Phantom limbs and the body schema.
Phantom limbs and the body schema.
复制标题
幻肢和身体图式。
DOI：
10.1097/00132586-197506000-00055
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发表时间：
1975
期刊：
影响因子：
--
通讯作者：
R. Melzack
中科院分区：
文献类型：
--
作者：
P. Bromage;R. Melzack
被截肢的肢体在其主人的意识中一直是“幽灵”。传入通路的暂时或永久切断也可能引起幻肢位置与真肢位置不同的主观体验。人们试图将幻像现象解释为一种“身体意象”或“身体图式”的表达，它服务于一种前意识的神经生理功能。人们对理论身体图式的性质和行为有不同的解释，但海德和福尔摩斯的原始命题仍然是最令人满意的。他们提出，身体形象是由个人经历形成并不断改变的，它的作用是一种姿势模型，“在进入意识之前，所有随后的姿势变化都是根据这种模型进行测量的。”2没有有组织的数据体来支持身体图式的posturaI概念，也没有定义Head和Holmes提出的内在可塑性的极限。3就幻影现象而言，身体图式的定义缺乏一个缺乏虚假神经信息的纯去传入的实验模型。外伤性或病理性的幻像受到神经瘤或中枢神经病变周围胶质瘤不受控制的外周输入的污染。大传导麻醉提供了一个有吸引力的工具，可逆的人的传入神经，幻像现象与脊髓麻醉相关的研究已在下肢。在这些情况下报告的通常弯曲的幻像姿势被解释为最近记忆的“固定”，产生于脱神经前立即采取的姿势。不幸的是，没有任何一种传导麻醉技术可以提供完全和纯粹的神经分化。首先，没有神经生理学上的保证，所有肢体传入神经的阻断是完全的，即使有足够的临床麻醉。其次，硬膜外或蛛网膜下腔的局部麻醉穿透脊髓的表层物质6，这可能会部分阻断从背角6层调节本体感觉信息的下行通路。然而，尽管有这些保留意见，传导阻滞仍然是目前可用来治疗人类可逆性脱神经和唤起幻像现象的最有用的方法。我们观察了臂丛麻醉后的幻肢行为，以及硬膜外和蛛网膜下腔麻醉后的幻肢行为。我们的结果使我们同意Holmes和Head的建议*蒙特利尔皇家维多利亚医院麻醉科。这项研究于1973年6月在温哥华举行的加拿大麻醉师协会年会上发表，并得到了M.R.C.资助。硕士1008人。267
AMPUTATED LIMBS persist as "phantoms" in their owners' consciousness. Temporary or permanent severance of afferent pathways may also give rise to subjective experiences in which the position of the phantom limb is different from that of the real one. 1 Attempts have been made to explain phantom phenomena as expressions of a "body image" or "body schema" subserving a preconscious neurophysiological function. Varying interpretations have been placed upon the nature and behaviour of the theoretical body schema, but the original proposition of Head and Holmes remains the most satisfying. They proposed that the body image is formed and constantly changed by individual experience, and its role is a postural model, "against which all subsequent changes of posture are measured before they enter consciousness. "2 No organized body of data exists to support the posturaI notion of the body schema, nor to define the limits of intrinsic plasticity proposed by Head and Holmes. 3 In terms of phantom phenomena, definition of the body schema lacks an experimental model for pure deafferentation that is devoid of spurious neural information. Phantoms of traumatic or pathological origin are contaminated by uncontrolled peripheral input from neuromata, or from gliosis around central nervous lesions. Major conduction anaesthesia provides an attractive tool for reversible deafferentation in man, and phantom phenomena associated with spinal anaesthesia have been studied in the lower limb. 4,~ The generally flexed phantom posture reported under these circumstances has been interpreted as a recent memory "fixation" arising from the position adopted immediately prior to deafferentation. 5 Unfortunately, no technique of conduction anaesthesia can be relied upon to provide a complete and pure form of deafferentation. First, there is no neurophysiological assurance that blockade of all limb afferents is complete, even in the presence of adequate clinical anaesthesia. Second, local anaesthetic in the epidural or the subarachnoid space penetrates the superficial substance of the spinal cord, 6 and this may produce partial blockade of descending pathways modulating proprioceptive information from lamina 6 of the dorsal horn. 7 Nevertheless, with these reservations, conduction blockade remains the most useful method currently available for reversible deafferentation in man, and for the evocation of phantom phenomena. We have observed the behaviour of phantom arms after deafferentation by brachial plexus anaesthesia, and phantom legs after epidural and subarachnoid anaesthesia. Our results lead us to agree with Holmes and Head's proposition *Department of Anaesthesia, Royal Victoria Hospital, Montreal. fDepartment of Psychology, McGill University This study was presented at the Canadian Anaesthetists' Society Annual Meeting, June, 1973, in Vancouver, and was supported by M.R.C. Grant No. M.A. 1008. 267