NEUROPHYSIOLOGICAL
STUDY OF THE E-MOTION
H.
Godard*, C. Pirovano°, L. Bedodi°°, A. Cola°°, G. Galperti°°, R. Sensi°°
and G. Martino°
*
Université de Paris VIII Saint Denis.
°
METIS - Medicine and Memory - International Center of Studies and Therapies for
Women’s Health -
°°
Rehabilitation Dept. - National Cancer Institute - Milan
Articles
on the work of Hubert Godard
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INTRODUCTION
Research
conducted over the course of eight years on the physical and psychological
damage in women operated on for breast cancer led us to study some inexplicable
phenomena related to the oncological trauma and to the surgery (1-3).
We
found post-surgical limitations of the shoulder girdle in daily movement that
could not be explained through muscular, articular, electromyographical and
radiological examination. In the classical clinical approach, only the force and
amplitude of the basic movements of the joint are measured.
Observation
of the subjects while walking and while performing the movements of daily life
revealed changes in the coordinative structures (acquired sensory-motor
automatisms) that were not reflected in the voluntary action tests. When walking,
65% of the breast-operated women showed a loss of pendular motion of the
homolateral arm. From the observers' perspective, the arm looked anchored to the
trunk or paretic (like dead). When asked to move the arms symmetrically while
walking the patients performed the movements without difficulty. In most cases
the loss of pendular motion of the arm when walking, causes over time and by
compensation, a malfonction of one hip joint.
A
second series of experiments was carried out with patients in the pre-operative
phase and with a sample of healthy women; 50% of the women with breast cancer in
the pre-surgical period presented reduced pendulousness in comparison with 10%
in the healthy group (4). The pendulousness further decreased after surgery, in
some cases as far as complete arrest of the arm.
A
third series of experiments was conducted with post-surgical subjects, without
functional or articular deficit, participating in body-mind therapy groups (
immediately post-surgery and during subsequent radiation therapy). We observed
that these patients had less ability in space directionality [exteroception]
(5), in space projection [ex-proprioception: Awareness of body positions in
reference to the spacial surroundings] (6) and in the ability to anticipate an
action with the arm on the side of the operated breast.
Following
Damasio (7), Edelman (8), Reed (9), we suspected a link between emotion,
perception and the loss of movement in our oncological patients. Starting from
these works we investigated, through a new trial with the EMG, the
neuro-physiological implications of the emotional situations and of the
fluctuations in perception in the context during the movement (e-motion).
Specifically
the aim of this study was:
-
to understand the relationship between the strength in the motion and the
organization of the projection in space ;
-
to evaluate the importance of the balance between proprioception and
exteroception as crucial anticipatory factors of the movement;
-
to focus on the implication of the relational context regarding the subject
during the classical diagnostic-prognostic electromyography;
-
to improve the techniques of rehabilitation by paying attention to the
individual's emotional perceptual organization.
MATERIALS
AND METHODS
The
experiment was carried out on 10 healthy volunteer subjects: 5 men and 5 women,
aged between 28 and 46 years and without previous neuro-motor deficits. We chose
to evaluate the overall capacity of extension of the forearm against resistance
in several different contexts.
Strength
of extension of the forearm is based on the work of the triceps brachi which can
be inhibited or facilitated by the action of the antagonist: the biceps brachi.
The stronger the work of the antagonist, the weaker the overall capacity of
extension. The amount of biceps action is thus taken as the indicator of an
inhibition in the movement.
The
triceps could be considered a muscle with a clearly prevailing phasic, alpha
mediated activity and it has, as antagonist, the biceps, a muscle implicated in
the gravitational equilibrium with an important gamma activity. The two muscles
could be considered "pure" antagonists because the articulation of the
elbow is structured in way that allows few additional
movements
during the flexion-extension of the forearm.
