Implicaciones en el movimiento humano de las adaptaciones del esquema e imagen corporal secundarias a una amputación / Implications in human movement of the adjustments about the scheme and body image as an outcome of an amputation

Introducción: el movimiento corporal humano es el resultado de la interacción entre elementos psicológicos, biológicos y sociales. Las amputaciones generan alteraciones en la estructura mental del individuo ocasionando restricciones en la participación social; por ello, es necesario comprender la influencia de la imagen y el esquema corporal de los sujetos con amputación según la teoría del movimiento continuo. Métodos: se realizó una revisión de la literatura en las bases de datos PubMed, Science Direct, Clinical Key, PEDro, SciELO en el mes de abril de 2020; la selección de artículos se dividió en 3 fases, utilizando los términos"body schema", "body image", "amputee" y "movement".Resultados: se encontró un total de 142 artículos, de los cuales se incluyeron 13 que cumplían con los criterios de selección. Discusión: posterior a una amputación se producen alteraciones de la imagen y el esquema corporal, además de cambios plásticos en el sistema nervioso central; derivado de esto existirán modificaciones en el movimiento corporal de la persona.Se requiere favorecer el manejo integral del sujeto con amputación basado en la teoría del movimiento continuo abarcando esferas psicológicas, biológicas y sociales. Conclusión: la aceptación e integración de la imagen y esquema corporal son fundamentales para restablecer la capacidad máxima de movimiento de la persona con amputación.

Introduction: Human body movement is the result of the interaction among psychological, biological and social elements; ampu-tations generate alterations in the individual's mental structure causing restrictions on social participation; therefore, it is necessary to understand the influence of the image and body schema of amputee subjects according to the theory of continuous movement. Methods:A review of the literature was carried out in the databases PubMed, Science Direct, Clinical Key, PEDro, SciELO in April 2020; the selection of articles was divided into 3 phases, using the terms "body schema", "body image", "amputee" and "movement". Results: A total of 142 articles were found, of which 13 that met the selection criteria were included. Discussion: After an amputation, alterations of the image and body schema will occur. In addition to plastic changes in the central nervous system, therefore will be modifications in the person's body movement. It is necessary to favor the comprehensive management of the subject with amputation based on the theory of continuous movement, covering psychological, biological and social spheres. Conclusion: The acceptance and integration of the image and body schema are fundamental to reestablish the maximum capacity of movement of the person with amputation

Body image disturbance in eating disorders: concept and development / 上海交通大学学报（医学版）

Body image disturbance (BID) in eating disorders (ED) has always been a focus of intense investigations and debates since its concept was brought out. Experimental studies conducted in clinical ED patients have not only provided insights into the components, mechanisms and roles of BID in ED psychopathology, but also brought changes to relevant theories and concepts. This article provided a review of theoretical and empirical literatures on BID in ED, as well as a summary and analysis of recent developments and future prospects in this field.

Functional Neuroanatomy for Posture and Gait Control

Here we argue functional neuroanatomy for posture-gait control. Multi-sensory information such as somatosensory, visual and vestibular sensation act on various areas of the brain so that adaptable posture-gait control can be achieved. Automatic process of gait, which is steady-state stepping movements associating with postural reflexes including headeye coordination accompanied by appropriate alignment of body segments and optimal level of postural muscle tone, is mediated by the descending pathways from the brainstem to the spinal cord. Particularly, reticulospinal pathways arising from the lateral part of the mesopontine tegmentum and spinal locomotor network contribute to this process. On the other hand, walking in unfamiliar circumstance requires cognitive process of postural control, which depends on knowledges of self-body, such as body schema and body motion in space. The cognitive information is produced at the temporoparietal association cortex, and is fundamental to sustention of vertical posture and construction of motor programs. The programs in the motor cortical areas run to execute anticipatory postural adjustment that is optimal for achievement of goal-directed movements. The basal ganglia and cerebellum may affect both the automatic and cognitive processes of posturegait control through reciprocal connections with the brainstem and cerebral cortex, respectively. Consequently, impairments in cognitive function by damages in the cerebral cortex, basal ganglia and cerebellum may disturb posture-gait control, resulting in falling.

