Illusions, delusions and the brain. A Ramachandran lecture on body image and mind body interactions.

well ladies and gentlemen a very very warm welcome to you all and it's a very warm day typical of Glasgow as well you know and a special warm welcome to Professor Robert Chandra the Gifford lecturer of 2012 and to his son and his other farm other guests that are here today I'm Graham Kai I'm the vice principal of this University Clarke of Senate and also a member of the Gifford committee it's a very rare occurrence these days because we have so many public lectures to fill the beautiful this is quite something indeed and it only reflects the very high international esteem in which we hold professor Ramachandran and also reflects I think the strong influence that his work has had on academics and also non academics alike from a wide range of disciplines and interests as one of the world's leading neuroscientists he's been responsible for groundbreaking work in the fields of behavioral neurology and psychophysics professor Ramachandran theme for the 2012 Gifford lectures is body and mind insights from neuroscience yesterday he led a workshop on the topic of art metaphor and synesthesia and on Wednesday he will lecture on molecules neurons and morality and today the topic is illusions delusions and the brain but first just a short word about the Gifford lecture series this prestigious series was established by Adam Lord Gifford in the late 19th century rod Gifford was a call to the bar in 1849 was advocate deputes in 1861 and was appointed to the Court of Session as Lord Gifford in 1870 and I hope sir that you will allow me to make a parallel with your illustrious grandfather another great lawyer who was advocate general of Madras and co-author of the Constitution of India and a second parallel with you personally and that is the fact that gifford was a renowned public speaker and a polymath interested in a wide range of subjects including philosophy and metaphysics indeed I believe you have lamented the strict professionalism of science these days I would like to go back to the Victorian age of Gifford and Darwin Huxley when Sciences scientists had fun and even lawyers would write about philosophy the purpose of Lord Giffords bequest to the four ancient universities of Scotland was the sponsor lectures quote to promote and diffuse the study of natural theology in the widest sense of the term and for over a hundred years the Gifford lectures have been one of the foremost lecture series dealing with religion science and philosophy in an attempt to answer some of life's biggest questions so there's no pressure on you at all the educator and historian Jacques Bazaar described the Gifford lectures as virtuoso performances and the highest honor in a philosophers career well since the first lecture in 1888 Gifford lecturers have been recognized as preeminent thinkers in their respective fields and can I just mention Niels Bohr a tianjin song William James max mueller Pyrus murder Karl Reinhold Niebuhr Albert Schweitzer Henry Chadwick James George Frazer that golden bough man George Steiner Neil Chomsky BOHICA Alfred James Bofur Archbishop William temple Frederick koppelson Mary Warnock and I could go on to mention but a few but now we add professor Ramachandran to this impressive list professor Ramachandran is director of the center for brain and cognition and distinguished professor with the psychology department and neurosciences program at the university of california san diego an adjunct professor of biology at the Salk Institute he initially trained as a doctor and subsequently obtained a PhD from Trinity College Cambridge his early work was in visual perception but he's the best known for his experiments in behavioral neurology which have had a profound impact of the way we think about the brain Richard Dawkins no less has called him the Marco Polo or neuroscience but his work has had amazing practical application in areas such as autism phantom limb disorders epilepsy visual processing and so Nastasia in 2003 he gave the annual BBC reflexes the first physician psychologists to do so since they began in by Bertrand Russell in 1949 in 2005 he was awarded the Henry Dale medal and elected to an honorary life membership by the Royal Institution of Great Britain and his other honors and awards include honorary doctorates fellowships from All Souls Oxford and Stanford the presidential lecture award from the American Academy of Neurology their Aryan cappers medal from the Royal Netherlands Academy of Sciences and in 1995 he gave the decade of the brain lectures at the 25th annual meeting of society of neuroscience and most recently the President of India conferred on him one of the highest civilian awards and honor if ik title in india the padma bhushan time magazine named him on their list of the hundred most influential people in the world a Newsweek not to be undone or done named him a member of the Century Club well he's published over 180 papers and scientific journals and with all due respect I'm not going to mention them all here but his author of the acclaimed book phantoms of the brain helm that has been translated into nine languages and from the basis of a television series in Channel four which is also shown in America and his new book the tell-tale brain unlocking the mystery of human nature was in the New York Times bestseller list and so without further ado let us give a very warm welcome to Professor Roy and who will lecture on illusion delusions and the brain thank you for that very fine introduction I am of course deeply honored to be here giving the Gifford lectures which have occupied a central place in the history of ideas and the history of intellectual life in the english-speaking world and I would like to thank the committee for inviting me to deliver this lecture today now I'm going to talk about the human brain and its functions how the activity of 100 billion nerve cells in the brain little wisps of protoplasm gives rise to the whole spectrum of abilities that we call human nature gives rise to the human condition and let put to the problem in perspective the human brain is a three-pound mass of jelly the consistency of tofu which I could hold in the palm of my hand and yet it can contemplate the vastness of interstellar space contemplate the meaning of infinity the meaning of love passion charity and pity can even contemplate itself contemplating what we call introspection or self-awareness and how does all this come about speaking of the self where does the sense of self how did the sense of self emerge from the activity of cells in the brain now when you think of the self to really nebulous concept but it has several attributes that come to mind first of all there is a sense of unity you feel like you're one person acting in the world you have a sense of being a person in spite of a diversity of sense impressions coming into your brain in spite of diversity of actions memories passions emotions all of this going on in parallel and yet you feel like one person the sense of unity is a central attribute of being a human the second attribute there dozens of attribute I'm going to mention only three or four second attribute is a sense of continuity in time you will see a sense of having an autobiography and being able to look into the future look into the past engaging in a sort of time travel to and fro from the present self and this again is a truly truly astonishing ability of being part to being human then there's a self of agency you're not you don't feel like you're prisoner of chance and circumstance you're in control of your own future partly you have free will in other words and then there is of course self awareness you are aware of yourself as being a person having a life having a sense of sense of the eye and question is how does this come about since a personhood or some in fact it's hardly imagined so in other words you're not only aware but you are aware that you are aware you're aware of you being a person who's aware of events and objects in the external world in fact itself without being aware of itself sounds like an oxymoron it's not clear what it would even mean and paradoxically I think this is not true of everybody most of us your a sense of being aware a sense of self awareness but you also want to be more than merely human more than merely you want to transcend yourself and achieve communion with God how are well that happens in the brain I don't know we know for sure that the temporal lobes are partly involved and I'll touch on this very controversial topic in tomorrow's lecture now what I'd like to focus on today's lecture is an aspect of self it's easier to tackle empirically as a scientist and as a clinician and that is your body image one of the fundamental attributes of self one we take for granted is the fact that the self is anchored in a body it's almost axiomatic I am here in this body I'm not in Susan's body I'm not in money's body I'm right here in fact it's so obvious that we take it for granted how does the self become clothed in this in this body of this physical flesh that we called my body how heroic of you close your eyes give a sense of being trapped in or being enclosed in a rancor in a body and how a sense of moving around in space and time vivid sense may different parts my but it's called body image - neurologist Henri head and lot Russell brain - real names believe it or not coined the phrase body image how does the brain construct body image how do you study this but the way we study this is to look at patients where it changes it a small change in a specific part of the brain either caused by a stroke or a tumor or head injury or a genetic change or a change caused by D afferent ation removing the sensory input to the brain you can correlate these changes in the brain the changes in the mind the changes in behavior and correlate structure and function and eventually figure out how the brain constructs your sense of being anchored in a body and the first thing I'd like to talk about is phenomenon