Skip to main content
SpringerLink
Log in

Losing a Hand

  • Chapter
  • First Online:
The Hand and the Brain

  • 1686 Accesses

Abstract

Amputation of a hand results in profound synaptic reorganisations in the brain cortex. The cortical representational area of the amputated hand is at first ‘silent’ but rapidly becomes invaded by adjacent cortical areas. Cortical reorganisations can result in phantom sensation, a feeling that the lost hand is still there. Phantom sensation can sometimes be combined with severe phantom pain. Mirror treatment, based on an illusion that the lost hand is still attached, may be an effective way of treating severe phantom pain. Amputated fingers or hands can often be microsurgically replanted (reattached to the body). When a replanted hand is reinnervated, it resumes its correct position in the brain cortex. The salamander is unique among animals since it can spontaneously regenerate an amputated extremity. It has been suggested that the mechanism behind this phenomenon is based on an interaction of stem cell-like cells at the amputation level interacting with a specific Schwann cell-produced protein (nAG). If these mechanisms could 1 day be applied to humans, it would open up a totally new landscape for treating amputations.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 39.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 49.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Giummarra MJ, Georgiou-Karistianis N, Nicholls ME, Gibson SJ, Chou M, Bradshaw JL. Corporeal awareness and proprioceptive sense of the phantom. Br J Psychol. 2010;101(Pt 4):791–808.

    Article  Google Scholar 

  2. Ramachandran VS, Rogers-Ramachandran D, Stewart M. Perceptual correlates of massive cortical reorganization. Science. 1992;258(5085):1159–60.

    Article  Google Scholar 

  3. Ramachandran VS, Blakeslee S. Phantoms in the brain: human nature and the architecture of the mind. London: Fourth Estate; 1999.

    Google Scholar 

  4. Yang TT, Gallen C, Schwartz B, Bloom FE, Ramachandran VS, Cobb S. Sensory maps in the human brain. Nature. 1994;368(6472):592–3.

    Article  Google Scholar 

  5. Ramachandran VS, Altschuler EL. The use of visual feedback, in particular mirror visual feedback, in restoring brain function. Brain. 2009;132(Pt 7):1693–710.

    Article  Google Scholar 

  6. Lundborg G. Nerve injury and repair. Regeneration, reconstruction and cortical remodelling. 2nd ed. Philadelphia: Elsevier; 2004.

    Google Scholar 

  7. Mercier C, Reilly KT, Vargas CD, Aballea A, Sirigu A. Mapping phantom movement representations in the motor cortex of amputees. Brain. 2006;129(Pt 8):2202–10.

    Article  Google Scholar 

  8. Di Pino G, Guglielmelli E, Rossini PM. Neuroplasticity in amputees: main implications on bidirectional interfacing of cybernetic hand prostheses. Prog Neurobiol. 2009;88(2):114–26.

    Article  Google Scholar 

  9. Wall JT, Xu J, Wang X. Human brain plasticity: an emerging view of the multiple substrates and mechanisms that cause cortical changes and related sensory dysfunctions after injuries of sensory inputs from the body. Brain Res Brain Res Rev. 2002;39(2–3):181–215.

    Article  Google Scholar 

  10. Kaas JH, Florence SL, Jain N. Subcortical contributions to massive cortical reorganizations. Neuron. 1999;22(4):657–60.

    Article  Google Scholar 

  11. Pons TP, Garraghty PE, Ommaya AK, Kaas JH, Taub E, Mishkin M. Massive cortical reorganization after sensory deafferentation in adult macaques. Science. 1991;252(5014):1857–60.

    Article  Google Scholar 

  12. Ramachandran VS, Stewart M, Rogers-Ramachandran DC. Perceptual correlates of massive cortical reorganization. Neuroreport. 1992;3(7):583–6.

    Article  Google Scholar 

  13. Elbert T, Flor H, Birbaumer N, Knecht S, Hampson S, Larbig W, et al. Extensive reorganization of the somatosensory cortex in adult humans after nervous system injury. Neuroreport. 1994;5(18):2593–7.

    Article  Google Scholar 

  14. Flor H, Elbert T, Muhlnickel W, Pantev C, Wienbruch C, Taub E. Cortical reorganization and phantom phenomena in congenital and traumatic upper-extremity amputees. Exp Brain Res. 1998;119(2):205–12.

    Article  Google Scholar 

  15. Borsook D, Becerra L, Fishman S, Edwards A, Jennings CL, Stojanovic M, et al. Acute plasticity in the human somatosensory cortex following amputation. Neuroreport. 1998;9(6):1013–7.

    Article  Google Scholar 

  16. Antfolk C, D’Alonzo M, Controzzi M, Lundborg G, Rosen B, Sebelius F, et al. Artificial redirection of sensation from prosthetic fingers to the phantom hand map on transradial amputees: vibrotactile versus mechanotactile sensory feedback. IEEE Trans Neural Syst Rehabil Eng. 2013;21(1):112–20.

    Article  Google Scholar 

  17. Ramachandran VS. Behavioral and magnetoencephalographic correlates of plasticity in the adult human brain. Proc Natl Acad Sci U S A. 1993;90(22):10413–20.

    Article  Google Scholar 

  18. Rosen B, Ehrsson HH, Antfolk C, Cipriani C, Sebelius F, Lundborg G. Referral of sensation to an advanced humanoid robotic hand prosthesis. Scand J Plast Reconstr Surg Hand Surg. 2009;43(5):260–6.