No limiar do mundo visível: a noção de esquema corporal nos cursos de Merleau-Ponty na Sorbonne / On the threshold of the visible world: the notion of body schema in Merleau-Ponty's courses at the Sorbonne / Au seuil du monde visible: la notion de schéma corporel dans les cours de Merleau-Ponty à la Sorbonne / En el umbral del mundo visible: la noción de esquema corporal en los cursos de Merleau-Ponty en la Sorbonne

De acordo com o propósito geral de estudar longitudinalmente o uso que Merleau-Ponty faz da noção de esquema corporal em sua filosofia, no presente artigo dedicamo-nos aos seus cursos na Sorbonne, localizados em um período intermediário da sua obra. Neles, o filósofo enceta discussões acerca da corporeidade a partir da psicologia da criança e da psicanálise, tomando por eixos centrais o problema da intersubjetividade e a teoria do esquema corporal. Merleau-Ponty compreende que a aquisição de um esquema corporal uno, "total", implica um descentramento de si, de modo que o corpo próprio, o de outrem e o mundo possam se entrelaçar num "tecido relacional" que envolve inextricavelmente visibilidade e espessura intracorporal. Consideramos que nesses estudos Merleau-Ponty dá um importante passo em direção à noção de carne tal como encontrada em seus textos mais tardios.

In line with the general goal of a longitudinal study about Merleau-Ponty's use of the body schema notion in his philosophy, in this paper, we look at his course at the Sorbonne, located in an intermediary period of his work. In these courses, the philosopher starts discussions on corporeity, based on the philosophy of the child and psychoanalysis, with the intersubjectivity problem and the body schema theory as the central axes. Merleau-Ponty understands that the acquisition of a single, "total" body scheme implies decentering from oneself, so that one's own body, the other person's body and the world can intertwine in a "relational tissue" that inextricably involves visibility and intra-body thickness. We consider that, in these study, Merleau- Ponty takes an important step towards the notion of flesh as found in his later works.

Suivant notre intention générale qui est d'étudier longitudinalement l'utilisation que Merleau-Ponty fait de la notion de schéma corporel dans sa philosophie, nous nous consacrons dans cet article à ses cours à la Sorbonne. Ces cours font partie d'une période intermédiaire de son oeuvre. Le philosophe y amorce des discussions concernant la corporeité à partir de la psychologie de l'enfant et de la psychanalyse, en abordant le problème de l'intersubjectivité et la théorie du schéma corporel. Merleau-Ponty comprend que l'acquisition d'un schéma corporel unitaire, "total", implique une décentralisation de soi, de façon que le corps propre, le corps d'autrui et le monde puissent s'entrelacer dans un "tissu relationnel" qui implique inextricablement visibilité et épaisseur intra-corporel. Nous considérons que dans ces études Merleau-Ponty effectue un grand pas vers la notion de chair telle qu'on la trouve dans ses textes plus tardifs.

Según el propósito general de estudiar longitudinalmente el uso que Merleau-Ponty hace de la noción de esquema corporal en su filosofía, en este artículo nos dedicamos a sus cursos en la Sorbonne, localizados en un período intermediario de su obra. En esos, el filósofo enceta discusiones acerca de la corporeidad a partir de la psicología del niño y del psicoanálisis, tomando por ejes centrales el problema de la intersubjetividad y la teoría del esquema corporal. Merleau-Ponty comprende que la adquisición de un esquema corporal uno, "total", implica un descentramiento de si, de manera que el cuerpo propio, el de otro y el mundo puedan entrelazarse en un "tejido relacional" que involucra inextricablemente visibilidad y espesura intra-corporal. Consideramos que, en esos estudios, Merleau-Ponty da un paso importante hacia la noción de carne tal como encontrada en sus textos más tardíos.

