Monday, December 3, 2007

Mirror Box Therapy - Part VI

or: Outlook - Possibilities - Thoughts

OK - our brains are built to predict the future - let's see if I can help that along. ;-)

Blakeslee - in her excellent book - has reported that there are preliminary results that viewed the problem of Anorexia from a body map disorder point of view. What if people with anorexia "just" have a different body map - one that is much much thinner than their real bodies.

Easy: they feel extremely uncomfortable in their own bodies. I imagine it like your whole body being numb (think of the effect you feel after you visited your dentist - now only include your whole body).

The only way to make the felt image and the actual image fit is to starve yourself - in 20% of cases even to death. That's how strong this urge is.

The thing we have to recognize about emotions and the urges they produce is that they are strong motivators - they "make us do things". And only when we have satisfied whatever the emotion tells us does the urge go away. Viewing pain as an emotion like hunger and so on makes it much easier to grasp what's it all about.

My best guess is that eventually all body dismorphic disorders will be recognized to really be "body map" disorders and be treated accordingly.

(I know that pain is not a real emotion - it's much more than that. But some of the effects it has on us and on our behavior are very similar which makes it easier to talk about it.)

Another very frequent condition where feedback therapy shows good results is tinnitus.
Again - peripheral thinking (i.e. in terms of damaged structures) hasn't amounted to much progress being made.

Now - thanks to brain imaging we can see that tinnitus is the same as phantom limb pain only for our sense of hearing. The auditory cortex where sounds are mapped becomes disorganized - creating random noise. By re-training the auditory cortex - as Herta Flor and Colleagues have done - having the patient distinguish different frequencies and so on - the symptoms can be markedly reduced.

Another treatment that is able to alleviate such symptoms is TMS (transcranial magnetic stimulation) which shows even better results.
One clinic in Germany at Regensburg University is working with this technique. And on a sad side note - largely unnoticed by the medical establishment as yet.

Migraines - with aura - are yet another field where neuroscience has found an identifiable cause - quickly spreading cortical depression. And the easiest way to describe treatment I have to think of the term "re-booting". It seems that a few neurons go haywire - causing others to join in. By zapping those neurons - which are located in the visual cortex - you can stop the effect from spreading.

A handheld device is currently undergoing final tests and should be on the market soon.

As for other frequent conditions:
focal dystonias, writers cramp, jips in golfers, RSI, .... are all due to some form or other of the map areas becoming deformed, fused or altered in some unintended way. Treatment as I stated before has to re-establish normal maps, creating congruence between the VR program and the actual sensory information.

If you don't suffer from any of these conditions count yourself lucky.

Not only was treatment unavailable till now - since no real cause could be found sooner or later people were accused of the symptoms being all in their heads - which in a way they were - but as real physiological manifestations - not some unexplained "psychological" phenomenon.

Don't get me started on the harm that was done to these people by so-called medical professionals who are too lazy to pick up a book or medical journal once in a while and are too arrogant to question their own knowledge.

A much more common problem everyone has to deal with sooner or later is aging and it's accompanying aches and pains.
The best term for this combination is sensori-motor amnesia - which - as far as I can tell - comes from Thomas Hanna who built on the work of Feldenkrais.

What do "old" people have in common?
Their posture, their way of walking, their difficulty in looking over their shoulders (which makes driving a car dangerous), and so on and so forth.

Yet - with a little hands on treatment - they are able to regain a lot of their mobility within minutes.

How come?
Well - I see daily life as a constant struggle between adaptive and (cumulative) maladaptive learning.

Babies learn all day long. They learn a language or two or three, they learn social norms and customs by imitation, they learn how to move their bodies in thousands of different ways. After a while they become school children - and learning takes on more of a purely "mental" form - the memorization of knowledge. "Body learning", i.e. different types of movement aren't explored any more.

Now you might say that during the teenage years most people pick up a sport - and you'd be right. But it is one sport - with one specialized way of moving - and not a great variety of things.

After that you have a job - and if you are really unlucky it either involves sitting or doing the same repetitive tasks over and over again.

What happens when you either have to little movement (sitting) or too much small movements is that your body maps change. Add to that that the tissue becomes hypoxic and you have a recipe for disaster:
this body map change is accelerated by the presence of pain.

Now - before pain becomes "felt" there is already nociceptive information being sent to the brain which uses reflex responses to automatically adjust posture and such. Just watch people at the cinema - they are constantly shifting position to distribute the pressure from sitting over a wider area of the body.

Only when those mechanisms don't suffice to change the nociceptive input pain is produced.

