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Last week, The New Yorker Magazine featured a profile of Dr. VS Ramachandran, the brilliant neurologist at UC San Diego known for his compelling work with people suffering from phantom limb pain, capgras syndrome, and other vexing neurological conundrums (the article “Brain Games” is by John Colapinto, May 11, 2009. p. 76, and much of this blog post paraphrases information in that piece). Dr. Ramachandran studies the structure and function of the human brain, and his work has produced some of the landmarks in “nueroplasticity”, the study of how the brain changes as it learns. He is most famous for his cunning experimental treatments, including the use of a simple mirror to trick the brain into stopping phantom limb pain.
People who have enjoyed using the Feldenkrais Method, and who have read Dr. Feldenkrais’ work, will appreciate the way Ramachandran’s work uses a person’s sensory experience (the gaps, distortions and patterns) to help him find his way towards a solution. If you have taken Feldenkrais classes, you know that the lessons use strategies of movement, sensing and feeling to help you restore healthier, more flexible patterns of movement and action. For many people, the pain, stiffness or discomfort they experience are inextricably linked to these patterns and habits of self use and sensation — the neurological grooves that form in the brain. As you work to change the pattern, the pain disappears. Ramachandran’s mirror experiment is a stunning example of this idea.
90% of people who lose a limb experience phantom limb pain (for some the pain can be so severe they commit suicide. People who have lost an arm have described the feeling of their phantom hand becoming stuck in a fist so tight, they feel the constant stab of their finger nails digging into their palm). Without the limb to visually and kinaesthetically confirm their movement and sensation, the brain becomes stuck in a closed-circuit loop, no longer connected to, or influenced by the outside environment. In Dr. Ramachandran’s experiment, a mirror was placed perpendicular to the person’s chest at the shoulder of the missing arm, creating a symmetrical reflection of their existing arm. The person was then asked to focus their gaze entirely on the reflected image in the mirror and to see it as their missing limb. They were then asked to begin moving both the good arm and the restored image of the limb, and little by little the brain was tricked into sensing a restored connection with the missing limb. By interacting with the restored image, the brain manages to substitute the healthy neurological pattern of communication with the good limb, for that of the damaged limb. Dr. Ramachandrandran later wrote of the experiment, calling it, “The first example in medical history of the successful ‘amputation’ of a phantom limb.”
Many patients using the therapy have reported an immediate cessation of their pain , and now Dr. Jack Tsao, a neurologist for the US Navy, has been using the therapy at Walter Reed Medical center to help injured US military veterans returning from Iraq and Afghanistan. In trial groups, every one who used the mirror therapy reported a reduction in their pain, and some reported it disappeared all together.
Dr. Ramachandran’s work in this and many other areas of the brain are both exciting and compelling. If you have enjoyed the work of Oliver Sacks and Moshe Feldenkrais you will also enjoy Dr. Ramachandran’s insights.
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