A noção de esquema corporal na filosofia de Merleau-Ponty: análises em torno da Fenomenologia da percepção / The notion of body schema in Merleau-Ponty's philosophy: analyses regarding the Phenomenology of perception

Ao longo da obra de Merleau-Ponty, além de conceitos filosóficos e imagens do seu pensamento, evidenciam-se alguns dispositivos teórico-antropológicos que revelam sua aproximação com as ciências humanas. Este é o caso da noção de esquema corporal. Interessados em discutir o papel que o desenvolvimento crítico desse conceito possa ter desempenhado na passagem do primeiro momento da sua obra ao período em que o filósofo vê-se em condições de esboçar uma nova ontologia, no presente artigo estudamos a presença da noção de esquema corporal na Fenomenologia da percepção. Mostramos que, neste livro, Merleau-Ponty dessubstancializa a noção em questão, que, de núcleo cognitivo organizador da nossa experiência corporal, passa a expressão da permeabilidade das partes do nosso corpo umas em relação às outras, mas, igualmente, da permeabilidade do corpo em relação ao mundo e a outrem. (AU)

The Throughout the work of Merleau-Ponty, besides philosophical concepts and images of his thinking, some theoretical-anthropological devices exist that reveal his approximation of human sciences. That is the case of the notion of body schema. Interested in discussing the role the critical development of this concept may have played in the passage from the first phase of his work to the period when the philosopher finds himself able to outline a new ontology, in this paper, we study the presence of the body schema notion in the Phenomenology of perception. We show that, in this book, Merleau-Ponty unsubstantiates the notion under analysis which, from a cognitive core that organizes our bodily experience, turns into the expression of our body parts' mutual permeability, but also of the body's permeability towards the world and other people. (AU)

Interlocução entre Psicanálise e Fisioterapia: conceito de corpo, imagem corporal e esquema corporal / Dialogue between Psychoanalysis and Physical Therapy:: body concept, body image and body schema / Interlocución entre Psicoanálisis y Fisioterapia:: concepto de cuerpo, imagen corporal y esquema corporal

O objetivo do presente estudo é investigar como os estagiários de fisioterapia compreendem os conceitos de corpo, imagem corporal e esquema corporal e, a partir dos dados coletados nesta investigação, realizar uma interlocução entre tais compreensões e o entendimento psicanalítico dos mesmos conceitos, a fim de refletir sobre a possibilidade de um trabalho interdisciplinar entre Psicologia e fisioterapia. Participaram da entrevista oito acadêmicos que estavam cursando o último semestre de estágio do curso de fisioterapia e que responderam a uma entrevista semiestruturada que buscou averiguar a sua compreensão sobre os conceitos discutidos neste estudo. A análise de conteúdo das entrevistas e a interlocução com os conceitos psicanalíticos evidenciaram que o conhecimento dos futuros fisioterapeutas sobre os conceitos de corpo, imagem corporal e esquema corporal podem receber uma contribuição deste estudo. O fisioterapeuta poderá compreender melhor os aspectos psicológicos presentes no quadro sintomatológico do paciente e conseguir efetivar uma intervenção que considere a fala do paciente...

The present study aims to investigate how physical therapy interns comprehend body concepts, body image and body schema and, with the data collected during this investigation, to enable a dialogue between such comprehensions and the psychoanalytical understanding of the same concepts in order to reflect upon the possibility of an interdisciplinary psychology-physical therapy intervention. Eight graduate students were interviewed, all in the final semester of their internship programs. A semi-structured interview was applied to these students, which sought to investigate the students’ understandings of the concepts discussed in this study. The analysis of the content obtained from the interviews and the dialogue established with psychoanalytical concepts have evidenced that the knowledge of future physical therapists concerning the concepts of body, body image and body schema may benefit from this study. Physical therapists will be able to better understand the psychological aspects present in patients’ symptomatic picture will also be able to help these professionals in successfully performing an intervention that takes the patients’ discourse into account...