that's well known to most of you called phantom limbs and an arm or a leg is amputated you get a vivid sense of the arm continuing to be present and this is what we call a phantom limb and phantom limbs have been known for since antiquity actually were described by Silas Weir Mitchell around late 18th century and the Philadelphia physician and he coined the phrase phantom in the sense of you and after you lost an arm sense of this arm missing on continuing to haunt you like a ghost called a phantom limb the Sirian 98% of a patient after amputation of an arm or loss of an arm in an accident continue to vividly feel the presence of their arm it's very very common and it's very serious problem clinically because about two-thirds of these patients experience excruciating pain in phantom limb now when I first encountered these patients in medical school I was very intrigued by it but I didn't quite know how to study in patients at that time and not long well about ten twenty ten fifteen years ago I saw a patient of the phantom limb was very intrigued he was sitting in my office and out of curiosity I started testing him doing simple clinical neurological exam starting with testing his reflexes and all that everything was normal he was neurologically intact and everything seemed normal then I started testing his sensation by taking a q-tip a cotton bud and touching different parts of his body and what asked him what do you experience so I had him blindfolded he was sitting on a chair by the way am i audible of the back okay is that I'm a clearly audible all right so he's this chap was at a left on amputated as a result of a car accident had a vivid phantom limb on the left side just above the elbow and he was sitting in my office blindfolded and it took a q-tip to touch different parts of his body and ask him what what he was feeling he said oh you're touching my right shoulder doctor there's my right chest that's my love sedima forehead that's my left Qi or you know what that's amazing I feel that in my left phantom thumb that's my phantom index finger it's my phantom pinky what I found was there's a complete map of the phantom left hand on the left side of his face and that's what's depicted that a neck slide it's a phantom thumb there's a thumb representation there T label T the ball of the thumb index finger you know you get the sense of it that's the entire map of the hand on the surface of the face now why does this happen why is there a map of the hand in the face returned IV go to the brain the entire body surface is mapped onto the contralateral surface of the brain is a vertical strip of cortical tissue called a post central gyrus behind that central furrow called the central sulcus and there is a complete map of the opposite side of the body the skin surface of this body on the vertical strip of cortical tissue this map is called a pen field map that's the artist whimsical depiction of the surface of the body in the surface of the brain and you see it's a normal map but there is something peculiar or odd about it namely to continues map right except that the face instead of being near to the Mac is dislocated and below the hand is that clear it was like okay we don't know why that happened something that's lost in luzhin repast but embryo in the embryo but that's the way that's the way it is so this gave me the clue as to what's going on in these patients now when you remove the arm sensory input from the hand skin does not go to that region of the brain anymore so the hand region of the brain is suddenly deprived of sensory input when you amputate the hand right so that reason in the brain is now hungry for new sensory input the sensory input from the face skin normally goes only to the face area the brain now invades the vacated territory corresponding to the missing hand so when you touch the face it activates not only the face area of the cortex like it should it also cross activates the hand region activates those cells so when you touch the face not only does it activate the face area the brain also activates a hand area fooling the brain into thinking whatever it is reading that signal higher up into thinking that the hand is being touched so when you touch the face patient gives a vivid sensation of the sensations vivid perceptional sensations are rising from the missing phantom hand now we then did an additional few experiments on these patients it turns out there is a second map so one map is in the face and if you touch other parts of the body you don't experience anything but there is a second map on the stump just above this thumb the thumb index finger pinky all the fingers neatly laid out so why are there two maps this is a different patient by the way you know the right arm is amputated so why are there two maps the arm has been removed there's one map on the face one map about the amputation the reason is when you remove the sensory input from the hand that region is d afferent it a trillion is the prayer input so the sensory input from the face can invades from this side sensory input from the upper arm normally goes only to the upper arm invades from the other side so when you touch the upper arm it goes and activates not only the upper arm cells cells in the hand as well so that's why you get exactly two maps one on the upper arm one in the face as you would expect right this is quite radical because it's telling you we saw this patient just three weeks after amputation this is telling the old Dogma we were all raised in a psychology student in his medical students these connections in the brain are laid down in the fetus or in early infancy they're fixed once they're laid on you can't change these connections in the adult brain hence the notorious lack of plasticity in the adult brain but is what we are showing here is in fact there's tremendous amount of plasticity they can map even the basic sensory maps of the brain can change over a two centimeter distance in a matter of weeks in fact we have shown some of these changes can occur as as early as two or three days after amputation for distances spanning a centimeter or more now the other experiment we did is to have this chat we took a q-tip dipped it in hot water put it on his face skin and immediately he said oh my god my phantom thumb feels hot but you take a piece of ice put it on his face neither where the pinkie is it is oh my god my phantom pinkie feels ice ice cold so not only is there reorganization going on but it's not higgledy-piggledy the touch fibers find their way to the touch maps in the brain the cold to the cold and the warm to the warm now then what happened was in one day out of curiosity I said I put the water on his face and the water started dribbling down his face he said oh my god you're not going to believe this doctor is it work I can feel the doctor I can feel the trickle actually going down my phantom like this like this and it comes and it stops exactly the base of my thumb right so the connections are precise enough that you can actually follow the path of the trickle down the phantom then for fun I said just raise your stump and pointed to the ceiling and he did that then I had put the water on his face started tripping nom he said oh my god the trickle the water is trickling uphill going up towards the ceiling defying the laws of gravity now when you listen to patients often and um you realize they don't make up stories like this this chap is actually experiencing the trickle flowing uphill because it was because the precision of reorganization of them the brain now you can take the same patient and then you can do brain imaging so this chaps the right arm was amputated his left arm is normal you see looking at the top of the brain green corresponds to the left arm the red correspond to the face the blue corresponds to the upper arm the right arm was amputated so the green is missing the input from the face can the red has invaded the territory corresponding to the green the hand area and the upper arm is also invaded this so you can track the physiological anatomical changes in the brain along with and correlate them with the perceptual sensory changes is one of the goals of cognitive neuroscience now one of the things you see in these patients with phantom limbs is they'll say they can move their phantom you'll say my phantom is reaching out and shaking your hand doctor it's reaching out and patting my little brother on the shoulder reaching out and grabbing the phone these are very vivid the patient's not delusional he knows that there's no arm that there is a very vivid perceptual illusion the phantom is actually moving now that we don't know where these signals originate but the front of the brain it sends commands to the arm sends out a command which goes down the internal capsule down the spinal cord out to the arm in all of us command goes and moves the arm and you get feedback from the arm muscles going back to the brain saying the arm is moving appropriately you also get feed-forward signals every time a command is sent to the arm in all of us a copy of the command has an email see see a copy of the command gets simultaneously sent to the body image centers in the brain to monitor the command and match it with this sensory feedback in these people arm is missing there's no feedback coming in but the feed-forward signal still goes down more a command goes into the arm missing arm because the brain doesn't know the arm is missing and a copy of the command gets into the parietal lobe and it's monitored these experiences phantom sensations in a phantom now that's in about 2/3 of patients but in about one-third of patients the arm the phantom arm is immobilized the patient will say I'm sending a command to the arm doctor to make it move but it refuses to budge patient will say things like my phantom arm is fixed in an awkward painful position like this and you mimic the position of the phantom of the normal arm it refuses to budge I try to move it hoping to relieve the pain but it's an cramped in this awkward position my phantom nails are