Assignment Answers Pdf Of Cortical Remapping Process:MKG102

Running head: CORTICAL REORGANIZATION
CORTICAL REORGANIZATION
Name of the Student
Name of the University
Author Note
CORTICAL REORGANIZATION 1
In …

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Running head: CORTICAL REORGANIZATION
CORTICAL REORGANIZATION
Name of the Student
Name of the University
Author Note
CORTICAL REORGANIZATION 1
Introduction
The cortical reorganization also known as cortical remapping is aprocess that helps in
explaining how the already present cortical map is affected due to astimulus thereby leading
to the formation of another cortical map (Breedlove and Watson 2019). It should be noted
that all parts of the body are somehow connected to one or the other part of the brain which
leads to the formation of acortical map. As stated by the hypothesis of cortical reorganization,
the cross-modal responses of the brain are interceded by the creation pertaining to new
pathways in the part of the brain that has been deprived of senses (Breedlove and Watson
2019). Hence, the primary aim of the essay is to discuss the theory of cortical reorganization
and how ithelps in explaining phantom pain.
Discussion
Cortical reorganization is also referred to as the ability of the brain to again reorganize
itself through the formation of neural connections that are based on factors like the
experiences of every individual, environment as well as lifestyle (Collins et al 2018). Studies
and research have shown that adult central nervous system has the ability to develop to
adaptive changes as well as substantial cortical reorganizations that might trigger recovery
function (Collins et al 2018). Studies conducted in animals, as well as humans, have
successfully shown how damage pertaining to the central nervous system leads to cortical
reorganization which often depends on the aspects like age, rehabilitative training, along with
the location of the injury (Richardson et al 2018).
It has been reported that plasticity which is considered to be the capability of the
central nervous system to adapt to the requirements of the new environment as well as lesions
through functional changes within the synapses tends to occur at the cortical as well as the
subcortical levels pertaining to the neuroaxis (Richardson et al 2018).
CORTICAL REORGANIZATION 2
Phantom pain is mostly described as pain which makes individuals feel like the pain
is originating from apart of the body that no longer exists. Doctors initially believed that this
phenomenon of post-amputation was considered to be a psychological phenomenon, but it
has now been claimed as areal sensation that tends to originate from the spinal cord and the
brain. In other words, it should be noted that after an amputation, patients tend to experience
sensations that tend to emanate from the lower part of their body (Fleischer et al 2019). This
effect has been most commonly defined as phantom pain or sensation.
For most amputee patients, phantom pain shows only mild distractions, however, in
some cases the sensations tend to become intense as well as painful for the patient. These
types of pain either occur simultaneously or might be influenced by environmental changes
or stimulation which occurs from the body itself (Fleischer et al 2019).
Fang et al (2020), state that the reason behind the above sensation of phantom pain
can be effectively explained with the theory of cortical reorganization. It should be noted that
when an incident occurs that tends to disrupt the cortical maps like an amputation or achange
that takes place in the neuronal characteristics, then the map no longer tends to be relevant.
The part of the brain which is responsible for amputated change as well as neuronal change
becomes dominated by the cortical regions that are adjacently located which still tend to
receive input thereby resulting in the creation of a remapped area that tends to give pain
sensations from the part of the body which is not there or has been removed (Fang et al.,
2020).
Experts believe that phantom pain mostly results due to mix-ups in nervous system
signals, especially between the spinal cord as well as the brain. It should be noted that when a
body part has been amputated then the connections of the nerve starting from the periphery
and extending to the brain have atendency to remain in place (Nardone et al 2019). There
CORTICAL REORGANIZATION 3
have been several research, along with neurophysiological as well as neuroimaging studies
that have shown the association between cortical reorganization and limb amputation and
have also stated the consequences pertaining to the reorganization which is connected to
phantom limb pain (Nardone et al 2019).
Amputations are one of the reasons often leading to reorganization within the motor
cortex. Due to an absence of inhibitory activity within the pathways of sensory cortical
feedback then as a result of amputations, the activity results in continual efferent motor
cortical directions because of heightened cortical excitability (Dumanian et al 2019). Thus,
from the above explanation, it can be said that cortical differentiation, as well as lack of
inhibitory activity, might have an impact on phantom pain, however, this requires further
elucidation (Dumanian et al 2019).
It should be noted that Th øgersen et al (2020) state that there has been no definite
understanding regarding why and how the amputation, as well as subsequent cortical
reorganization, is related to the aspect of phantom pain since several transcranial magnetic
stimulations have shown no relationship in the pain intensity and shift in the cortical map.
