The University of Southampton

Author: Andres Palacios Perez

Unlocking the Mystery of the Phantom Limb: Prosthetics as the Key to Relief

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I recently read a novel by Norman Doidge called ‘The Brain That Changes Itself’, and a chapter that caught my attention was on phantom limb pain. After reading this chapter, I realised that people who have lost limbs have to endure more problems than just adjusting to life without a hand or leg. They also must deal with excruciating pain that, to us as outsiders, does not exist. Many of us do not have this problem. However, many people in this world do. There are around 500 million amputees who have sadly lost a leg or arm due to disease, war, or accident. I believe the use of prosthetics and their advancement can help alleviate the pain.

The phantom pain phenomena

People who have this problem sometimes experience something known as phantom limb pain. This is when an amputee perceives pain in a limb that is no longer there. One of the main theories that draws my attention is the Central Theory: the brain tries to recreate a memory of the lost limb but fails because it does not receive feedback. I find this to be such an interesting phenomenon because, currently, there’s no guaranteed way to treat it; around 60-80% of amputees experience phantom limb pain. I then began wondering if there are any ways that people have managed to help others with this problem, and interestingly, I found this fascinating article about a man who helps people with mirrors.

Stephen has managed to ‘cure’ the phantom pain of many individuals using mirrors. As I study neuroscience, I find this impossible as there is no scientific basis. However, many people report that mirror therapy truly has helped them overcome the pain, including Stephen himself, and I cannot dispute this.

This provides a good explanation of how mirror therapy works.

How prosthetics can help.

After reading this, I began to wonder if prosthetics can help with this problem. Rather than using mirrors, the integration of a prosthetic with peripheral feedback may reduce the pain.

Many kinds of prosthetics exist, from a toe to an entire leg. Scientists are trying to improve prosthetics every day with new innovations. These new innovations can help people who have missing limbs live a higher quality of life.

A paper published in 2018 found that leg amputees using an electrocutaneous feedback prosthetic were able to alleviate phantom limb pain. Furthermore, another paper discussed a biological interface developed by the University of Michigan. They developed a new approach which involves a small graft of muscle tissue surgically attached to the end of a severed nerve in an amputee’s arm. This is known as the Regenerative Peripheral Nerve Interface(RPNI). The researchers managed to demonstrate that RNPIs attached to the peripheral nerves will contract when the person thinks about contracting. This links back to the Central theory as the brain receives the feedback it looks for.

 I find this incredible because we can ‘trick’ the brain into believing that the limb is still there.

How far can they go?

From what I have been reading, I can extrapolate that the true potential of prosthetics lies in the full integration of the brain and machine.

However, this raises concerns for me as there are ethical issues. For example, when they become advanced enough, people may opt to remove their limbs willingly to have an advanced body part. Where do you draw the line on this? Is mutilation of one’s own body acceptable if it’s consensual?

These are all questions that really must be considered when the time comes, and I personally believe that physical enhancement should not be allowed without reason.

This is a very interesting discussion. Samanth Subramanian, a writer and journalist, discusses the neural link and the future of prosthetics and potential ethical issues. (start at 13:33, end at 16:58) https://qz.com/2141720/modern-prosthetics-go-beyond-bionic-limbs-and-into-the-brain

The Infinite Potential of Tissue Engineering

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The potential of tissue engineering.

I find the potential of tissue engineering to be very interesting, mainly because I believe that there is no limit to the potential. One of the main uses for tissue engineering is to replace lost tissue and to maintain damaged tissue or even potentially an entire organ. But that is another issue altogether!

There are some other aspects to tissue engineering, and these include regenerative medicine, which has been used interchangeably with tissue medicine.

The interesting history of tissue engineering

The idea of tissue engineering has always been more of a dream or a fantasy before modern technology came about. A very intriguing perspective that I have found recently explores the idea that the concept of tissue engineering has been around in the early history of man, which is the story of Eve being created from the rib of Adam. This is so fascinating to me because it shows how humanity has this innate desire to create and not be bound by any limitations.

However, in modern times, the concept of tissue engineering was introduced in the late 1980s, and this opened a gate of endless possibilities and different applications for the future.

One of the first examples of tissue engineering being successfully implemented was in 1991, when an individual with Poland’s syndrome was the first human to receive a tissue-engineered implant that was composed of synthetic polymer.

The ability to save human lives.

Unfortunately, in our world currently, there is a shortage of organs that are available for transplantation. Additionally, I was saddened to find an article in the New York Post showing how there are failures in the management of organs and a lot of available organs are actually going to waste and will be discarded even though the number of people that are in desperate need for a new organ will never run out. It was reported that around 17 people die per day while waiting for a transplant, and there are around 106,000 people in America on the waiting list.

This is why I believe that tissue engineering can provide a possible solution to this devastating problem. With the improving technology, the possibility of creating 3D organs is increasing, with biomedical engineering researchers developing 3D temporary organ structures called scaffolds. With this technology, the possibility of creating material that can help with recovery is increasing.

Problems with Tissue Engineering

I am very excited about the prospect of tissue engineering and its potential future applications. I am very aware that there are limitations to this.

Some of these limitations are the materials used. For example, alginate is a difficult material to use as it collapses easily. Moreover, the challenge I believe to be the hardest to overcome is receiving donations from others.

If we were to use stem cells to engineer tissue for another, there are many ethical questions that must be addressed, such as the problems of taking stem cells from a human embryo.

In my humble opinion, I believe that taking stem cells from an embryo is unethical, and this mainly revolves around religious problems, as being raised in a catholic family has shaped my views on certain matters such as this.

However, if improved communication to try and get more people to donate their stem cells, then it may be possible to overcome this problem, and many more lives could be saved in the future.

Here is a video of a scientist explaining his views on the ethical issues of embryonic stem cells that I largely agree with.