digging into my phantom palm is excruciating me painful I wish I could open my phantom hand that might relieve the pain what's going on here there is no fan there is no arm there is no nails right now when I looked at the case sheets and I look at the charge one of the things I observed was many of these patients actually had a pre-existing nerve lesion like a brachial plexus avulsion so the brachial plexus was the end of the spinal cord and the palm was actually paralyzed but intact and painful from and in tight and real arm in a sling now after a few months the arm was amputated perhaps in a misguided attempt to get rid of the pain patients then stuck with a phantom limb in a phantom sled sling with the phantom pain persisting with the vengeance so why would this happen well maybe when the arm was in time every time the brain sent a command to the intact arm saying move brain is getting feedback saying no it's not moving move to the front of the brain sends a command through the spinal cord into the into the real entire arm is paralyzed the art message comes back visually saying it's not moving no move no move no so the brain forms a heavy an association or link between the very attempt to move the arm and the failure to move the arm this week all learned paralysis right when you amputate the arm who's learned paralysis is carried over into the phantom so you get this state of you get this oxymoron of a phantom limb being paralyzed so then I said well can you somehow unparallel paralyzed down can you unlearn the learned paralyzed paralysis well how do you do that what have you given visual feedback all of a sudden that his arm his phantom arm is obeying his command and how do you do that it's a phantom but we said well let's use virtual reality something like that to take pick up the brain signals feed it back into the computer humor virtual virtual image of his hand and keep even false visual feedback that the arm is moving again I talked to my colleagues at Caltech and they said well you can do this it'll cost you about half a million dollars wipe out all your grants then I said well maybe you can do this in a simpler technique and I thought of using a $2 mirror so you put a mirror on the table inside a box called a mirrored box patient then puts his phantom inside the left side let's assume his left side of the phantom puts the phantom in the left side of the mirror right the shiny right side of the mirror he puts the right arm on the right side of the mirror and looks at the reflection of the right arm in the mirror so that the reflection is optically superimposed on the felt position of the phantom is that clear so the left arm is a phantom he puts it on the left side of the mirror in the box put the right hand intact right hand on the right side of the mirror and looks inside and he sees the reflection it's as though you have optically resurrected his phantom patient then chuckles the first patient I had had lost his arm ten years ago he had a brachial avulsion I almost paralyzed 11 years ago for one year it was paralyzed in cruciate any painful arm was an amputated after a year and then he had a persisting phantom limb for the last ten years which is equally paralyzed and pain persisted in the phantom limb the phantom was in an awkward position so I said I said Derek I knew every morning he gets up tries to move his phantom hoping to relieve his pain and the pain persists so Derek look inside the box look at the reflection of your arm he looked puts his arm in there and he's chuckled and he says that's funny I can see my phantom obviously he's not delusional but he says it's very hard I can actually experience my my phantom limb and I said can you move both arms as though you're conducting an orchestra or clapping or tapping or doing something symmetrical while looking in the mirror he's then going to get an illusion that the phantom left arm that was you resurrected optically is obeying his command is that clear okay she's asked him to make symmetrical movements while looking inside the mirror he's going to see the reflection of his normal hand mimicking the phantom as though the Phantom was obeying his command he said oh well doctor I can't move my right arm like I can move my right arm but I cannot move my phantom you know that I get up every morning and I try to move it it refuses to budge even an inch I said look just try it anyway pretend it's ESP it's okay and he puts it on so oh my god oh my god is unbelievable my phantom is moving I can feel it moving for the first time in my live in the last 11 years and I said and it's amazing and it feels good and I said close your eyes hope now it's fixed won't budge open your eyes oh my god oh my god is moving again this is this is astonishing so I mean I'm moving my phantom for the first time in 10 years and I said well this is Bali's and no on the contrary it feels good it relieves my cramp and it relieves my phantom pain right I said close your eyes again try again try hard he says no my real handle move my phantom move then I said okay this is good it provides evidence for my idea that visual feedback is critical and the idea of learned paralysis of the phantom limb but I'm not going to get a prize for getting somebody to move his phantom limb if you think about it's a completely useless ability but then I said well maybe sometimes the paralysis some other types of paralysis you see in Neurology like paralysis in stroke there may be a component of learned paralysis because in the early days of stroke most of what what's causing the stroke is permanent damage to the internal capsule the fibers that go from the motor cortex down to the spinal cord those fibers are damaged and you can't do anything about that but some of the paralysis may result from edema swelling of the brain for the first few weeks during the stroke and that swelling interrupts the passage of signals down the interrupt on the internal capsule temporarily causing a part of the paralysis now even when the edema goes away subsides maybe you're stuck with that component of learn paralysis so maybe that component of paralysis can be overcome using a mirror but I said well first of all this works only when there's a mirror you can't keep carrying a mirror around you what can you somehow unlearn the learn paralysis but continues using the mirror so I told Derek look why don't you take this box home 75.2 dollars take it home with you play with it every day spend about an hour every day exercising looking at your real arm moving conducting mirror mirror symmetric movements and watching your phantom move and then report back to me and I'll call you back after a week or two so I phone him after a week and I said then he sounds all excited on the phone I said what's going on said well it's very intriguing I showed my girlfriend this when I move my real on my phantom moves and it feels like it's moving it relieves the pain while I'm moving it but I've been doing this for a week when I closed my eyes it refuses to budge and it's painful I'm sorry I know you wanted to move again I said okay well c'est la vie then two weeks later he phones me he sounds all agitated on the phone I said calm down direct what's going on you're not going to believe this sir you're not going to believe this is the world The Phantom AMA had for the last 11 years it's gone it's disappear and I said he's joking he said no it disappeared and I mean an initial reaction was alarmed I said here's the chap I permanently fortified his body image what about human ethics of the human subjects approval and ethics and all of that I've permanently altered his body image as a direct does this bother you he said no none on the contrary the last three days have not had my phantom arm you know the excruciating phantom pain I had in my phantom wrist my phantom elbow and a phantom for a time I don't have an arm or an elbow so I have not had those pains in the last three days but I still have my phantom fingers dangling from my shoulder and you on your mirror box doesn't reach so can you change the design of the box they eliminated my fingers this is about five eight or nine years ago and he still has his fingers dangling premiere he's had no recurrence of the phantom no recurrence of phantom pain so I tell my physician colleagues this that this is the first example in the history of medicine for successful amputation of a phantom limb usually using a mirror now since that time this has been tested in clinical trials on I don't have data here but there's a paper published in New England Journal of Medicine about three years ago on a large group of patients about 1/3 the patient's about nine patients were given a mirror and for two weeks about half an hour a day then about eight patients were given plexiglass plate as a control placebo eight patients were given this visual imagery the eight patient's in the mirror so substantial record if in phantom pain from a pain scale of one to ten they dropped from eight to about two and the patients with the mirror of patient with visual imagery patient the plexiglass showed no recovery at all and then the patient with the plexiglass was transferred over to the mirror they show again the same recovery this is now been now being used throughout the world in pain clinics as it standard routine treatment for phantom limb pain now what about stroke remember I mentioned that maybe there's a component of stroke that mailed to be learned paralysis so I was joking about this to my postdoctoral colleague Eric Altoona who's now a physician in New York and Eric and I said let's try this mirror technique on paralysis you that you get from stroke and I said you must be joking I mean stroke paralysis cured with the mirror he said well let's try it you know it only cost two dollars said okay so he had nine patients brought in and then we tried this mirror procedure same procedure except the patient is a real arm a real paralyzed arm instead of the phantom the patient is a real paralyzed arm in this side he puts the normal and you send commands to both arms right first