    Article  Google Scholar 

  19. Merzenich MM, Nelson RJ, Stryker MP, Cynader MS, Schoppmann A, Zook JM. Somatosensory cortical map changes following digit amputation in adult monkeys. J Comp Neurol. 1984;224(4):591–605.

    Article  Google Scholar 

  20. Manger PR, Woods TM, Jones EG. Plasticity of the somatosensory cortical map in macaque monkeys after chronic partial amputation of a digit. Proc Biol Sci. 1996;263(1372):933–9.

    Article  Google Scholar 

  21. Weiss T, Miltner WH, Huonker R, Friedel R, Schmidt I, Taub E. Rapid functional plasticity of the somatosensory cortex after finger amputation. Exp Brain Res. 2000;134(2):199–203.

    Article  Google Scholar 

  22. Lundborg G, Richard P. Bunge memorial lecture. Nerve injury and repair – a challenge to the plastic brain. J Peripher Nerv Syst. 2003;8(4):209–26.

    Article  Google Scholar 

  23. Flor H, Elbert T, Knecht S, Wienbruch C, Pantev C, Birbaumer N, et al. Phantom-limb pain as a perceptual correlate of cortical reorganization following arm amputation. Nature. 1995;375(6531):482–4.

    Article  Google Scholar 

  24. Knecht S, Henningsen H, Elbert T, Flor H, Hohling C, Pantev C, et al. Cortical reorganization in human amputees and mislocalization of painful stimuli to the phantom limb. Neurosci Lett. 1995;201(3):262–4.

    Article  Google Scholar 

  25. Knecht S, Soros P, Gurtler S, Imai T, Ringelstein EB, Henningsen H. Phantom sensations following acute pain. Pain. 1998;77(2):209–13.

    Article  Google Scholar 

  26. MacIver K, Lloyd DM, Kelly S, Roberts N, Nurmikko T. Phantom limb pain, cortical reorganization and the therapeutic effect of mental imagery. Brain. 2008;131(Pt 8):2181–91.

    Article  Google Scholar 

  27. Schmalzl L, Thomke E, Ragno C, Nilseryd M, Stockselius A, Ehrsson HH. “Pulling telescoped phantoms out of the stump”: manipulating the perceived position of phantom limbs using a full-body illusion. Front Hum Neurosci. 2011;5:121.

    Google Scholar 

  28. Ramachandran VS, Rogers-Ramachandran D, Cobb S. Touching the phantom limb. Nature. 1995;377(6549):489–90.

    Article  Google Scholar 

  29. Rosen B, Lundborg G. Training with a mirror in rehabilitation of the hand. Scand J Plast Reconstr Surg Hand Surg. 2005;39(2):104–8.

    Article  Google Scholar 

  30. Schmalzl L, Ragno C, Ehrsson HH. An alternative to traditional mirror therapy: illusory touch can reduce phantom pain when illusory movement does not. Clin J Pain. 2013 Feb 26.

    Google Scholar 

  31. Posner MA, Rinaldi E. Upper extremity replantations in Renaissance art. J Hand Surg Am. 2008;33(8):1440–1.

    Article  Google Scholar 

  32. Maricevich M, Carlsen B, Mardini S, Moran S. Upper extremity and digital replantation. Hand (N Y). 2011;6(4):356–63.

    Article  Google Scholar 

  33. Bjorkman A, Waites A, Rosen B, Lundborg G, Larsson EM. Cortical sensory and motor response in a patient whose hand has been replanted: one-year follow up with functional magnetic resonance imaging. Scand J Plast Reconstr Surg Hand Surg. 2007;41(2):70–6.

    Article  Google Scholar 

  34. Muneoka K, Han M, Gardiner DM. Regrowing human limbs. Sci Am. 2008;298(4):56–63.

    Article  Google Scholar 

  35. Sanchez Alvarado A. Developmental biology: a cellular view of regeneration. Nature. 2009;460(7251):39–40.

    Article  Google Scholar 

  36. Kumar A, Godwin JW, Gates PB, Garza-Garcia AA, Brockes JP. Molecular basis for the nerve dependence of limb regeneration in an adult vertebrate. Science. 2007;318(5851):772–7.

    Article  Google Scholar 

  37. Stappenbeck TS, Miyoshi H. The role of stromal stem cells in tissue regeneration and wound repair. Science. 2009;324(5935):1666–9.

    Article  Google Scholar 

  38. Kragl M, Knapp D, Nacu E, Khattak S, Maden M, Epperlein HH, et al. Cells keep a memory of their tissue origin during axolotl limb regeneration. Nature. 2009;460(7251):60–5.

    Article  Google Scholar 

  39. Straube WL, Brockes JP, Drechsel DN, Tanaka EM. Plasticity and reprogramming of differentiated cells in amphibian regeneration: partial purification of a serum factor that triggers cell cycle re-entry in differentiated muscle cells. Cloning Stem Cells. 2004;6(4):333–44.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Hand Surgery Department of Clinical Sciences, Malmö Lund University Skäne University Hospital, Malmö, Sweden

    Göran Lundborg MD, PhD

Authors
  1. Göran Lundborg MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer-Verlag London

About this chapter

Cite this chapter

Lundborg, G. (2014). Losing a Hand. In: The Hand and the Brain. Springer, London. https://doi.org/10.1007/978-1-4471-5334-4_14

Download citation

  • DOI: https://doi.org/10.1007/978-1-4471-5334-4_14

  • Published:

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-4471-5333-7

  • Online ISBN: 978-1-4471-5334-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation