Is skin stretch to the kinesthetic brain as mirror therapy is to the visual brain?

[Diane]

It suddenly occurred to me after mulling this Gandevia article (http://www.somasimple.com/forums/showpost.php?p=41340&postcount=1) around for a few days, that the pain matrix treated via mirror therapy is the same pain matrix treated through skin stretch, with the advantage of having an existing body part to treat. Let's look again: When delivered alone, strong skin stretch evoked illusory elbow flexion in 5/10 subjects (9°±4°). Simultaneous strong skin stretch and vibration increased the illusory elbow flexion for the group by 1.5 times, compared to vibration (p<0.05). For the knee, vibration was applied over the patellar tendon and skin stretch over the thigh. Skin stretch alone evoked illusory knee flexion in 3/10 subjects (8°±4°) and when delivered during vibration, perceived knee flexion increased for the group by 1.4 times, compared with vibration (p<0.05). Hence inputs from cutaneous receptors, muscle receptors, and combined inputs from both receptors likely subserve kinesthesia at joints throughout the body.

If skin stretch provides an illusory movement, on an actual part, is that not just as good as a visual movement of a phantom part? For pain relief I mean? as per Wall?

And are not the actual limbs thoroughly contiguous with/integrated into their virtual (phantom) aspects anyway, via S1, M1 and S2, M2 and who knows how many other somato-sensing/responding maps?

Is one illusion not just as good as another as far as helping the brain change? The science is developing after the application instead of having preceded it, but it seems to me that as long as there is logical hookup, it's a minor detail which preceded which in this case.

[Luke Rickards]

Diane,

This is the exact description I've been giving patients for the last year or so when I stretch skin.

[Barrett Dorko]

Yes Diane, you're truly onto something. Perhaps in a few years from now this post will be something all of us point to.

[Diane]

Luke,

Why didn't you say something here? :p

What else are you holding back? :zip:

(:D:thumbs_up)

[Luke Rickards]

Diane, I thought I got it from you?? Didn't you suggest this when we first found that study of skin stretch in the knee ages ago. (Edin, 2001)

[Diane]

From me? Ages ago? I don't think so.. I got the name "Gandevia" from Matthias just a week or so ago. By "we" do you mean you and me? Yes, you found the paper I think.. but this idea that kinesthetic illusion might be similar to visual illusion didn't occur to me until today. If you've been thinking this way for a year without saying anything... urrr.

Unless you discussed it already and it re-occurred to me today.. OK, I don't have great recall.

Maybe this is me becoming repetitive in my old age. If so, I'm at least glad I'm becoming repetitive about something which might be important to developing a good treatment construct.... :rolleyes:

[Luke Rickards]

If you've been thinking this way for a year without saying anything... urrr. Maybe it was something that occurred to me. Sorry I haven't mentioned it.

At any rate, it sounds like a much more convincing idea in light of your reference above.

[Diane]

Maybe you came up with it as a metaphor? Anyway, nice metaphor. I will forgive you for not starting a thread yourself. :)

Maybe this is a good thought experiment to pursue. Do you have any other papers that would support the idea? Can you link that Edin 2001 paper?

[Luke Rickards]

Do you have any other papers that would support the idea?Not yet.;)

[Diane]

So, here is how it must work (if it's true), bearing in mind Wall's idea that a consummatory movement is needed for pain resolution.

Mirror therapy:
Visual illusion -> visual cortex/movement illusion -> motor cortex/action plan/consummatory movement <-> pain matrix/pain resolution <-> re-mapping

Skin stretch:
Kinesthetic movement illusion -> sensorimotor cortex -> motor cortex/action plan/consummatory movement <-> pain matrix/pain resolution <-> re-mapping

In the case of a limb or a part that is still present, ideomotor movement is the new movement output.

Any thoughts?

[Barrett Dorko]

I'm thinking wow. I might just be able to teach this, crazy as it sounds.

[BB]

Take a look at this editoria (http://rheumatology.oxfordjournals.org/cgi/content/full/44/9/1083)l from Moseley. This is what prompted me to go ahead and get the Blakeslee book.

It appears the McCabe has identified some mapping support of motor intention and motor action needing to be consistent.

If the intention is appropriate, but the map for action has become blurred it does not meet the intention. It may be that touch, through differentials, redefines the maps...makes them less blurry, so that the action CAN meet the intention.

Maybe we are all just cartographers helping to draw more accurate maps?

[Diane]

Look who the other author is!
This is it, isn't it? Yes, we are helpers helping the brain remap itself.

I have thought this for years.... that it's brain bits not getting along quite perfectly that makes the brain ask for help in the form of pain.

[toddhargrove]

I am a rolfer who gives clients some joint mobility drills as “homework.” (I won’t say the name of the joint mobility system but it starts with a “z”.)

In order to get them to do the drills in the right way (or to convince them that they could be helpful), I tell them various things like: the primary target for the movements are the virtual bodies in the brain and not the physical tissues in the body; that they should think in terms of reprogramming software not stretching/pulling hardware; that they are remapping the areas being moved; that the health of the maps is as important as the health of the physical tissues. I’m still struggling with the best ways to explain these things but telling some of the stories from the Blakeslee book helps get the idea across that defects in the maps can cause BIG PROBLEMS.

[BB]

I'm thinking of a story. Here is how it goes so far.

You know how a submarine captain can navigate? He uses maps and he can use sonar. If the maps are accurate and he reads them correctly there are no problems in getting where he is going. But, if his maps get smudged, so he can no longer pick out the small details, he may have trouble navigating accurately.