of all the patient is an illusion visual illusion of the paralyzed arm is moving he also has a subjective tactile senses proprioceptive sensation that the arm is moving again sometimes they go into tears saying oh my god on my arm is moving and you look at the other side of the mirror this is not actually moving and they're very disappointed but with repeated usage in the mirror question is does the arm actually start annoying now astonishingly in three out of the nine patients the arm the paralyzed arm paralysis resulting from stroke actually started moving for the first time in months in three patient there was slight movement in three patient there's nothing three prisons where we saw absolutely no movement were seen years after the stroke the patients who started recovering was seen months weeks or months after the stroke so he instituted early soon after the stroke the procedure seems to be effective now it's been done on over 40 patients by Birla and in controlled double-blind placebo-controlled trials where neither the experimenter and nor the patient nor the evaluator knew which one was the procedure and found to be effective highly effective in some patients in promoting accelerating recovery of function in a paralyzed arm and stroke and moderately effective in other patients we don't know what the reason for the variability is but some patients benefit enormously and you may say well that's only about 20% of patients who recover but considering that one sixth of mankind one sixth of humankind is taught suffer from paralysis from stroke one sixth of all of you and then you know is 20% of that one says it's pretty large number of patients now that's surprising in itself in clinical trials so now it's starting to be used in clinics throughout the world there's a third condition which I find absolutely fascinating of chronic pain chronic pain in an intact limb not in a not in a phantom limb but an intact limb there's a curious condition called reflex sympathetic dystrophy or complex regional pain syndrome type 2 which medical jargon means we don't know what it is okay CRP H 2 complex regional pain syndrome - what happens here is this in all of us in any one of us there's a trivial injury like a metacarpal bone fracture finger bone fracture there's initial pain eMobile reflex immobilization the hand is paralyzed temporarily the thing that is finalized there's swelling there is warmth this inflammation all of these changes happen in a matter of minutes or hours and that finger becomes swollen and after a few weeks healing starts in this practice starts healing the changes start reversing swelling subsides the pain subside the finger starts moving again but in about 5% of patients this does not happen the pain persists the swelling persists the paralysis process inflammation process normally does it persist it spreads to involve the entire hand and the entire arm becomes paralyzed swollen excruciating ly painful and inflamed for life for decades at a time there is no known treatment for this except sympathetic blocks sometimes helps but there are 30 great treatment that are used none of which works so we said well maybe there is such a thing as learned pain so when there is chronic pain every time the brain attempts to move our finger there's the excruciating pain the brain simply gives up into stop moving your finger so the normal process of healing and recovery failed to occur so the there's excruciating pain and you're stuck with pain and paralysis forever and with bone atrophy hair loss sweating all of these physiological changes take place itself take place in the finger and the entire hand now we said if this is true what if we put a mirror of that and by the way even the slightest touch of the pain elicits touch of the finger this is excruciating pain it's called cause algae because it order before a mirror you now he's seeing the reflection of the normal landed and he stroked and massaged the normal and so you get the visual feedback saying that the district paralyzed painful arm is being massaged with impunity for you seeing it being massaged in that you actually see in the mirror reflecting the normal line but it looks like the dystrophic painful hand is being massaged but there is no pain with the security of the learned pain similarly move your normal hand and simply attempt to move your move your disturbing and slightly it looks like your dystrophic hand is obeying is moving fine with impunity and there's no pain what if you do this short answer is this is done online patients in about half the patients is grammatical coding on the table for the first time in years or months the patient starts moving his hand again without pain this has now been done in clinical trials controlling with 50 patients 48 patients actually by a group in Germany so it's probably reliable who did this experiment and found that in about 1/3 the patients were on the mirror there's all 18 patients all 18 pages were in the mirror showed substantial decrement depend from excruciating pain 8 on a scale of 0 to 10 down to 2 - barely noticeable pain all 18 patients who are in visual imagery showed no pain should not decrease in pain in fact they showed an increase in pain all 18 patients were in a plexi lots of mirror for an increase in pain and then the people who are on mirror on the plexiglas were transferred over crossed over to the mirror they also showed the decreasing in four weeks of what one hour a day and the decrease in pain persisted at least for six months they were not followed up after six month so now you have a cure for reflex sympathetic dystrophy in a real arm that's now widely used in clinics throughout the world but there is an aspect of this that I want to especially am emphasize but before I get them I want to continue talking about reflexivity disagree let me tell you something else about phantom pain which I find extraordinary we thought we had discovered everything there is to discover about a phantom pain and as I thought I discovered everything India to discover until I observed something absolutely amazing let's assume I'm a patient in the phantom limbs with the phantom arm and I simply watch you your arm being touched guess what happens so phantom limbs have been known for about 200 years right nobody had observed this supposing I have a phantom left arm and I watch your left arm being that you're a normal person what you astonishing thing is I feel it in my phantom left arm if I stroked you the patient with the phantom left arm feels it in his phantom depending on where your stroke right why the devil would this happen okay why does it happen but it happens we think because of an extraordinary discovery made by giacomo rizzolatti and his colleagues in Parma in Italy for group of neurons in the brain called mirror neurons you will recall I mentioned that when you normally move your arm and I move my arm the front of my brain the premotor cortex and motor cortex but especially premotor cortex sends commands to my arm muscles to my finger muscles orchestrating the precise sequence of muscles which is required for reaching out and grabbing an object or pulling an object or pushing an object right these are standard garden-variety motor command neurons discovered by one mon cousin about years ago but it turns out some of these neurons in my brain this is what hurts a lot I discovered about 15% of them will fire let's say I find a neuron that fires when I reach out and grab a peanut that neuron will fire when I simply watch another person reaching out and grabbing a peanut so it's called a mirror neuron who's mirroring what you do similarly this is a neuron that's act that fires when I take a peanut and put it in my mouth that's a motor command neuron the same neuron will fire when I watch you reaching out and grabbing a peanut and when I saw this discovery I jumped off my seat because the implications are enormous it means this neuron is effectively saying what's happening in that Sam's brain is the same thing as would happen if you were to reach out and grab a peanut therefore that chap's intending to reach out and grab a peanut this neuron called a mirror neuron in my brain he's reading your intentions is constructing a theory of other minds a theory of your mind taking your vantage point towards a peanut right it's doing a virtual reality simulation of what's going on in your brain in my brain and this is the basis of what you call imitation as well they have to adopt your program tidge point your point of view in carrying our actions in the world and I have more to say about mirror neurons the next lecture tomorrow's lecture but there's also mirror neurons in the back of the brain and sensory cortex remember I told you there's a sensory map the entire body surface in the surface of the brain the Penfield map I just showed you earlier well it turns out just behind that the secondary sensory cortex is got which represents muscle twitches and proprioception joint and muscle sense and all of that but there's also a map of salts of the body body image that a part of the brain now in these regions of the brain where there's a touch map ordinarily if you touch my body servers that the right side of my brain in the postcentral gyrus a neuron will fire if you touch my elbow another neuron fires you touch my shoulder another neuropathies a complete map astonishingly 10% of these neurons will fire if I simply watch being touched right so this is almost like an empathy neuron what I was reading the signals hired up is saying but it's all the way people felt if I poke if you poke me with a needle selves in mind here is single in a new syllable fire but in 10% of these neurons will fire when somebody and I watched you being poked with a needle that my pain neuron will fire when I watched you being poked with a needle again these are the mirror neurons for touch mirror neurons with pain now that explains why okay now here's a paradox right my pain neuron some of my pain neurons are touch neurons fire when I simply watch you being poked but when I watch you being