Though some changes in the cortical representations of neighbouring regions have been
observed there have been the same mixed results (Th øgersen et al 2020).
On the contrary, Andoh et al (2018), in their article have stated that transcranial
magnetic stimulation or TNS measurements pertaining to the motor cortex help in clarifying
the aspect of adiscrepancy pertaining to cortical reorganization after amputation and thereby
help in defining the types of neural connection of phantom limb pain.
Thus, the author, in his article states that sometimes pain in itself can cause or might
lead to reorganization of motor context, this is because of several change patterns in the
CORTICAL REORGANIZATION 4
motor cortex as well as somatosensory cortex that have been experienced by patients going
through phantom limb pain (Andoh et al 2018).
Unlike the authors mentioned above, Zheng et al (2021), have tried to focus and give
an emphasis on the function of cortical reorganizations to explain phantom pain, where it has
been stated in the article that amputees tend to demonstrate massive cortical reorganization
and further demonstrates astrong relationship between plastic changes along with the sum of
chronic phantom pain.
It has been stated in the article that patients who tend to undergo an amputation are
more likely to have along-lasting impact on the hyperexcitability of nociceptive pathways,
and it is this hyperexcitability that tends to contribute to the transmission of mislocalization
of signals that originates from neighbouring and diffusing projecting pathways that are
commonly associated with the reorganization (Zheng et al 2021).
It cannot be denied that pain has several extensive bilateral projections, the
connection of nociceptive afferents then helps in explaining why the referred sensation had
been elicited due to the painful contralateral stimuli along with ipsilateral pertaining to an
amputation (Makin and Flor 2020). Thus, this phenomenon helps in explaining how cortical
reorganizations can effectively explain the aspect of phantom pain.
Apart from this, the fMRI studies have shown a link between the intensity or a
presence pertaining to phantom limb pain with alterations in cortical reorganization through
sensory representations as well as motor maps present in humans (Makin and Flor 2020). The
fMRI studies have shown that when there is an expansion or ashift in the representation of
lip to amputated hand area then it has been correlated with higher levels of pain, which
results in higher cortical remapping and intense pain (Duarte et al 2020).
CORTICAL REORGANIZATION 5
It is stated that phantom pain present in amputees of the upper limb tends to be self-
regulating of cortical remapping that has been linked with the increased inputs in the zone of
the cortical representation pertaining to amputated limb (Duarte et al 2020).
Thus, in the above cases, local activity, as well as structural integrity, might be
leading to greater pain intensity. There are different techniques for imaging analysis along
with experimental protocols that can be the reason behind mixed findings which have to be
considered while evaluating literature (Modest et al 2020). It should be noted that transcranial
magnetic stimulation and the MRI studies have shown shifts in the network connections
which will help in facilitating cortical reorganization that can be the reason behind phantom
limb pain (Modest et al 2020). However, frequent reorganization can result in the unmasking
of the synaptic connection because of the absence of inhibition that is clearly associated or
linked to the pain intensity.
Gunduz et al (2020), state that cortical reorganization tends to provide insight into
underlying mechanisms of phantom limb pain. Understanding the mechanisms of central
reorganizations will help in explaining modulation for potential pain effects pertaining to the
techniques of neuromodulation like the brain stimulations that are non-invasive (Gunduz et al
2020).
The author, unlike the authors of another article, states that the modulation pertaining
to the plasticity of sensory-motor through the non-invasive stimulation of the brain, like the
current transcranial stimulation which takes place directly, plays an essential role in
optimizing rehabilitation as well as managing pain in patients who have undergone
amputation (Gunduz et al 2020).
However, it should be noted that the function of somatosensory cortex, as well as the
reorganization which occurs after amputation, is still difficult to be understood, hence, further
CORTICAL REORGANIZATION 6
studies need to be done by making use of more than one measurement of reorganization that
will help in elucidating the research on the above area (Pacheco et al 2020).
Conclusion
Thus, to conclude it should be noted that the theory of cortical reorganization will
help in effectively explaining the aspects of phantom pain. The above discussions have
clearly highlighted how cortical reorganizations can help in explaining and determining
phantom pain in patients.
CORTICAL REORGANIZATION 7
References
Andoh, J., Milde, C., Tsao, J.W. and Flor, H., 2018. Cortical plasticity as abasis of phantom
limb pain: Fact or fiction?. Neuroscience, 387, pp.85-91.