In this instance, he might have to use his sonar to "ping" off of something else and give him a reading. He can use these pings to draw in the missing details from his map. There must be something for the sound waves to "ping" off of though.

We are that something that the nervous system can "ping" off of. It uses it to redraw its maps so that it can navigate accurately. The ping can come from any novel input that the system can read and respond to. Just like sonar.

What do you think?

[Diane]

Thinking about all of it from the point of view of helping the brain restore its maps is consistent with everything, even making that z approach make more sense.
I like the sonar metaphor.
Barrett, do you mean the thing you plan to teach is crazy, or that you think you can teach it is crazy? Never mind, you don't have to answer that.

[nari]

I haven't got the text at hand, but Butler stressed in his book and course that smudging can be remapped/repixelated by our intervention, as well as appropriate intervention on the brain owner's part.

OK, I invented the repixelation bit because I am doing a lot of photo editing at present and restoring smudges to definitive lines. :)

Nari

[Diane]

Nari, did he mention skin stretch or Gandevia?

[Diane]

Just want to make sure this cortical maps thread (http://www.somasimple.com/forums/showthread.php?t=4608#post41588) is linked in here.

[nari]

Diane, I can't remember his mentioning Gandevia verbally, and there is no reference for him in Butler's course book. There was also no mention of skin stretch, only neurodynamic movements.
I think skin stretch is well and truly yours.

Nari

[Matthias]

As far as I know there isn't a study out there yet which has looked at blind people with amputations yet. If visual feedback is absolutely necessary for our brain they should be much likely to develop chronic pain problems.

But since their visual cortices "light up" as if they are seeing things there might be a way to work around that problem.

Tactile feedback works just as well - but a bit slower I think.
Flor used several electrodes on the patients backs to re-train cortical maps: http://www.hubmed.org/display.cgi?uids=12206052

Again - I think that visual feedback is king when it comes to monitoring feedback - but tactile feedback is definitely second.

[Diane]

Hi Matthias,
Glad to see you here. :teeth:
Interesting idea about blind amputees with phantom pain - it would be hard to provide mirror therapy. Maybe something would have to be devised with auditory input or something, echolocation...

I think you're right about visual input being the dominating sense, but kinesthesis might trump in that it has been around longer - I think smell is usually thought to be the first sense to develop evolutionarily, but even single cell organisms can "sense" via mechanosensation (http://www.somasimple.com/forums/showthread.php?t=4607). Or perhaps chemosensitivity and tactile sensitivity co-evolved, or were overlapped once upon a time.

Nari, skin stretch has been around as long as primates have I think.. :rolleyes:

[Jon Newman]

This thread reminds me of those "rides" at amusement parks in which a person is essentially watching a very large movie while suspended in a chair that can move small amounts in a variety of planes. The illusion of movement is significantly diminished with eyes closed or even with eyes open but focused on something other than the screen. Actually, I shouldn't say illusion of movement because there is movement. More accurately, the richness and emotion (the meaning) of the movement is lost. For example, flying is the typical illusion used in these attractions. The felt sense of flying is diminished or lost without the visual input.

Further, while watching an IMAX (http://en.wikipedia.org/wiki/IMAX), one can get a strong sense of movement where there is no alteration of external forces. I emphasize external forces because there will be notable changes in muscular tensions with observable postural changes being common.

Pausing to think, this same thing can happen without the amusement park ride or the IMAX. A regular movie screen or even watching TV can do this if the subject is in a sufficiently empathic mode.

[Luke Rickards]

Here (http://www.somasimple.com/forums/showthread.php?p=41610#post41610) is the Herta Flor study Matthias referred to.

[Diane]

Here is the entire Gandevia article referred to in post 1, free access.

[nari]

Diane,

Of course skin stretch has been around forever. But the explanation for its effect has not.

Nari

[Matthias]

I'm currently in the process of re-reading Alain Berthoz amazing book "The Brains Sense of Movement". Will do a series of blog postings about it (hopefully still in 2007 ;-) ).
He say that Bach-Y-Rita developed a device that helped blind people "see" by providing tactile information - they were able to catch a ball while wearing the device.

He says that vision and tactile input were equal (!) for the brain!
This is the article he talks about:
Bach-Y-Rita "Vision substitution by tactile image projection", Nature, 221 (1989): 963-964.

[Barrett Dorko]

Matthais,

Check out A Sense of Things (http://www.barrettdorko.com/articles/a_sense_of_things.htm) on my site for more about the implications of Bach-y-Rita's wonderful work.

I understand that he passed away during the last year.

[BB]

Hi Matthias,

Bach-y-Rita is and his device is also mentioned in the Blakeslee book. Great blog, by the way!:thumbs_up

[Diane]

Great blogpost (http://neurotopian.blogspot.com/2007/11/thanks.html) today Matthias. Thank you.

[Diane]

Take a look at Matthias' latest post (http://neurotopian.blogspot.com/2007/11/mirror-box-therapy-part-i.html) on mirror therapy. Good advice in there about self-management of pain (anywhere in the body), thinking/treating with principles not formulae. Great post Matthias. Thank you.

I was struck by Matthias' idea of treating central pain in paraplegics with mirror therapy - a mirror set up on top of the TV, so the para could see their own upper body reflected, and also a video of a lower half of a body performing ordinary walking. What a brilliant idea. Should work for any sort of leg pain, low back pain. Moseley (http://www.somasimple.com/forums/showthread.php?p=42316#post42316) has tested it.

:clap2::thumbs_up