poked I don't say ouch I don't experience the pain I empathize with your pain or I empathize with the touch I know you're being touched I know that what it feels like to be touched I put myself in your shoes using my mirror neurons but I don't literally experience your touch qualia your pain qualia otherwise I'd get confused right now why is that the reason it turns out is because my skin my body surface is informing my body sending a null signal to my brain say look buddy empathize by all means but sending it but you're not being touched don't worry you're not being poked don't worry so sending a signal partially vetoing the output of the mirror neuron system say empathize by all means but don't actually feel the touch because you're not being touched you're not being poked with a needle fine don't don't worry but when you amputate my arm and have a phantom that null signal doesn't come to my brain so the neuron signaling pain signals know not so I actually start feeling the pain and touch and I simply watch you being poked or touched right so you think of what this implies it implies that these neurons are dissolving the barrier the only thing that's separating your sensory awareness and my sensory awareness is my bloody skin they remove the skin I start feeling your sensations right so I call these neurons Gandhi neurons or hyper empathy neurons because it's effectively dissolving the barrier between one mind and another mind and I'll return to this in tomorrow's lecture on it potential role in autism explaining symptoms of autism what's returning to reflect him very dystrophy I told you about the return of movements of the hand elimination of pain which is surprising itself when you use a mirror but what happens is sometimes in a matter of hours or you would dare to the swelling goes away the inflammation was we can put a thermometer the temperature changes all of these strong evidence against placebo because you can't change your own skin temperature you can't change this well you can like experience less pain as a result of suggestion placebo you can experience dressed or restoring hand movements nor the swelling or nordley swelling subsiding in or the warm the inflammation going away what's going on here well we did an experiment not long ago where we actually found no I should take that back prions kossler did an experiment in in Philadelphia where he showed if you have a dystrophic hand you can these patients have difficulty in judging the hand orientation or look this person has had a metacarpal bone practices nothing wrong with his brain metacarpal bone fracture hand finger fracture arm is swollen inflamed if he simply watches another person rotating his hand he's asked to judge what his hand is doing by mimicking with mimicking it with his other normal hand he can't do it he's very much worse at it that clue is in we found the patients with reflex indirect dystrophy pain and paralysis and inflammation and swelling in the left hand side caused by metacarpal bone fracture can no longer has difficulty in doing arithmetic can no longer name which finger is which when I point and I said which finger is this he was it at the pinky that's the index finger his problem with fingers with your fingers right what's going on here all that's happened is it's fracture to his finger ball that is the trophic changes retrograde trophic changes when all the way back along the spinal cord back to the brain into the vicinity of the region that represents his hand in the fingers post central gyrus it is not far from that is angular gyrus that's where their hand representation is of the dystrophic hand that inflammation has spread from the hand backwards to the brain about mind-body interaction and affecting the cortex there and it's spreading turns out the de fair representation of fingers the representation of the ability to calculate in your mind 15 you take a patient with dyscalculia damage to the inferior parietal lobule to the angular gyrus to the left hemisphere you ask him what is 17 minus 3 because oh it's 11 ask him to play chess with the employed chess with you discuss politics he'll discuss politics to recite a poem you'll reside upon quite normal in every other respect subtract 3 from 17 uses 11 subtract 1 from 21 you'll say 18 profound is carefully it may not be a consonant according to MacDonald Creech Lee and other people who describe this may not be according to these people also have difficulty with fingers naming fingers because how do you learn to count in childhood you use your fingers to learn to come so these are closely linked in the brain not just functionally but structurally and recite an adjacent areas so when that's damaged angular gyrus is damaged you get discal killya and you get finger agnosia astonishing thing is we find that a patient with damage to the metacarpal bone and swelling and blooming land has Gerstmann syndrome components response syndrome has dyscalculia that's finger aggressive this is early days we've only seen this in two patients so take it with a generous pinch of pinch of salt everything I've told you earlier is all being repeated many times so it's old but this one is a brand new finally I'm just telling you discovered about couple of months ago so now everything I've told you so far is learning tell you about the rubber hand illusion is that time what what would what time is it okay okay we've talked about the extraordinary before I go to this now think of the implications of all this RSD using mirrors to create artists day and producing brain changes because of damage to the bone using mirrors that click phantom limbs stroke and all of that extraordinary implication is the following now when I was a student and almost every medical student every psychology student every neuroscience students thought these are the brain works sensory information comes in to the brain there are sensory modules color motion shape there are different modules performing different computations like a digital computer admittedly this is a caricature but something along these lines is we are all time module is very specialized for one function and its autonomous relatively functioning autonomously from other brain modules it's specialized for one one function and it's hardwired at birth by genes then the information comes in and computes some aspect to the information makes explicit some aspect of information send it to the next stage in processing to another module which then make some aspect of information explicit then sends it to the next module the sort of serial hierarchical bucket-brigade model of vision sensory processing well it's false it's wrong that's not what's going on what these experiments are telling you is at each stage in sensory processing there's a partial processing and a partial solution sent sent back to the earlier stage to bias the processing release rate and this progressive was tremendous interaction during the so-called brain modules in this case between vision and proprioception like the mirror visual feedback technique relieving pain in a dystrophic hand or in a phantom hand each module is extraordinarily malleable so these so-called modules are actually in a state of dynamic equilibrium with the sensory information that's coming in instead of being hardwired at birth so the modules talk to each other the modules are not hardwired they talk to the environment the interact will be influenced by the environments coming in they're in equilibrium with the skin and bones I talked about mind-body interaction and they're in equilibrium with other brains through the mirror neurons this is a completely different from picture of the brain function and what we learn in textbooks now admittedly you know one overstate this there is division of labor in the brain especially in the early stages of processing there's an area for motion processing called MT for color pricing called v4 once you get past the early sensory regions all hell breaks loose now let me tell you one last thing we thought we had studied all the bizarre syndromes that aren't the study then we came across another syndrome which I've studied extensively with Palma gear and David and dr. McGill was a former postdoc of mine he's now I think should be here in the audience somewhere so we studied this extraordinary syndrome called TR converse of phantom limbs teleport terminal philia where a patient phantom limb patient when you remove the arm continues to feel the presence of their arm patient with a potent aphelion once his arm remove once his arm amputated this is not that rare but very few people have heard of it but if you clinician the head of it here's a person who's completely normal in every respect who wants his healthy arm amputated they're all alters were crazy Freudian theories to explain this one theory is that this chap wants attention this is nonsense we want attention why would you want an arm remote why not have his ear remote or something more in our cause it seems a rather drastic measure to have you have attention drawn to you another theory is you want your arm removed to create a huge big amputation stump which resembles a big penis and I'm not making this up you see it in psychiatry textbooks the most absurd thing I've ever heard so when I was looking at the charts again one of the things I noticed is that it's much more common to want your left arm amputated than your right arm this suggests it's a neurological basis secondly not necessarily procedures is a neurological basis because we know the body image is constructed in the right hemisphere there's a disease called miss Oakley Jia where patient starts developing Boren's for the left arm you get in right parietal brain disease stroke affecting the right parietal was the disease called Samara para free Nia where the patient has stroke affecting the right parietal patient denies ownership of the left arm so the shades of similarity between this disorder called Samara perineum which you see in right hemisphere stroke and this disorder called put him in fili of a patient wants his left