Altered bodily perceptions in chronic neuropathic pain conditions and implications for treatment using immersive virtual reality.

Chronic neuropathic pain is highly disabling and difficult to treat and manage. Patients with such conditions often report altered bodily perceptions that are thought to be associated with maladaptive structural and functional alterations in the somatosensory cortex. Manipulating these altered perceptions using body illusions in virtual reality is being investigated and may have positive clinical implications for the treatment of these conditions. Here, we have conducted a narrative review of the evidence for the types of bodily distortions associated with a variety of peripheral and central neuropathic pain conditions. In addition, we summarize the experimental and clinical studies that have explored embodiment and body transformation illusions in immersive virtual reality for neuropathic pain relief, which are thought to target these maladaptive changes, as well as suggesting directions for future research.

Features and Extra-Striate Body Area Representations of Diagnostic Body Parts in Anger and Fear Perception.

Social species perceive emotion via extracting diagnostic features of body movements. Although extensive studies have contributed to knowledge on how the entire body is used as context for decoding bodily expression, we know little about whether specific body parts (e.g., arms and legs) transmit enough information for body understanding. In this study, we performed behavioral experiments using the Bubbles paradigm on static body images to directly explore diagnostic body parts for categorizing angry, fearful and neutral expressions. Results showed that subjects recognized emotional bodies through diagnostic features from the torso with arms. We then conducted a follow-up functional magnetic resonance imaging (fMRI) experiment on body part images to examine whether diagnostic parts modulated body-related brain activity and corresponding neural representations. We found greater activations of the extra-striate body area (EBA) in response to both anger and fear than neutral for the torso and arms. Representational similarity analysis showed that neural patterns of the EBA distinguished different bodily expressions. Furthermore, the torso with arms and whole body had higher similarities in EBA representations relative to the legs and whole body, and to the head and whole body. Taken together, these results indicate that diagnostic body parts (i.e., torso with arms) can communicate bodily expression in a detectable manner.

Music Upper Limb Therapy-Integrated: An Enriched Collaborative Approach for Stroke Rehabilitation.

Stroke is a leading cause of disability worldwide. It leads to a sudden and overwhelming disruption in one's physical body, and alters the stroke survivors' sense of self. Long-term recovery requires that bodily perception, social participation and sense of self are restored; this is challenging to achieve, particularly with a single intervention. However, rhythmic synchronization of movement to external stimuli facilitates sensorimotor coupling for movement recovery, enhances emotional engagement and has positive effects on interpersonal relationships. In this proof-of-concept study, we designed a group music-making intervention, Music Upper Limb Therapy-Integrated (MULT-I), to address the physical, psychological and social domains of rehabilitation simultaneously, and investigated its effects on long-term post-stroke upper limb recovery. The study used a mixed-method pre-post design with 1-year follow up. Thirteen subjects completed the 45-min intervention twice a week for 6 weeks. The primary outcome was reduced upper limb motor impairment on the Fugl-Meyer Scale (FMS). Secondary outcomes included sensory impairment (two-point discrimination test), activity limitation (Modified Rankin Scale, MRS), well-being (WHO well-being index), and participation (Stroke Impact Scale, SIS). Repeated measures analysis of variance (ANOVA) was used to test for differences between pre- and post-intervention, and 1-year follow up scores. Significant improvement was found in upper limb motor impairment, sensory impairment, activity limitation and well-being immediately post-intervention that persisted at 1 year. Activities of daily living and social participation improved only from post-intervention to 1-year follow up. The improvement in upper limb motor impairment was more pronounced in a subset of lower functioning individuals as determined by their pre-intervention wrist range of motion. Qualitatively, subjects reported new feelings of ownership of their impaired limb, more spontaneous movement, and enhanced emotional engagement. The results suggest that the MULT-I intervention may help stroke survivors re-create their sense of self by integrating sensorimotor, emotional and interoceptive information and facilitate long-term recovery across multiple domains of disability, even in the chronic stage post-stroke. Randomized controlled trials are warranted to confirm the efficacy of this approach. CLINICAL TRIAL REGISTRATION: National Institutes of Health, clinicaltrials.gov, NCT01586221.