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Several studies discuss the damaged body schema of amputees and people suffering from CRPS. By damaged body schema I mean where the body their mind constructs doesn't match up with the body that is objectively there. Ie. limbs perceived as there or not there despite evidence, CRPS, extension/contraction of perceived limbs differing from reality.

The types of damage I'm most interested in are pain resulting or allegedly resulting from a disruption of the body schema itself such as phantom limb pain, autoscopy/out-of-body experiences and CRPS. Phantom limb sensation also interests me. Mostly, the important distinction I wish to draw is healing through the power of one's own volition or through the help of others, as diametrically opposed as I can get it.

What is the relative effectiveness of self-initiated versus therapy provided by others in repairing a damaged body schema?

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(1) Could you clarify what you mean by damaged body schema? What types of damage are you interested in? (2) Would you be able to add a couple of the references to the studies that you've read to make the question more useful for others? –  Jeromy Anglim Mar 26 '13 at 7:42
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I think that's clearer. cheers. –  Jeromy Anglim Apr 4 '13 at 12:08
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I'm enjoying the subtext in the bounty box: "The question is widely applicable to a large audience...Quite a niche question, sure..." Just poking fun, but I do agree! It is quite a niche question, but it is still a large enough niche to be well worthwhile. :) Good luck though! Anyone aware of research (or even anyone with enough personal experience to weigh in authoritatively) on this specific subtopic would definitely deserve the bounty. –  Nick Stauner Jan 21 at 8:24
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@NickStauner haha! I hadn't even put those two together, you're right. Agreed! I've not got much rep here, but there's at least enough to throw at this question. I'm still very interested in an answer and this is the only SE question I've ever asked that didn't get any replies. –  LitheOhm Jan 21 at 15:53
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@LitheOhm youtube.com/watch?v=qbE2ch-9ZFc it may be a little offensive. –  caseyr547 Jan 21 at 16:16
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1 Answer

Background

Phantom Pain happens when a limb is lost over the course of one's life or missing since birth. Essentially the brain generates pain and sensations for the missing limb. It is thought to be a psychological problem brought on by inherit physiological traits of the human brain. As a psychological problem it is subject to conscious and unconscious retraining. No treatment has as yet proven completely effective against phantom pain.

Mirror Therapy is one scientific clinically useful treatment for phantom pain developed by Vilayanur S. Ramachandran. It normally involves the use of a mirror box in later stages of rehabilitation.

A mirror box was featured on the American Television show "House" as a treatment for a war veteran. This clip illustrating the fictional use of a mirror box from that episode is inaccurate as it shows the mirror box as a instant cure all however it does accurately describe the process by which the mirror box is used. The clip may be considered somewhat offensive because House is always somewhat offensive.

In a mirror box the patient places the good limb into one side, and the stump into the other. The patient then looks into the mirror on the side with good limb and makes "mirror symmetric" movements, as a symphony conductor might, or as we do when we clap our hands. Because the subject is seeing the reflected image of the good hand moving, it appears as if the phantom limb is also moving. Through the use of this artificial visual feedback it becomes possible for the patient to "move" the phantom limb

-wikipedia

Mirror therapy has been proven by fMRI imaging to extort spatial attention.

In this first study on the neuronal correlates of the mirror illusion in stroke patients we showed that during bimanual movement the mirror illusion increases activity in the precuneus and the posterior cingulate cortex, areas associated with awareness of the self and spatial attention. By increasing awareness of the affected limb the mirror illusion might reduce learned non-use. The fact that we did not observe mirror-related activity in areas of the motor or mirror neuron system questions popular theories that attribute the clinical effects of mirror therapy to these systems.

-The neuronal correlates of mirror therapy: an fMRI study on mirror induced visual illusions in stroke patients

Attention (which is in this case not the same word as "pay attention") is as William James defined "withdrawal from some things in order to deal effectively with others.". Or as Shaun P. Vecera and Matthew Rizzo defined "The processes that permit an organism to choose some environmental inputs over others".

Spatial attention again defined by Shaun P. Vecera and Matthew Rizzo is "restricted to visuospatial attention—those attentional processes that select visual stimuli based on their spatial location".

Conclusion

Mirror therapy typically begins in a doctors office. A doctor trains a patient during in or out patient rehabilitation to look into the mirror and clench or move both the present and missing limb. After the technique has been proven useful to the individual it can be done at home without a doctor supervision and minimal training with the same overall results for both upper and lower body. Home based treatment results in nearly equal compliance.

It is my hypothesis that increased prevalence of virtual and augmented reality will allow for new kinds of spatial attention treatments for those with multiple amputations and chronic arthritis effecting both hands.

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