arm amputated the other clue that came from plugging in or leaking learn a lot from just talking to the patient another clue that came from the patient is patient himself volunteer Lisa he took a felt pen and drew a line an exact precise line where the one with amputation he says he doesn't want it one inch below that one inch above that and by the way about one third to have these patients go on to get themselves amputated it's not legal in the United States an amputated healthy limp you can go to Mexico you can go to Canada get an amputee can get an elective amputation so it's not just some strange psychological compulsion the actually going to serious clinical problem now by the way I want to emphasize the people who want this amputation done don't regard it as a clinical problem they regarded as something desirable pleasurable and in fact after have their amputation have vast majority is about happier they said there's a weight lifted off their back the depleted relieve the depression they feel comfortable and happy they don't like being told is something wrong with your brain Samantha it's all relative rule so the question is what's changed in their brain first of all how do you know it's even real how do you know they're not making it up maybe the Freudians are right well one of the other things if you talk to the Pyrenees I asked envision do you feel like the arm feels alien and bother when they get it amputated sometimes they say the surgeon has left one inch too short too long so you should really tight it so it gets it perfectly on their line so the exact line is important so as a patient who could draw the line now this is the case of the arm field of the alien it doesn't feel like it's part of your body image no no that's not true it feels very much like part of my body it feels like it's too much a part of my body it feels intrusive that's why I want to get rid of it but that gave me the clue that gave Paul and me the clue but what might be going on he feels is intrusive the first thing we did was we did a test called galvanic skin response if I poked you with a needle what happens is the message goes to the thalamus and it goes to this cortical insula then goes to the amygdala but you've sent it you've sense the pain then it cascades down the autonomic nervous system you start sweating and it's a good test of whether you how much you're experiencing pain when I poke you the needle the more direct has been asking you do you feel pain is that unpleasant if I touch you you won't get a galvanic skin response galvanic skin response simply measures put two electrodes in your palm and measures the sweating in your skin when you watch a horrible violence seen on the television screen or if I poke you the needle somewhere you get a huge big galvanic skin response measuring the change in skin resistance it is the basis of the lie-detector test when you say something and you're lying to somebody also get a galvanic skin response any emotion emotional turmoil or change produces changing changes in your sweating but you cannot avoid which you cannot block which is why it's used as a lie detector test so we put this galvanic you put the electrodes on his palm on his other palm measure his galvanic skin response of course normally it's no response then you poke him with a needle on a soldier there's a huge big jolt in galvanic skin response we just touched his arm touched his shoulder there's no galvanic skin response we touched his arm above the line where he wanted his amputation there is no galvanic skin response we touched his arm below their line there's a huge jolt he says unpleasantly you Jule you can't make make this up you can't create a false galvanic skin response that told us he's not making this up remove these q-tip mu this move the stick above the line where he wants amputation and touch him there is no sweating there's no galvanic skin response if you move it below the line he starts sweating this again and instantly this shows us the genuine physiological phenomenon simple experiment took half an hour to do now the next question is you can do brain imaging experiments called thousands of dollars but we did that we went to the body image center in the brain first thing we said is look maybe this chap does not have a representation of the arm in his man I told you earlier about the somatosensory cortex vertical strip there which has representation of the body skin surface muscles and joints as to and I said maybe that region of the map body map is missing the arm so the arm feels alien but that doesn't explain why he says no it doesn't feel anything feels intrusive but we thought would test it anyway he went and recorded signals from that you magnet encephalography we found is perfectly normal the arm is represented there no problem she said there goes our theory that this is not represented right then we went further back to the inferior parietal lobule there and superior parietal lobule those regions of the parietal lobes is it further back further back here sitting at the crossroads between somatosensory input from the skin surface and joints and muscles hearing from the temporal lobes vision from the occipital lobes combines all of this to create your body image when I close my eyes vivid sense of my different body part my fingers my arm my body that's created in the inferior player in the superior and inferior parietal lobule in the actually in the right hemisphere not in the left hemisphere but in the other side I don't have a picture of that and we found that the sensation that represented fine the postcentral gyrus completely normal but when you get to the superior parietal lobule the body image center which combined signals from different sensory input sensory inputs to construct a poly model poly sensory body image that internally constructed body mean is missing that harm congenitally probably therefore what happens is when you touch this chaps arm but when you and when you're not touching him when he's moving some signals are coming in prey into the brain they are normal they're being picked up by the post central gyrus normal signals are being activated normally but there is no place for the signals to go - it goes here this is whoops there's nothing there this creates a discrepancy in the brain which the brain abhors the brain abhors discrepancy in it therefore sends a signal to the insular cortex which detects discrepancies in signals and sends alarm bells ringing and you start sweating new tax plan so you've got to figure out the whole thing that's the reason you get a portal aphelion again let me add a note of caution everything I told in the first 90% of my talk by phantom limbs stroke reflex injury dystrophy RSD and all of that we're on sure grounds been replicated hundreds of times this is only reported by our group the gear Brian and I on three patients I believe it needs to be replicated before you believe it but we think it's right the last thing I want to tell you about can I tell everyone one last experiment okay he's the rubber hand illusion forget about patience let's look at normal people any eating student volunteer you have a student volunteer standing here putting his hand here and then what you do is you put a partition so I'm the volunteer I'm the student and he put the hand here and I put a partition here so I cannot see my own hand the student volunteer cannot see his own hand is that clear I put a partition I can position any way I want and I just put a partition so he cannot see his own hand then I put a dummy hand from Halloween shop in front of the partition so he can see the dummy hand in front of the partridges it's discovered by Botwin he can : so if I'm the volunteer I cannot see my own tree and so let me let's talk about the volunteer he cannot see his own real name but he sees a plastic dummy hand in front of the partition and I the experimenter go and I tap tap-tap stroke stroke tap tap stroke stroke tap tap stroke stroke stroke stroke stroke stroke stroke stroke tap tap random sequence of strokes and taps applied to the dummy hand which is watching and simultaneously in perfect synchrony using my other hand I applied to his real hidden hand so I do this he's watching the dummy ham being stroke stroke tap tap stroke stroke stroke stroke nap time well I'm tapping his hidden left hand so he sees the dummy hand being strapped have been stroked in random sequence and he feels his own left hand but he can't see it being told inscribed in precisely the sentiment what happens in about a minute or less he starts feeling the sensations his tactile sensation emerging from the dummy rubber hand as though you were stroking and tapping the dummy rubber hand his sensations were emerging from damier ebene why because of Bayesian logic of all perception the brain says the brain is essentially a machine for detecting statistical correlations the sensory input it's saying I can't see my left hand but I'm feeling touches and strokes and in my left hand I'm simultaneously seeing this dummy being touched and struggling tap in precisely the same sequence how can that be a coincidence therefore I am being stroked and tapped captain touched in that dummy hand so only solution that break makes sense of the brain we did this experiment a variation of this almost at the same time I should say we discovered it independently but we use the table instead of a hand is even more astonishing you don't need a WM dummy hand okay you have the patient not the patient the student volunteer put his left hand here and simply watch the table he can't see his own left hand and I come along and I tap tap stroke stroke tap tap stroke stroke his hidden left hand which he cannot see he's seen me tap and stroke the table in precise synchrony guess what happens in about a minute or two he feels his sensations emerging from the table okay now think of the extraordinary implications of that and I'll conclude the lecture so much so that I can approach menacingly with a hammer and approach the table and do that and he pulls his hand away or I can make