El objetivo del presente estudio es investigar cómo los becarios de fisioterapia comprenden los conceptos de cuerpo, imagen corporal y esquema corporal y, a partir de los datos colectados en esta investigación, realizar una interlocución entre tales comprensiones y el entendimiento psicoanalítico de los mismos conceptos, a fin de reflejar sobre la posibilidad de un trabajo interdisciplinar entre psicología y fisioterapia. Participaron en la entrevista ocho académicos que estaban cursando el último semestre de prácticas del curso de fisioterapia. Éstos respondieron a una entrevista semiestructurada, que buscó averiguar la comprensión de los académicos sobre los conceptos discutidos en este estudio. El análisis de contenido de las entrevistas y la interlocución con los conceptos psicoanalíticos, evidenciaron que el conocimiento de los futuros fisioterapeutas sobre los conceptos de cuerpo, imagen corporal y esquema corporal puede obtener una contribución con este estudio. El fisioterapeuta podrá comprender mejor los aspectos psicológicos presentes en el cuadro sintomatológico del paciente, así como también el estudio auxiliará el fisioterapeuta a conseguir hacer efectiva una intervención que lleve en consideración lo dicho por el paciente...

Dolor crónico y modificaciones de la conciencia corporal / Chronic pain and disturbances in body awareness

Este artículo aborda la relación entre el dolor crónico y la conciencia corporal. El dolor crónico se refiere a un conjunto de patologías que se caracterizan por la presencia constante de dolor, cuya intensidad y duración no pueden ser explicadas en términos de lesiones del sistema nervioso periférico. La falta de explicación en términos de daño periférico ha llevado a los investigadores a suponer que el sistema nervioso central desempeña un papel crucial en estos síndromes. En particular, se ha propuesto que la cronicidad del dolor causada posiblemente por una perturbación de los mecanismos involucrados en lo que podría llamar-se la conciencia corporal 'exteroceptiva'. En la primera parte de este artículo presento estudios que muestran una relación bidireccional entre el dolor crónico y la conciencia corporal exteroceptiva, así como la hipótesis que el este dolor resulta de la perturbación de los mecanismos subyacentes a este tipo de conciencia corporal. A continuación, presento algunos problemas que esta hipótesis no logra explicar, y considero la relación entre el dolor crónico y el sistema nervioso autónomo. Por último, considero esta última relación a la luz de la noción de conciencia corporal 'interoceptiva', y sugiero que la comprensión de los mecanismos que relacionan los aspectos exteroceptivos e interoceptivos de la conciencia corporal, podrían contribuir a la comprensión de la naturaleza y el desarrollo de dolor crónico.

This review article addresses the relationship between chronic pain and body awareness. Chronic pain refers to an ensemble of pain conditions whose common characteristic is the fact that peripheral lesions cannot explain the duration and intensity of the pain. The lack of explanation in terms of peripheral damage has led researchers to assume that the central nervous system plays a crucial role in these conditions. In particular, one suggestion about how such central factors might operate is by influencing patients’ body awareness. In the first part of this article I present evidence showing a bidirectional relationship between chronic pain and what might be called ‘ exteroceptive’ body awareness, as well as the related hypothesis that pain results from a disruption in the mechanisms underlying exteroceptive body awareness. Next, I discuss some issues that this hypothesis fails to explain, and I consider the relationship between chronic pain and the autonomic nervous system. Finally, I relate this latter relationship to the notion of ‘interoceptive’ body awareness, and explore the idea that understanding the mechanisms that relate exteroceptive and interoceptive aspects of body awareness might shed light on the nature and development of chronic pain.

Neuroanatomical aspects of the body awareness

The cerebral cortex is the most complex part of the human brain and is responsible for thinking, reasoning, cognitive functions, memory and sensory perception processes, among others. The cerebral cortex can be classified into areas, from the specific functions it performs. Particularly noteworthy are the cortical areas, which integrate from multimodal stimuli and enable the individual to perceive his own body and its relationship with the space around it. This capacity is built from the attitudes and values that the individual has in relation to his or her body (body image) and the dimensional perception of its segments (body schema). This process depends on complex neural mechanisms that are related to different cortical areas. The aim of this study was to compare the cortical areas involved in the construction of body perception: body image and schema. As a result, it was observed that the areas with predominance in the perception of body size are more related to the right parietal region and those related to cognitive aspects are located in the prefrontal area and parts of the limbic system.