The
neuro-physiological investigation was carried out with electromyography, by
concentric needle electrodes of Adrian and Bronk. The recruitment pattern was
recorded continuously during maximum voluntary activity, with sweep speed of 20
msec. And amplitude of motor units of 0.2 mV per division. [Some examples of the
electromyographical traces that were recorded are shown below]
Subjects,
in seated position, were asked to support the back of the wrist on a bracket and
to maintain the extension of the forearm resisting the examiner's attempt to
flex it. ( test against resistance).
-
Initially the request was to exert the maximum possible extension of the forearm
against resistance (test A).
-
The experiment was then repeated asking the subject to imagine the arm extending
with a horizontal aim in space before and during the movement in order to modify
the intentional perception within the context ("Imagine that your fingers
lengthen out to reach the wall of the room" or using other
visual-kinesthetic modality, "that your fingers emit a beam of light that
reaches the wall "). As in the first test, during this trial the examiner
tried to flex the arm of the subject (test B).
-
Finally we repeated test B, this time with a disturbance of the visual spatial
projection, by interposing an obstacle between the subject's arm and the wall.
(An examiner passed through the aiming field of the subject) (test C).
RESULTS
During
maximum voluntary activity (test A): In the 10 subjects examined the
electromyographic examination highlighted an unexpected, clear activity of
biceps brachii (antagonist of the movement) while the examiner registered the
strength of the extension of the forearm against resistance. The recruitment
pattern changed from discrete activity to a reduced interference.
With
a spatial projective aim (test B), in all the examined subjects, the
electromyographic data and the examiner's perception of the strength of
extension clearly changed. The examiner perceived an "invincible"
resistance, 3-4 times stronger than in the A - test , while the EMG showed a
clear reduction in the recruitment of motor units in the biceps with patterns of
single unit potentials and at times complete electrical silence.
Setting
an obstacle to modify the spatial context (test C): In
all
the examined subjects the EMG activity in the biceps brachii reappeared although
in a moderate way relative to test A. There were patterns of discrete activity
and the strength against resistance was also somewhat reduced. (Figure 1).
DISCUSSION
In
the A-test the
electrical activity registered in the biceps brachii (antagonist muscle during
the maximum extension of the forearm) could not be caused by the will of the
subject who is actively trying to obtain the maximum motor performance. The
electrical activity of the biceps could be explained by the tonic-emotional
arousal (increase of the gamma tone) linked to the context of struggle during
the extension of the forearm which modifies the proprioceptive/ex-proprioceptive
balance necessary for efficient movement. Without an exproprioceptive reference,
the subject no longer perceives the reality of the actual context (which
includes the external) but only the relationship with the examiner (A-test:emotion).
Since
the two muscles contract together, a part of the pure extensor activity of the
triceps is lost in the conflict with the flexion of the forearm induced by the
biceps. In other words, a part of the potential energy of the triceps has been
transformed into caloric, not productive energy (entropy) instead of being used
for the movement .
In
the B-
test the addition of a clear exproprioception before and during the movement
ameliorates immediately and often completely the situation in the observed
subjects. Clinically the examiner registers the maximum strength of the triceps
and the EMG reports the electrical silence of the biceps. This is due to a
better relationship between proprio /ex-proprioception. When we introduce the
projective and aiming element we suppress or clearly reduce the gamma activity
of the biceps, while the triceps becomes wholly constituted from kinetic pure
energy (alpha). We can say that the ability to project in the space suppresses
the unconscious inhibition, the unaware activity that conflicts with the
voluntarily programmed action. The relationship is then triangulated for the
examinees who feel their arm, face the examiner and relate to the surrounding.
This situation brings them to the maximum potential of action (B test: ex-motion).
In
the C
- test, the evidence, in most cases, a reactivation in the biceps brachii
simultaneously with the reduction of the spatial projection, confirms the
influence of the subject's evaluation of the context and the symbolic dimension
(conscious and unconscious) on the tensional organization of the shoulder girdle.
Over time this situation of poor spatial projection (absence of projects for a
part of the body) decreases the sensorial afference stimuli and leads to a
structural modification of the related primary sensory cortex's territory.
