The four studies in this thesis deal with peripheral and central factors in phantom limb phenomena. Study 1 documents sensations referred to the phantom limb during transcutaneous electrical nerve stimulation (TENS) applied at the outer ears, face, and torso. The results suggest that some phantom sensations are maintained by activity of sympathetic fibers in the stump. Other sensations appear not to involve a peripheral mechanism. Studies 2 and 3 focus on sympathetic nervous system correlates of phantom sensations reported during TENS applied at the outer ears and contralateral leg. The results indicate that TENS significantly reduces the intensity of phantom limb paresthesias whereas a placebo control has no effect. Significant relationships between (a) phantom limb intensity and (b) stump skin conductance and temperature suggest that a cycle of sympathetic-efferent-somatic-afferent activity explains phantom limb paresthesias. Skin temperature was significantly lower at the stump than the intact limb in amputees with phantom limb pain (PLP), but not in those with a painless phantom, or no phantom limb at all, indicating that PLP is associated with reduced blood flow to the stump. Study 4 examines PLP that resembles pain experienced in the limb before amputation. These somatosensory memories constitute compelling evidence of a purely central component of PLP. Finally, amputees with and without PLP could not be differentiated by scores on personality, depression, or anxiety inventories. The results of the four studies indicate that the experience of phantom limb paresthesias involves a central mechanism that acts on peripheral structures whereas others qualities of experience depend exclusively on activation of central neural structures. Implications for treatment, research, and clinical practice are discussed.

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Made available in DSpace on 2015-07-22T20:49:33Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-11-24 / Objetivo: avaliar pessoas com amputações de membros inferiores e descrever as variáveis sociodemográficas e clínicas, além de identificar quais dessas influenciam a qualidade de vida e alterações psíquicas. Métodos: estudo transversal, que incluiu pessoas submetidas a amputações de membros inferiores em todos os níveis e etiologias, sendo excluídas as que apresentaram idade inferior a 14 anos. Foram utilizados os questionários SF-36 e SRQ-20 para avaliar a qualidade de vida e as alterações psíquicas respectivamente em relação a variáveis sociodemográficas e clínicas. Resultados: foram entrevistadas 138 pessoas, com idade média de 62 anos, baixa renda e escolaridade, o SF-36 mostrou que apenas as que não eram casadas apresentaram escores médios de várias dimensões significantemente maiores e a avaliação das condições psíquicas foram influenciadas pelo gênero feminino, não ser casado, não ser independente, tempo de amputação e número de doenças associadas, porém depois da regressão logística, apenas o número de doenças associadas e independência mostraram-se significativas. Conclusões: as alterações na qualidade de vida estiveram associadas à presença de condições mórbidas e ao fato de ter um companheiro; 43% dos pacientes apresentaram doença psíquica, que estiveram associadas com o número de doenças crônicas e o fato de não serem independentes; além disso, foram excluídos do mercado de trabalho, não foram reabilitados. / Objective: To evaluate people with lower limb amputations in community base and describe the demographic and clinical variables, and identify which of these influence the quality of life and psychological disorders. Methods: A cross-sectional study that included people who undergone amputation at all levels and etiologies; were excluded younger than 14 years. Was used the SF-36 and SRQ-20 to assess quality of life and the psychological changes respectively in relation to demographic, social and clinical variables. Results: 138 low income and education people was interviewed; the SF-36 showed that only those who were not married had average scores significantly higher in several dimensions and assessment of psychological conditions were influenced by women, not being married, not independent, time of amputation, and number of associated diseases, but after logistic regression, only the number of associated diseases and independence were significant. Conclusions: changes in quality of life were associated with the presence of morbid conditions and to having a partner, 43% of patients had mental illness that were associated with the number of chronic diseases and that they were not independent and, moreover, ware excluded labor market and ware not being rehabilitated. / TEDE / BV UNIFESP: Teses e dissertações