These two examples give you an idea about what aging is:
it is the slow accumulation of changes in our body maps with the effect that we un-learn how to move bit by bit. This process is accelerated/aided by sub-conscious pain and automatic reflex responses (reflexes are stereotypical - that's why old people "all" have the same posture).

It's not because our bodies can't move freely anymore - the brain simply has forgotten how to send the appropriate motor commands.

The solution: life-long body learning. Feldenkrais, Somatics, Yoga, .... - all build on this.

It's a bit more difficult to incorporate this into daily life - but things like the Nike Free are a good way to start.

Those shoes really do help your feet to become alive again.

What are you waiting for?
Go do something now or I will send them after you: ;-)



Adiemus said...

I read this post with a good deal of interest after having your blog recommended to me by jeiseas. I do take issue with your comment that pain is not a 'real emotion', however.

You've almost reverted to the old body-mind dichotomy - by suggesting that things psychological aren't 'real' unless they can be examined under some sort of imaging...

The current model of pain emphasises the biopsychosocial nature of pain - the definition of pain from the International Association for the Study of Pain is that pain is an 'unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage'.

Things don't have to be either physical or psychological - they can be both. While it's tempting to hope that imaging technology can locate all mechanisms at the microcellular level, I'm not sure that everything can be reduced in this way without over-simplifying the interaction between micro and macro systems.

BTW I love the photography!!

Take a look at my blog -

Matthias Weinberger said...

I knew from the start that that sentence would get me into trouble. ;-)

Pain is no "real" emotion in that it only shares some of the features but not all. Pain is something like the next step in the evolution of emotions.

You can artificially create emotions: just look at the work done by Paul Ekman who studies facial expressions - when his subjects are asked to produce certain expressions they also feel the corresponding emotion.

The brain monitors what happens in the body (interoception) and produces the emotions that fit the state the body is in.

You can re-produce emotions at will so to speak. You can't do that with pain - no matter how hard you try.
That's why there is no way to fake pain - either it's there or it isn't.

That sets it apart from the other emotions.

jeisea said...

Thanks so much Matthias. This is just brilliant.
Re your comment "there is no way to fake pain - either it's there or it isn't." There is also no way to fake mirror therapy. It works if you get it right. It doesn't work if you don't - plain and simple.
I have posted about your series on mirror therapy on my blog and will pass this link on to some of my News site contacts.


Anoop said...

I am just curious. Does some cases of chronic pain NEEDS movement or exercise to lower pain. I am thinking terms of peripheral nerve damage or nerves being hypoxic.

Or every pain can be resolved though changes in CNS?


Matthias Weinberger said...

Anoop: think of someone who just had a serious trauma - gunshot wound, car accident, .. - they often feel no pain whatsoever.
Pain is always in your head - nowhere else.

I'm not saying that exercise and other things aren't necessary - it certainly makes it easier to get rid of the pain - but it's not a necessity per se.

Anoop said...

If we can safely ignore the periphery, what is all the neurodynamc techniques by Shacklock and Butlers working on?

Is it worth even looking at considering they were mainly devoloped to treat an impaied peripheral nervous sytem?


dermoneuromodulator said...

About life-long body learning, I will post this link from Go Animal:

I blogged about it here:

Mark said...
This comment has been removed by a blog administrator.
Colleen and Pasha said...

I've enjoyed your blog so much that I finally want to leave a quick comment. When I was diagnosed with RSD 2 yrs ago after breaking the wrist of my dominant hand, I had just read the great article about Prof. Ramachandran in The New Yorker. I ran out and made a mirror box with 3 mirrors (since no one had recommended this to me, nor had I seen a mirror box). I put a mirror between the 2 hands, then one facing me and one below the hand, then ran my eyes over them during movement. In 2 weeks my hand went from a giant red club to almost completely normal looking. My therapist bought the box from me. It could be interesting to try this additional eye stimulation of 3 mirrors for acute RSD.
I was diagnosed (and used the mirrors) 4 months after the RSD had begun. I was lucky to be diagnosed within 6 months. Thank you for giving us all of the excellent material on your blog. From your big fan, Colleen

Colleen and Pasha said...

me again - oops, at the risk of boring you to death. A year and a half after achieving normal hand size with mirror therapy, my brain still "saw" my hand as the swollen club. Two days after starting pregabalin treatment, I finally perceived it as it's true size. Interestingly related to your remark about anorexia, I had always needed to stay extra thin to be comfortable in my body, and the pregabalin (now gabapentin - even better) made me perfectly comfortable in my normal body size! I strongly believe that Gabapentin should become first-line treatment for anorexia, in cases with tolerable side effects. Sorry to rave on - love your blog.