O esquema corporal de crianças com dificuldade de aprendizagem / The body scheme of children with learning disability / El esquema corporal de niños con dificultad de aprendizaje

Reconhecendo a importância do esquema corporal para o desenvolvimento global da criança, o objetivo desta pesquisa foi verificar o desenvolvimento do esquema corporal de escolares na faixa etária de 6 a 10 anos com queixa de dificuldades de aprendizagem, encaminhados ao Núcleo de Avaliação e Intervenção Motora - NAIM/LADEHU/UDESC. Participaram do estudo 39 crianças, sendo 24 meninos e 15 meninas, provenientes de escolas públicas de Florianópolis. O esquema corporal foi avaliado através da Escala de Desenvolvimento Motor - EDM. Todos os participantes apresentaram atraso no desenvolvimento da Idade Motora Geral e na Idade Motora do Esquema Corporal. O déficit aumentou conforme a idade cronológica dos participantes e a classificação do Quociente Motor Geral e do Quociente Motor do Esquema Coporal do grupo foi Muito Inferior. Os dados sugerem que o desenvolvimento das capacidades motoras, em especial do esquema corporal, são fundamentais para o desenvolvimento de habilidades essenciais à aprendizagem escolar.

Recognizing the importance of body scheme for the overall development of the child, our goal, in this work was to investigate the development of body scheme for students aged 6 to 10 years with complaints of learning difficulties, referred to the Division of Motor Assessment and Intervention - NAIM / LADEHU / UDESC. The study included 39 children, 24 boys and 15 girls from public schools of Florianopolis, Southern Brazil. The body scheme was assessed by the Scale of Motor Development - EDM. All participants showed delayed development of General Motor Age and Motor Age of Body Scheme. The deficit increased with the chronological age of the participants and the classification of General Motor Quotient and Motor Quotient of Body Scheme was much lower. The data suggest that the development of motor skills, body scheme in particular, are fundamental to the development of essential skills to academic learning.

Reconociendo la importancia del esquema corporal para el desarrollo global del niño, el objetivo de esta investigación fue verificar el desarrollo del esquema corporal de escolares de 6 a 10 años con queja de dificultades de aprendizaje, encaminados al Núcleo de Evaluación e Intervención Motora - NAIM/LADEHU/UDESC. Participaron del estudio 39 niños, siendo 24 niños y 15 niñas, provenientes de escuelas públicas de Florianópolis. El esquema corporal fue evaluado a través de la Escala de Desarrollo Motor - EDM. Todos los participantes presentaron retraso en el desarrollo de la Edad Motora General y en la Edad Motora del Esquema Corporal. El déficit aumentó conforme la edad cronológica de los participantes, y la clasificación del Cociente Motor General y del Cociente Motor del Esquema Corporal del grupo fue Muy Inferior. Los datos sugieren que el desarrollo de las capacidades motoras, en especial del esquema corporal, son fundamentales para o desarrollo de habilidades esenciales al aprendizaje escolar.

Two Cases of Callosal Disconnection Syndrome: Impaired Body Cognition of Nondominant Limbs

Callosal disconnection results in the functional independence of each hemisphere and usually produces characteristic signs including alien hand, left-sided apraxia, left agraphia and left tactile anomia. Our two patients; a 75-year-old right-handed woman with hypertension and a 71-year-old right-handed woman with diabetes mellitus, showed impairments in the identification of body parts with their left hands in addition to characteristic symptoms such as left ideomotor apraxia, agraphia, tactile anomia, and right alien hand signs with groping and grasping. Brain MRIs of these patients upon admission demonstrated infarcts in the medial portion of the left frontal lobes and in the corpus callosum supplied by the left anterior cerebral artery. The impairment of body parts cognition in our patients can be attributed to the failure of the patient's left hand to communicate with the body schema stored in the left hemisphere.