Merzenich et al. (10,11) demonstrated the rapidity of the transformation of
these territories in absence of the afferent stimuli. The impoverishment of the
sensory cortex then decreases, in its turn, the ability of the motor cortex's
retroactive loops linked with the sensory area. The work of these retroactive
loops represents, according to Weisendanger (12), 98.5% of motor cortex activity.
Thus a vicious circle is formed which can progress as far as the complete
disappearance of a motor activity without any evident somatic injury.
CONCLUSION
We
registered, with EMG, the different potentiality of the muscular activity
submitting the subjects to motor resistance in various perceptive/projective
tests. When we ask the subject to only counteract the examiner we noticed a
paradoxal electrical activity in the antagonist muscle which reduced the
strength potentiality and brought rapid fatigue. The relationship was only
oppositional and dual because of poor exteroceptive references (emotion).
Without
spatial attention, a weak force was registered. This is due to the emotional
situation that elicited an accentuation of the gamma activity increasing the
spindle response (modification of the firing point of the stretch reflex by the
gamma loop) of the antagonist muscle.
When
we ask the subject to extend the forearm with adirectionality and a spatial
projection of the hand, we registered the full strength of the agonist muscle,
with absence of activity of the antagonist. The action by the exteroceptive and
exproprioceptive references became triangulated and therefore potentially
maximized (ex-motion).
This
EMG study helps us to understand why many of the oncological patients that we
observed lost some basics movements without clinical explanation. This loss came
from the reduced capacity to have movement projects of a part of the body due to
the physical and emotional trauma in this part. Over time, the repetition of
this situation transforms sensory organization ( transformation of the body
image) and then motor capacity. Our neuro-physiological results emphasize the
importance of considering the role of sensory activity in motor rehabilitation;
clarify the relationship between the quantity of muscular strength and the
quality of the projection in the space (proprioception and emotion /
ex-proprioception and ex-motion); calls into question the value of the standard
approach of
studies
using EMG that disregard the importance of the context during clinical
evaluation; emphasizes the importance of a program of rehabilitation that gives
attention to the patient's e-motional/perceptual organization.
BIBLIOGRAPHY
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Martino, G. Prevenzione e terapia degli esiti. In: U. Veronesi (ed.): Manuale di
senologia oncologica. Milano: Masson, 1993, pp. 431-442.
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Martino, G. Il recupero del paziente oncologico: aspetti psicologici e
riabilitativi. In: G. Beretta, E. Ghislandi, G. Luporini, A. Scanni (eds.) Atti
del XV Corso di Aggiornamento in Oncologia Medica. Milano, 26-29 giugno 1994.
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Merson, M., Pirovano, C., Balzarini, A., Luini, A., Biasi, S., Galimberti, V.,
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Paris, 1994, pp. 63-75
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Fitch H.L., Tuller B., Turvey M.T.: The
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N.J.: Lawrence Erlbaum Associates, 1982.
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Damasio A. R., L’erreur de Descartes,
Editions O. Jacob, Paris, 1995
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Edelman G. M., Biologie de la conscience,
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Reed E. S., An outline of a theory of
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Wall J.T., Kaas J.H., Sur M., Nelson R.J., Felleman D. J. and Merzenich M.M. Functional reorganization in somatosensory cortical areas 3b and 2 of
adult monkeys after median nerve repair: possible relationships to sensory
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Merzenich, M.M., Recanzone, G. H., Jenkins, W.M., and Nudo, R.J. How the brain functionally rewires itself. in Arbib M.A., Robinson
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12.
Weisendanger M. "Contrôle cortical des mouvements et régulation par les afférences
proprioceptives" Journal de physiologie, Paris, 1976
All
the Authors have worked (and some are still working) at the Rehabilitation
Department of the National Cancer Institute of Milan where for more than twelve
years they have worked to ameliorate the quality of life of people with cancer.
Original
publication:
MOTION
ED E-MOTION IN ONCOLOGIA
In “Psiconcologia - A cura di Dino Amadori”
Marco
L. Bellani, Ed., Masson. 2001,
pp 875-881.
Articles
on the work of Hubert Godard
Back to the Somatics article collection