Mar. 5, 2013 ? Changes in the brain following amputation have been linked to pain arising from the missing limb, called 'phantom pain', in an Oxford University brain imaging study.
Arm amputees experiencing the most phantom limb pain were found to maintain stronger representation of the missing hand in the brain -- to the point where it was indistinguishable from people with both hands.
The researchers hope their identification of brain responses correlated with the level of phantom pain can aid the development of treatment approaches, as well as increase understanding of how the brain reorganises and adapts to new situations.
The Oxford University researchers, along with Dr David Henderson-Slater of the Nuffield Orthopaedic Centre, report their findings in the journal Nature Communications.
'Almost all people who have lost a limb have some sensation that it is still there, and it's thought that around 80% of amputees experience some level of pain associated with the missing limb. For some the pain is so great it is hugely debilitating,' says first author Dr Tamar Makin of the Centre for Functional Magnetic Resonance Imaging of the Brain (FMRIB) at Oxford University.
I can feel my fist clenching, my fingernails digging in. I can see the hand isn't there but the sensation is so realistic.
Treatments for phantom limb pain tend to be limited to standard drugs for pain relief. The origin of the pain is not well understood. There may be many factors that lead to the pain, including injured nerve endings where the limb was lost and changes in the brain areas connected with the missing limb.
Lynn Ledger, a 48 year old trained therapist and advisor to charities on management training from Nottingham, took part in the study. She had her left arm amputated halfway between the elbow and shoulder in May 2009 after radiotherapy for a rare form of cancer failed to deal with an extensive tumour in her arm. She experiences severe pain as if it was coming from the missing limb.
'I've pretty much tried everything to deal with the pain but nothing has worked,' Lynn says. 'There are no drug treatments that work because the condition is not fully understood yet. I can only use various distraction techniques, breathing exercises and mental imagery techniques, to help me manage the pain.
'It's very hard to describe the pain to others. I have a nonexistent limb, but I still sense it and feel pain. It's like: imagine you are wearing a lady's evening glove that stretches from the fingers up the arm past the elbow. But everywhere the glove covers, it's as if it's constantly crushing your arm. There are also shooting pains and intensely painful burning sensations that come and go, but the crushing pain is constant.
'When I heard about this study I wanted to be involved as it was trying to improve people's understanding of the condition.'
Kirsty Mason from Bracknell is 22 and about to start a new job as a support worker for people with mental health problems, as well as being an assessor for disabled students for their assisted technology needs. She lost her right arm four years ago just below the elbow after blacking out at a train station and falling on to the rails just ahead of a train coming in. She woke to find a wheel stopped on her arm. Since then she's learned to write with her left hand and began driving last year. She also took part in the brain imaging study.
'With me it's all or nothing,' Kirsty says of her phantom pain. 'I get the usual pins and needles and a constant niggling pain that I can shut out by doing other things. But the worst pain is a kind of burning. It's less frequent but it's intense: 90-100 on the scale. It sounds silly, but the only thing I can do is stick my hand in a freezer. It numbs it.
She says: 'I can feel my fist clenching, my fingernails digging in. I can see the hand isn't there but the sensation is so realistic. If someone throws me a ball, I'll move both hands to catch it. I'll put out both hands if I fall over.'
The Oxford University team used MRI imaging to study how the phantom limb pain felt by people who have had an arm amputated is related to changes in the brain.
They compared MRI data for 18 amputees, with differing levels of phantom pain, with 11 individuals born with one hand through a limb deficiency and a control group of 22 adults with two full limbs.
The amputations had been done 18 years ago on average, but the participants still experienced sensations for the missing arm. By asking them to move the fingers of the phantom limb while in the MRI scanner, the researchers were able to look at how the missing hand is represented in the brain.
They found that the brain maintained its representation of the hand, even though the limb was no longer there. The extent to which the representation was maintained was linked to the strength and frequency of the pain the amputees felt: those feeling the greatest pain retained the strongest representation of the missing hand.
'We were astonished to find that in amputees experiencing strong phantom pain, the brain's response was indistinguishable from that seen in people with intact limbs,' says Dr Makin.
The researchers found that the amount of grey matter in the phantom hand area of the brain was reduced in amputees compared to those with two hands. But again this was linked to the amount of pain amputees felt. Those experiencing stronger pain showed less structural degeneration in the missing hand area following the loss of the limb.
However, while those with strong phantom limb pain maintained the local brain structure and function for the missing hand, there was evidence that connections to other parts of the brain were disrupted more.
In particular, the representation of the missing hand was more out of synch with the area looking after the other hand on the opposite side of the brain.
Dr Makin says: 'Most people experience "phantom" sensations in a missing limb after amputation. This disconnect between the physical world and what they are experiencing appears to be linked to a functional detachment in the brain. There seem to be reduced connections between the missing limb part of the brain and the rest of the cortex that's involved in movement.
'Our results may encourage rehabilitation approaches that aim to re-couple the representation of the phantom hand with the external sensory environment.'
While the Oxford University researchers, led by Professor Heidi Johansen-Berg, have found brain changes that are correlated with phantom limb pain in this study, they cannot tell if they are causal. To get a better understanding of that, they are beginning a trial with people who've had an arm amputation to see if a brain stimulation technique can influence the phantom pain they experience, taking MRI scans before, during and after the technique.
The brain stimulation approach uses a tiny electric current from two electrodes placed at appropriate places on the outside of the head to try and boost the connection of the phantom limb area of the brain to the rest of the cortex.
They were funded by the Royal Society, Marie Curie Actions, the Wellcome Trust, National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, and the Medical Research Council.
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The above story is reprinted from materials provided by University of Oxford.
