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Harriet Dempsey-Jones Ph.D.

Is What We Thought We Knew About Brain Plasticity Wrong?

New brain scans reveal phantom hands in the brain decades after amputation.

Kosala Bandara, Flickr
Blade runner - no amputee left behind
Source: Kosala Bandara, Flickr

Most people who have lost a limb still feel its presence decades later. What many people don't realize is that amputees can also purposefully move this "phantom limb" as well. This is more than just an interesting oddity—science is now realizing how these phantoms can help reveal the deep mysteries of the human brain.

With the help of high-resolution brain scanning (fMRI), my lab has recently found that asking amputees to move their phantom inside the scanner reveals incredibly detailed maps representing all five missing fingers in the brain. But why do these maps stubbornly persist, despite decades without any input from the missing limb? In a new study, published in the journal eLife, we ask why.

Life After Losing a Limb

If a person is unfortunate enough to lose an arm, a lot is going to change. How do you do simple tasks like put on socks? Or open a bottle of water? What might be less on a person’s mind (pardon the pun) is how losing an arm may change their brain.

There is some choice brain real estate that once controlled movement and sensation of the lost limb. So, what are those bits of brain up to now? This can be a surprisingly hard question to answer. Normally to explore the “arm” area of the brain (with brain imaging) we would touch or move that arm. If that arm is missing, this poses a problem.

Theo, San Antonio; Flickr
Now you see me, now you don't
Source: Theo, San Antonio; Flickr

Through decades of mostly animal research, researchers have instead been touching and moving the remaining parts of the body to see if anything appears to be encroaching on this missing hand zone. This has shown that if a monkey loses a middle finger, for instance, the brain area that once controlled the middle finger is taken over almost instantly by the neighboring index and ring fingers. It’s a territory invasion much like a bodily game of Risk.

This research painted a picture in which old body maps seem to be wiped away and the valuable brain space redistributed to support limbs that remain. But this turns out to be far from the whole story.

Lessons From Phantoms

Since animals have a hard time telling us what they are feeling, it’s only through recent human research that we have found out about the phantoms of lost body parts that haunt the brains of amputees, and the surprising insights they provide.

Most amputees have good control over the movement of their phantom limb. As mentioned above, we previously showed that asking amputees to move their phantom fingers in the scanner results in beautiful maps of the individual's missing fingers (image below). The amputees in that study, however, were selected specifically because they had highly vivid phantoms. This led us to wonder: Is it these phantom sensations that keep the missing limb alive in the brain?

Author provided, eLife
Maps of phantom fingers in the brain as revealed by fMRI
Source: Author provided, eLife

To answer this, we recently scanned a large group of amputees with varying levels of phantom sensation, phantom movement, and phantom pain. We found that the extent to which a person could move their phantom fingers was the best indicator of how alike a two-handed person’s map their map was.

Surprisingly, phantom movement was the most important factor in predicting the organization of these hand maps than the simple vividness of phantom sensations—how much they could feel their missing fingers. We were also surprised to find that these missing hand maps remain even in people who have little to no phantom sensations, indicating that these maps are incredibly stable once they have formed.

What If You Were Born Without a Limb?

Finally, we wanted to know what is going on in the missing arm area of people born without a limb, also called congenital one-handers. Here, however, we had a problem. People born without limbs don’t typically experience phantom sensations (although this is a little contentious). This meant we couldn’t ask these participants to move their phantom in the scanner, as we did with the amputees.

Asking congenital one-handers to imagine moving their missing arm in the scanner produced very little hand-like activity (most of which we think can be related to visual aspects of our task). But to look deeper, we needed a new tactic.

When you move your right hand, this activates the right hand’s own hand map in the left side of your brain. However, moving the right hand also causes activity changes that allow us to see the map of the unmoving left hand on the other side of the brain.

By getting the one-handed participants to move their intact hand, we could capture an indirect look at the missing hand map. When amputees and two-handers moved their intact hand, we saw a very normal-looking hand map on the missing hand side. Participants born without a hand showed no such activity, giving us new confidence there really is little to no hand map there at all.

How Will This Knowledge Change the World?

Phantom limbs capture our attention because they are fascinating and bizarre. But their scientific value is also becoming increasingly clear. Our research raises the question of whether people might be able to explicitly train their phantom hand to restore their finger maps to a more normal state. This may seem pointless, but scientists at the University of Pittsburgh in the U.S. are currently implanting electrodes into the missing finger maps of paralyzed patients, allowing them to control and feel individual fingers of a robotic hand. It may soon be time for the phantom hand to feel again.

This piece also appeared on the Conversation.