Breedlove, S. M., and Watson, N.V. 2019. Behavioral Neuroscience. (9th ed.). Oxford
University Press
Collins, K.L., Russell, H.G., Schumacher, P.J., Robinson-Freeman, K.E., O’Conor, E.C.,
Gibney, K.D., Yambem, O., Dykes, R.W., Waters, R.S. and Tsao, J.W., 2018. A review of
current theories and treatments for phantom limb pain. The Journal of clinical
investigation, 128(6), pp.2168-2176.
Duarte, D., Bauer, C.C.C., Pinto, C.B., Velez, F.S., Estudillo-Guerra, M.A., Pacheco-Barrios,
K., Gunduz, M.E., Crandell, D., Merabet, L. and Fregni, F., 2020. Cortical plasticity in
phantom limb pain: A fMRI study on the neural correlates of behavioral clinical
manifestations. Psychiatry Research: Neuroimaging, 304, p.111151.
Dumanian, G.A., Potter, B.K., Mioton, L.M., Ko, J.H., Cheesborough, J.E., Souza, J.M., Ertl,
W.J., Tintle, S.M., Nanos, G.P., Valerio, I.L. and Kuiken, T.A., 2019. Targeted muscle
reinnervation treats neuroma and phantom pain in major limb amputees: a randomized
clinical trial. Annals of surgery, 270(2), pp.238-246.
Fang, F., Potter, T., Nguyen, T. and Zhang, Y., 2020. Dynamic reorganization of the cortical
functional brain network in affective processing and cognitive reappraisal. International
Journal of Neural Systems, 30(10), p.2050051.
Fleischer, V., Koirala, N., Droby, A., Gracien, R.M., Deichmann, R., Ziemann, U., Meuth,
S.G., Muthuraman, M., Zipp, F. and Groppa, S., 2019. Longitudinal cortical network
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reorganization in early relapsing –remitting multiple sclerosis. Therapeutic advances in
neurological disorders, 12, p.1756286419838673.
Gunduz, M.E., Pinto, C.B., Saleh Velez, F.G., Duarte, D., Pacheco-Barrios, K., Lopes, F. and
Fregni, F., 2020. Motor cortex reorganization in limb amputation: a systematic review of
TMS motor mapping studies. Frontiers in neuroscience, 14, p.314.
Makin, T.R. and Flor, H., 2020. Brain (re) organisation following amputation: Implications
for phantom limb pain. NeuroImage, 218, p.116943.
Modest, J.M., Raducha, J.E., Testa, E.J. and Eberson, C.P., 2020. Management of post-
amputation pain. Rhode Island medical journal, 103(4), pp.19-22.
Nardone, R., Versace, V., Sebastianelli, L., Brigo, F., Christova, M., Scarano, G.I., Saltuari,
L., Trinka, E., Hauer, L. and Sellner, J., 2019. Transcranial magnetic stimulation in subjects
with phantom pain and non-painful phantom sensations: asystematic review. Brain research
bulletin, 148, pp.1-9.
Pacheco-Barrios, K., Pinto, C.B., Velez, F.S., Duarte, D., Gunduz, M.E., Simis, M.,
Gianlorenco, A.L., Barouh, J.L., Crandell, D., Guidetti, M. and Battistella, L., 2020.
Structural and functional motor cortex asymmetry in unilateral lower limb amputation with
phantom limb pain. Clinical Neurophysiology, 131(10), pp.2375-2382.
Richardson, C., Olleveant, N., Crawford, K. and Kulkarni, J., 2018. Exploring the role of
cortical reorganization in postamputation phantom phenomena, including phantom limb pain
in lower limb amputees: across-sectional study of the patterns of referral of sensations into
the phantom. Pain Management Nursing, 19(6), pp.599-607.
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Th øgersen, M., Andoh, J., Milde, C., Graven-Nielsen, T., Flor, H. and Petrini, L., 2020.
Individualized augmented reality training reduces phantom pain and cortical reorganization in
amputees: aproof of concept study. The Journal of Pain, 21(11-12), pp.1257-1269.
Zheng, B.X., Yin, Y., Xiao, H., Lui, S., Wen, C.B., Dai, Y.E., Yang, G., Liu, J. and Gong, Q.,
2021. Altered cortical reorganization and brain functional connectivity in phantom limb pain:
A functional MRI study. Pain Practice, 21(4), pp.394-403.

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