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Journal Reference:
- Tamar R. Makin, Jan Scholz, Nicola Filippini, David Henderson Slater, Irene Tracey, Heidi Johansen-Berg. Phantom pain is associated with preserved structure and function in the former hand area. Nature Communications, 2013; 4: 1570 DOI: 10.1038/ncomms2571
Note: If no author is given, the source is cited instead.
Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.
Source: http://feeds.sciencedaily.com/~r/sciencedaily/top_news/~3/FihWQOmrhiQ/130305131034.htm
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If you're sick of Apple's restrictive operating system but have yet to make the jump from iPhone to Android, here's what to expect, how to adjust, and how to cope with certain app withdrawal. 
The back button has long been a source of confusion for everyone because its functionality is far from consistent. In most cases, it'll just take you to the last thing you did in an app. If there is no last thing, it may take you back to your home screen. In general, you can expect this functionality but don't be surprised if it does something else. This is just an unfortunate user experience issue in Android that has yet to be fixed.
The home button simply takes you back to your home screen.
The multitasking drawer shows you your active apps so you can quickly switch between them without the need to go back to your home screen or open your app drawer. It works similarly to iOS, though it provides a vertical list (instead of a horizontal one) and provides a preview of the open app. Instead of tapping and holding to close apps, you just swipe them away.
The settings button is sometimes a soft button like the others mentioned in this section, but on certain devices it'll just appear contextually in apps. Just know that if you see a vertical ellipsis (three dots stacked on top of each other), that's where you'll access an app's settings. To get to your phone's system settings, just open the Settings app in your app drawer, on your home screen (if you keep it there), or via the notification drawer (explained later, in the Notifications section).
Like iOS, Android can have many home screens. On many phones, you'll have five. Some phones may have more or less. Rather than left to right, your primary home screen (or page, if you prefer to think of it that way) starts in the middle with additional ones to the left and right. On Android, you can display apps and make folders just like you did on iOS by tapping, holding, and dragging an app onto another app. Android doesn't force you to place anything on your home screen, however, so you have to do a little more work to make it look the way you want. While this might seem more complicated and tedious, organizing your Android home screen offers several distinct advantages. First, you don't have to display any apps you don't want and only the ones you do. Second, you can add widgets that provide information and functionality. Third, you can download custom launchers that let your home screen do even more for you, such as customize its appearance. We'll discuss all three in this section.
Unlike iOS, Android doesn't show all your apps on the home screen by default. Instead, you can add your most important ones to your home screen and find the rest inside the app drawer. The app drawer is a little icon (in your home screen's dock by default) that you tap to view your entire collection of apps. Once you're inside your app drawer, tapping and holding any app will take you back to your home screen so you can create a shortcut. Just place it wherever you want and you're all done.
On Android, Launchers refer to your home screen and the functions surrounding it. Unlike with iOS, you can download apps to replace the default option. You'll likely find little wrong with Android's default launcher, but you can do a lot more with a custom option. We're big fans of Nova Launcher, but there are plenty of good options. Each launcher has its various options, but most can customize icons, change home screen animations, pack more into your dock, and a lot more. Changing your launcher doesn't require more than downloading an option from the Google Play Store and opening it up. If you like it, read the next section to learn about how to set it as your default app.
In iOS, Apple forces you to use their apps as the defaults. In Android, you don't have to. If you prefer a different navigation app for your driving needs or an alternative mail client, you can make the switch without much of a hassle.
iOS' Notification Center looked like a play straight out of Android's book. The pull-down notification drawer both mobile OS' offer are very similar, though each comes with their own problems and conveniences.
When Apple released iOS 6, it delivered turn-by-turn navigation for free just like Google brought to Android several years prior. In most cases, Apple takes a lot longer than other companies but offers a better product when it finally comes out. This was not the case with Maps, and so you'll be very glad to make the switch to Google's phenomenal built-in navigation.
Although Siri isn't perfect, she's one of the better features of iOS. You can ask her to set reminders, buy movie tickets, look up directions, and much more. She's also very easy to call upon by simply long-pressing the iPhone's home button. While Android's voice commands (e.g. search, getting directions, sending text messages) tend to be smarter, faster, and generally better, you lose out on Siri's personality and some of her functionality when you make the switch. Of course, Android isn't without its alternatives.
When you have an iPhone, you have an official Apple device. When you buy an Android, you don't unless you purchase an official Google Nexus phone. That means you're at the mercy of your phone's manufacturer?and, to a lesser extent, your carrier?when it comes to receiving system updates, and this can be very frustrating because these manufacturers often communicate about update availability poorly and take their sweet time. If you have yet to switch to an Android and are simply considering it, we highly recommend purchasing a Nexus phone. This way you'll always receive updates as soon as Google releases them. If you went with a non-Nexus Android phone, however, you might prefer flashing a ROM.
With a few exceptions, most Android phones just won't compare to your former iPhone in terms of battery life. The differences may be minimal, but you won't be able to leave your phone on standby for a couple of days and still expect it to have a charge. While there are some tactics you can enlist, most of them cause more inconvenience than they're worth. You'll find it better to learn to cope, and manage just a couple of settings you can quickly toggle from your home screen.
Like jailbreaking on an iPhone, rooting Android provides additional privileges that allow you to do even more with your device. For many iPhone users, Android provides so much more flexibility that rooting may seem unnecessary. Personally, I only root for the purpose of creating an automated backup but there are many other reasons. If you want to root, our always up-to-date guide provides instructions for the most popular Android devices.
When switching to Android from iOS, you'll need a lot of new apps. Our Android App Directory provides a number of helpful suggestions in various categories, but many are the best options for Android users. For those coming from iOS, here are some options you'll want to check out:
Android can do a lot of awesome stuff that your iPhone couldn't. You'll find it fun to discover these new features as you explore everything the operating system has to offer. Here are a few things you'll want to check out:
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