key to unraveling the uncertainty of phantom

limbs.
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References

Eagleman, D. & Downar, J. (2015). Brain and behavior. Oxford University Press.

Kawashima, N., & Mita, T. (2016). Psychophysical evaluation of the capability for phantom limb

movement in forearm amputees. PLoS ONE, 11(5). Retrieved from

https://dominican.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=

true&db=psyh&AN=2016-47518-001&site=ehost-live

Ramachandran, V.S., Blakeslee, S. (1998). Phantoms in the brain. New York: Quill William

Morrow.

Ramsey, L. H., Karlson, C. W., & Collier, A. B. (2017). Mirror therapy for phantom limb pain in

a 7-year-old male with osteosarcoma. Journal of Pain and Symptom Management, 53(6),

e5–e7. https://doi.org/10.1016/j.jpainsymman.2017.02.003

Rogers, C., Lau, J., Huynh, D., Albertson, S., Beem, J., & Qian, E. (2016). Capturing the

perceived phantom limb through virtual reality. Advances in Human-Computer

Interaction, 2016. https://doi.org/10.1155/2016/8608972

Walsh, E., Long, C., & Haggard, P. (2015). Voluntary control of a phantom limb.

Neuropsychologia, 75, 341–348. https://doi.org/10.1016/j.neuropsychologia.2015.06.032