his galvanic skin response measure the government scan as I approach the table and he gets a huge jolt in his galvanic skin response showing that the table is now hooked up to his amygdala and those limbic system in producing he's sweating when I'm threatening the table basically right the table has now been assimilated into his body image now think of the extraordinary implications of this by the way the control is if you simply throw them the table without doing this without doing the cutting and stroking there is no galvanic skin response that's an obvious control so only after you have started identifying at the table from the table you get a galvanic skin response think of the implicating you will go around the world we started this lecture with the concept of the self what do you mean by itself in many aspects of the self is it itself as a bank account it has a name there's a birth certificate it has a mother it has a father now all of these things you can question maybe your name you got it wrong maybe your passport is a fake passport and maybe you and your mother's not your real man suddenly your father may not be a real father in England tone in Scotland to one out of ten people your father is not your real father so all of these assumptions about yourself that you carry around can be questioned call into question but if there's any one assumption it is an axiomatic foundation of your existence if the fact that you exist in your body this is your body when it dies you prepare for its funeral right there's nobody can question this being a body but in about one minute I can make you think this table is part of your body not in some abstract philosophical sense but quite literally to them so now you're to prepare for its funeral its future right so this shows how tenuous your sense of self really is so what am I let me conclude by saying all these questions that until recently been the province of philosophers what is the nature of the self what brings about the unity of sensory impressions what allows you to construct your body image and what what court is metaphor what is articles you talked about yesterday which until recently were the province of philosophy and they haven't made any progress in 2,000 years part of empowering me but I'm a closeted philosopher I love philosophy and have great respect for them but but I think that some of these questions we can now begin to understand empirically by doing the right experiments the right patience thank you very much thank you very much Lee there was an up to Lee brilliant lecture I could imagine that your research funders actually are delighted that you can produce such brilliant research and it only costs a $2.00 glass box earth mirror box are indeed a dummy hand from Halloween but we have time for some questions Thank You professor Reich and repose have such a fascinating lecture could I ask you in view of our capacity for empathy and and the fact of mirror neurons and so on how is it do you think that anybody is capable of carrying out torture this week well it's a good question they don't have mirror neurons you put that I'm not trivializing your question but certainly that people people people have suggested that sociopathic individuals may owe an impoverished mirror neuron system no direct proof of this so they have less empathy and then the intellectual factors kick in they say well if I can gain something by killing the sapper doing something nasty to him and why not do it right all you have to start invoking now this of course that leads to profound philosophical questions within man or in humans they're both propensity mirror neurons are telling you to be ethical to be kind considerate and all of that but there's also the animal side of you that the dr. Jekyll side of you oh no mr. Hyde side of you what is a conflict then you invoke county and moral imperative and all that so these philosophers philosophical questions inevitably arise when you did doing your holiday maybe that's what you had in mind thank you it's a good question but no simple answer wonder to what extent that say the case of the rubber hand illusion is a bit of a theatrical device if I had known what you were up to then I would restrain my hand from moving but the thing that we actually interests me is this business of a appetit me know a predominantly Mithila yes and this is this notion that you might want to get rid of your left hand now I wonder what sort of people our guy I see this is some sort of neurological disorder now wonder why maybe behind the medical people in Canada are or Mexico well advise the patient and mortal groans that this was a disorder and they shouldn't ambu amputate the arm but I just wonder what sort of people with desires for example with a concert pianist want to get rid of one arm especially since his job particularly needs both arms or indeed he'd want you wouldn't want to get rid of his his left arm because most piano concertos you know for one arm only written for the left arm so I just wonder what sort of people really have this of disorder it can be defined in terms of their job their lifestyle or well the fact they may need two hours or perhaps don't it's a good question do they have any personality characteristics or jobs they hold now we have been focusing primarily in the neurology to see if there's any change in the brain and not so much on the psychodynamic factors but they do play a role unfortunately we don't have a large enough number of their own see patients individuals by their own regardless is abnormal but you have we haven't seen a large enough number of individuals to study those variables I know the surgeon surgeon or tours have this condition when there are berman suddenly need two hands to the surgery months after surgery but they did they had it done when they retired right so common sense would dictate it to rely more on their hands the most like more likely less likely to actually get it amputated but beyond saying they are saying something obvious like that I don't have any insights hasn't really been studied in detail enough how you talking about metaphors before and I was wondering whether your work of metaphors drew on the work of linguists mark the coffin George Kaufman Mark Johnson do you know the book metaphors for you yes yes it's not real it rolls on right because you talk about embodiment on our moon absolutely it certainly yeah I would say that Marwar compliment is work very nicely especially the work I spoke talking about yesterday on synesthesia okay so how do you develop that work which even begun by linguists I'm not sure looks very promising but exactly how to proceed I'm not sure okay I'm getting my question very back I the way that I think I would feel while you were conducting those experiments makes me think of the way I would feel if I were just associating and I wonder if you think that there's a big connection between the two and how when people do dissociate in the psychological term a sense of the word you're talking about you feel that I am dissociating or the patients at dissociative but when the patient does suceeds okay and feels as if they were yes then shade the dissociation here but it's a unfortunately the solution is used as a catch-all phrase then we want to get it get to a deeper level of precision than that for example people have said the potent and feely acts an element of dissociation there but I think it's sort of what matter is to call an analgesic explanation dulls the ache of incomprehension without removing the cause I mean I'm not answering your question but you're asking what is the similarity between dissociative States and these specific syndromes that I study certainly there's no decision within phantom limbs certainly not in jello syndrome I discussed stroke Paul do you have any answer to that it doesn't happen an opportunity via either prof thank you very much for that I talk I'm I'm an anesthetist I have a specific question is there anything we could do very operatively to reduce the incidence of these chronic pain very good photos it's been claimed back and forth claims and counterclaims that phantom pain very often you see the patient has a pre-existing pain in the real arm that pain is claimed carries over into the phantom we've seen many examples of that so I believe that claim the question is if you have a pre amputation pain chronic pre amputation pain in the arm if you put an anesthetic or something to reduce the pain people have done it for as long as 12 hours in Canada reduce the pain by using a catheter for example in the spinal canal you do that for about 12 hours then it's claimed you do the amputation after that then then the incidence of phantom pain is substantially less but other people have repeated it and claimed not to find it you should try it important clinically is important yes hi um I had a an AVM which caused B to have a stroke occurred a year and a half a year and a half an AVM yeah it bled and then I had a stroke yeah um and anyway so recovered quite well but I still have a numb hand and I can feel hot and cold but it's really numbs I can't get the key keys out of my pocket wherever and I was wondering that looking at your mirror box thing just in case you've tried this or you I don't know what you would think and but when you were long ago was your area a year and a half okay I don't why I breath I spent tonight okay it's my reward you should pride it doesn't cost anything on it you know I have it wrong okay and but I sort of I'd already started moving it a bit and anyway I used it a bit but I was wondering do you think and because I can't get the sensation back but maybe if I try to hold so you hold something in my good arm and using the mirror book do you think that would have do you think that there's any kind of possibility that that would I could try and get the sensation that by yeah there have been reports of that the sensation to combine what Dory's them nervous d'oeuvres people are using the meta box now astonishing thing is after stroke is not merely the motor functions they've