The brain determines positions and movements of body parts from inputs arising at least from vision and proprioception. Using the brain event-related potential called the lateralized readiness potential, which reflects motor cortical activity during motor programming, we showed in a motor task that viewing one hand in a sagittal mirror-giving the impression to see the opposite hand-generated activity in the motor cortex of the seen hand (i.e., of the nonmoving hand hidden behind the mirror). The visual influence on cortical motor region occurred even when the proprioceptive input related to the real opposite effector was not aligned on the visual feedback of the hand given by the mirror. This dominance vision over proprioception was greatly reduced when the task was executed in the dark with hand position represented by small lights fixed on the moving hand, with no motor activity being recorded in the cortical area of the inactive hand. These results give new insights into how the brain weights and integrates visual and proprioceptive information in motor control.

Of the many procedures for treating painful neuromas, resection and proximal translocation are the most usual techniques, but these can decrease distal sensibility increasing deafferentation pain. In cases of intricate pain (nociception plus deafferentation), certain types of flaps allow the treatment of both components of the pain. We have used 30 such flaps in 28 patients: local flaps (exchange, advancement or lasso island flaps) and distant flaps (free "custom-made" toe flaps). The results of the different techniques provides 86.6% excellent or good results.

No abstract

Phantom limb sensations may be linked to motor activities in the deafferented cortices of amputees, with artificial visual feedback of an amputated limb leading to enhanced phantom sensations. The present study was designed to verify if cortical motor activity related to an amputated limb can be triggered by visual input using an objective behavioral measure and with a neurophysiological correlate. Trauma amputees and normally limbed subjects showed superior performance in a mirror-drawing task when the mirror was placed sagittally (giving visual feedback of the amputated/inactive limb) compared with when it was placed frontally. Measurement of lateralized movement-related brain potentials showed that, under the lateral mirror condition, contralateral motor activity of the viewed hand was observed in both normal subjects and trauma amputees. In contrast, this activity was not observed in subjects with congenital limb absence. These findings suggest that, in traumatic amputees, motor enhancement due to visualization of the movements of the missing limb reflects the effectiveness of motor commands to the missing limb, strengthening the hypothesis of the functional survival of deafferented cortical motor areas.

This pilot study indicates that use of the new UrgoStart Contact dressing, combined with offloading and debridement,may help promote the healing process of the neuropathic diabetic foot ulcers, and was well tolerated and accepted.