- Email: [email protected]
A reply to Millonig
cortex 47 (2011) 1065
available at www.sciencedirect.com
journal homepage: www.elsevier.com/locate/cortex
Discussion forum: Commentaries and replies
A reply to Millonig Daniel Antoniello a,* and Kenneth Heilman b a b
Albert Einstein College of Medicine, Neurology, Montefiore Medical Center, Bronx, NY, USA Department of Neurology, University of Florida, USA
We thank Dr. Millonig for his interest in our study. We agree that further study of this syndrome may not only help determine prevalence, but also broaden the clinical appreciation of distorted body image and shed light on the neural basis of conscious body perception. Especially with regard to patients with the striking syndrome of near volitional control of their Phantom Limb (PL). This phenomenon has certainly been described in the anosognosia literature, but is incompletely understood (Feinberg et al., 2000; Lu et al., 2000). Regarding the qualitative reports of our participants, it is important to keep in mind that their PL descriptions, which range from banal to bizarre, contain a variable range of perceptual intensity and duration that are consistent with the description of chronic PLs in patients with amputations and congenital limb deficiency (Hunter et al., 2008; Melzack et al., 1997). Regarding recruitment, participants were recruited through the Brain Rehabilitation and Research Center (BRRC) at the Malcom Randall VA Medical Center, Gainesville, Florida. These participants were post stroke individuals proactively seeking rehabilitation studies. They entered the BRRC screening with the hope that they would be selected for one of the various rehabilitation research programs. Our study was an ancillary project. At their initial screening BRRC participants underwent a neurological examination, the FugleMeyer Assessment, and neuropsychological testing to determine which rehab study was appropriate. Our participants were either called by phone from the list of participants that had been screened since 2002 or were recruited in person at their initial screening. Thus, the questionnaire interview took place over the phone or in person, respectively. Enrollment commenced at fifty participants. Only a handful of BRRC participants refused the interview.
The participants were unaware of the questionnaire’s subject, and thus overrepresentation from “voluntary sampling” is unlikely. However, due to selection bias this cohort contained a unique spectrum of characteristics: they were a highly educated (only one did not finish high school, nine had graduate degrees) and highly motivated group of participants with severe motor deficits and excellent language function. Because kinesthetic PLs necessitate severe motor deficit and coherent description required good language function, our ability to detect PLs was enhanced. This spectrum of deficit is different from stroke impairment demographics in the general population, and thus the prevalence cannot be generalized. While handedness was not specifically addressed, all but three of the participants were right handed. Of the two left handed participants, one reported a combined postural and kinesthetic PL. Lastly, our one ambidextrous participant reported a combined postural and kinesthetic PL.
references
Hunter JP, Katz J, and Davis KD. Stability of phantom limb phenomenon after upper limb amputation: a longitudinal study. Neuroscience, 156(4): 939e949, 2008. Feinberg TE, Roane DM, and Ali J. Illusory limb movements in anosognosia for hemiplegia. Journal of Neurology Neurosurgery and Psychiatry, 68(4): 511e513, 2000. Lu LH, Barrett AM, Cibula JE, Gilmore RL, Fennell EB, and Heilman KM. Dissociation of anosognosia and phantom movement during the wada test. Journal of Neurology Neurosurgery and Psychiatry, 69(6): 820e823, 2000. Melzack R, Israel R, Lacroix R, and Schultz G. Phantom limbs in people with congenital limb deficiency or amputation in early childhood. Brain, 120(9): 1603e1620, 1997.
DOI of original article: 10.1016/j.cortex.2010.12.004. * Corresponding author. Albert Einstein College of Medicine, Neurology, Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467, USA. E-mail address: [email protected] (D. Antoniello). 0010-9452/$ e see front matter ª 2011 Elsevier Srl. All rights reserved. doi:10.1016/j.cortex.2011.03.003
available at www.sciencedirect.com
journal homepage: www.elsevier.com/locate/cortex
Discussion forum: Commentaries and replies
A reply to Millonig Daniel Antoniello a,* and Kenneth Heilman b a b
Albert Einstein College of Medicine, Neurology, Montefiore Medical Center, Bronx, NY, USA Department of Neurology, University of Florida, USA
We thank Dr. Millonig for his interest in our study. We agree that further study of this syndrome may not only help determine prevalence, but also broaden the clinical appreciation of distorted body image and shed light on the neural basis of conscious body perception. Especially with regard to patients with the striking syndrome of near volitional control of their Phantom Limb (PL). This phenomenon has certainly been described in the anosognosia literature, but is incompletely understood (Feinberg et al., 2000; Lu et al., 2000). Regarding the qualitative reports of our participants, it is important to keep in mind that their PL descriptions, which range from banal to bizarre, contain a variable range of perceptual intensity and duration that are consistent with the description of chronic PLs in patients with amputations and congenital limb deficiency (Hunter et al., 2008; Melzack et al., 1997). Regarding recruitment, participants were recruited through the Brain Rehabilitation and Research Center (BRRC) at the Malcom Randall VA Medical Center, Gainesville, Florida. These participants were post stroke individuals proactively seeking rehabilitation studies. They entered the BRRC screening with the hope that they would be selected for one of the various rehabilitation research programs. Our study was an ancillary project. At their initial screening BRRC participants underwent a neurological examination, the FugleMeyer Assessment, and neuropsychological testing to determine which rehab study was appropriate. Our participants were either called by phone from the list of participants that had been screened since 2002 or were recruited in person at their initial screening. Thus, the questionnaire interview took place over the phone or in person, respectively. Enrollment commenced at fifty participants. Only a handful of BRRC participants refused the interview.
The participants were unaware of the questionnaire’s subject, and thus overrepresentation from “voluntary sampling” is unlikely. However, due to selection bias this cohort contained a unique spectrum of characteristics: they were a highly educated (only one did not finish high school, nine had graduate degrees) and highly motivated group of participants with severe motor deficits and excellent language function. Because kinesthetic PLs necessitate severe motor deficit and coherent description required good language function, our ability to detect PLs was enhanced. This spectrum of deficit is different from stroke impairment demographics in the general population, and thus the prevalence cannot be generalized. While handedness was not specifically addressed, all but three of the participants were right handed. Of the two left handed participants, one reported a combined postural and kinesthetic PL. Lastly, our one ambidextrous participant reported a combined postural and kinesthetic PL.
references
Hunter JP, Katz J, and Davis KD. Stability of phantom limb phenomenon after upper limb amputation: a longitudinal study. Neuroscience, 156(4): 939e949, 2008. Feinberg TE, Roane DM, and Ali J. Illusory limb movements in anosognosia for hemiplegia. Journal of Neurology Neurosurgery and Psychiatry, 68(4): 511e513, 2000. Lu LH, Barrett AM, Cibula JE, Gilmore RL, Fennell EB, and Heilman KM. Dissociation of anosognosia and phantom movement during the wada test. Journal of Neurology Neurosurgery and Psychiatry, 69(6): 820e823, 2000. Melzack R, Israel R, Lacroix R, and Schultz G. Phantom limbs in people with congenital limb deficiency or amputation in early childhood. Brain, 120(9): 1603e1620, 1997.
DOI of original article: 10.1016/j.cortex.2010.12.004. * Corresponding author. Albert Einstein College of Medicine, Neurology, Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467, USA. E-mail address: [email protected] (D. Antoniello). 0010-9452/$ e see front matter ª 2011 Elsevier Srl. All rights reserved. doi:10.1016/j.cortex.2011.03.003