come back with some of the sensory functions also returned in some patients not knowledge yeah so I persisted isn't here you might well I hadn't thought of it until so now I'm slightly excited I might go home and juggle with me I'll tell you the bill there's a question here and there's another one down here but this gentle with the back hello ed and a lot of your that the theories that you have around the development of phantom limb pain and continuation of phantom limb pain it seems to be very much influenced by visual feedback correct so given that I'm just wondering how would you account for the the similar symptoms and syndromes that yet with patients with lower limb amputations it obviously we don't usually have such strong visual feedback from the lower limb well not much research has been done with mirrors in Lordran but the mirror procedure works quite quite well as laudanum as well for our SDM for stroke and for phantom pain maybe not as well but we do have a you know it's not as vivid as with your hands but we do have a visual image if you'd like to in fact you can show this by using a magnifying lens and minifying lens and look at your leg and start walking you start wobbling it out so if you change the input what what you're used to seeing certain Heights and length you change that you get disoriented and unstable this means ordinarily you are using a lot of visual input from your leg much more so than you realize not as much as your hands but what you think the implications are of your research for a noodle neurologically impaired developing brain well I think it's extraordinary implication because very saying even an adult brain which assume that the connections are fixed in fact they are not fixed model like model of the brain I gave you about fluctuating equilibrium between different so-called modules modules interacting with your skin and problems with each other with other people for the infant brain is will be even more true they extend the malleability this tons of evidence showing I know that it's just trying to get people to em I think I appreciate that when we're still in that kind of medical model of trying to fix things but the sense in sensory input and how you influence that you would agree that that's you're kind of mean we end to the noodle plasticity oh yeah absolutely thank you that's great you mean ID please it's really back to the question about the threat your half million dollar grant and how you overcome that with a $2.00 box but we do have virtual reality systems we have our movie called avatar which is about the projection of the self do you see a role for these advanced virtual reality systems in training people to overcome urological problems I do indeed and people are inspired by the mirror partly who started introducing virtual reality because you see what the mirror you can't apply for a grant it's too cheap perfect but you say you're going to use a virtual reality is we can ask for a lot of money so people bring secondly there is a genuine rationale which is the fact that if you have bilateral amputation or bilateral paralysis you can't use a mirror so in those few cases we obviously have to use what your reality I'm sure enough people are using it just a very simple question obviously the brain is vulnerable and as you get older what advice would you give to a person to keep the brain working well the surround yourself with stimulating passionate interesting people and then fall in love again just surround yourself with interesting passionate people and fall in love all over again I was just being frivolous it's what I mean I'm half serious question okay tell me I'm going out on a bit of a limb here excuse the pun but um I was wondering whether you've drawn or considered any link between kind of rain oh sorry okay I um between kind of this kind of sense of embodiment and for instance I've heard some apes and humans included can also come to so experienced sort of tools and things like that's part of their bodies I wonder if though it might even be a neurological link between that and kind of our sense of what's ours like property and things like that and whether you consider this area this concept of extended ownership extending your body image to include tables and rubber hands can you think any then talk about ownership in general of very real estate and money and all of that is it is an extended version of the same sort of principle that's what you're asking it could be but it's a question ISM is just a pun or a metaphor or is it really using the same brain system certainly a blind man using a cane comes to mind when you're talking about these illusions of this kind so but practical question sir and I think I have a similar question to what you just asked the previous person and I wanted to know that if the ideas of like the rubber hand illusion and like and also to some extent mirror neurons do you think they provide some kind of an empirical support for like David Chalmers idea of the extent in mind that are there are their consciousness like our self-awareness is not just our own agency but it's like across objects and other people and like all it certainly supports the idea there's no crisp boundary between you and other people but in terms of thing he goes much further in basically the ability and pound psychism I think yeah which I don't I think that are generally emergent phenomenon which are associated with quality and consciousness but at the same time I don't think they're linked to specific brains the notion of location in place may not apply to a phenomenon like consciousness and qualia but that's going much further into speculation than our but then it is the Atari shape times time passes you got a device called a clock that measured the passage of time but in fact time is not located in the clock so likewise it could be that your brains are unknown as it's an antenna to consciousness but it's not consciousness not localized in the brain this gets it as guesses into a philosophical debate which is not my profession is it gentlemen here hello it may be a silly question but if you have our surgeon operating on your right hand could you use the mirror technique on the left hand to juice anesthesia in the right hand I'm sorry could you repeat that you're operating on your right hand I'm placing in the right hand could you do the middle tiny on the left hand to induce anesthesia in the right hand so oh I see what you're saying so you touch them stroke it in a way that feels like it's an STI mr. Tice would it then make it actually understated in a way yes I don't I don't know the initial ability to try to see but even changes the pain threshold slightly yeah I think you're asking an extreme version of that I'll be proven good question right Susan yes please I was interested in the link you were making between the things going on in brain regions to do with integration between the regions and that very specific phenomenon you were talking about of empathy as a tool for our interactions with other human beings and cooperation in that sort of thing so what I would like to know is human beings have clearly evolved ways of managing the tension between selfish behavior get more for me and cooperation let's all work together for the common good etc etc to put it crudely in that in that way do you see that that is being something that neuroscience needs to address the actual neural substrate of the evolved functionalities of our brain in relation to what when we're in neurons are there to do absolutely I think you do need an ecological perspective and mirror neurons by the very nature you're talking about interaction imitation is very much a part part of culture and learning skills from your parents and from peers and all of that so by the very nature meaning rich understanding of ethology and social behavior I'm just to fully understand with a mirror neurons a drink that's a slightly vague answer but something along those line I think we've got time for two more questions and we've got microphone here and the microphone here great pups beginning over here hi I realize this is very less a research that what you were talking about in reference to the amputation I know is body identity integrity disorder I was wondering if you put any sway on psychosocial implications perhaps carving certain neural pathways like some sort of trauma early in life um no it's a very good question but I can't address it right about 100 years ago somebody wrote a small book you can get it on the internet called the most annoying things in life and one of them was this phenomenon of the mist step thinking you were taking a step that wasn't there or not taking a step be careful that was there you mean metaphorically are literally well literally you know it can happen in your dreams too it's extraordinary feeling of yes there being what's happening there well I think it shows you how much perception is top-down that even you and even if you have a regular staircase by the way the distances are a constant and if you've changed one step slightly by half an inch you stumble and fall which means that you your brain has built-in knowledge about exactly how far you need to step down and perception is ridden through and through by top-down influences it's not a pass against not a pass of one way flow of information from sensorium into the higher brain centers but I I think we've actually must have told you out there were so many questions of our half-an-hour and we're very very grateful to you for for answering them all and especially for your for your lecture can I remind people that there is no lecture tomorrow but on Wednesday the topic is molecules neurons and morality same time same place but can we all thank you very much indeed you

Channel: University of Glasgow

Views: 156,871

Rating: 4.8928366 out of 5

Keywords: Ramachandran, VS Ramachandran, Neuroscientist, Psychology, mental habits, Vilayanur, neuroscience, brain, damage, neurology, mirror neurons, Rama

Id: kcR8-Sq8dZk

Length: 85min 14sec (5114 seconds)

Published: Thu Apr 25 2013