幻肢的神经病理现象学:从成因到治疗

Neuropathological Phenomenology of Phantom Limbs:Causes and Treatments

幻肢症状有着难以还原的、丰富的第一人称体验。几个世纪以来,这些体验在临床现象学报告中被反复、系统地描绘,并为哲学家反思身体的本体论与认识论问题提供了素材。我们试图提供一种神经病理现象学的框架,利用临床现象学案例、梅洛庞蒂的知觉现象学思想与新近神经科学证据之间的互惠约束,揭示幻肢患者的身体与正常人一样,并非仅仅是现象学意义上的躯体,而是活生生的身体。幻肢现象在神经病学上被归因为躯体感觉皮层的重组或重新映射后的知觉产物。习得的瘫痪幻肢的成因与身体意象的可塑性有关,而幻肢症状中本体感觉损伤则与身体图式的扭曲有关。基于这种框架开发的镜像视觉反馈训练在治疗幻肢痛方面产生了较好的效果。

Phantom limbs,as cases of abnormal presence or absence of parts of our body,seem to be handy illustrations of an irreducible and vivacious first-person dimension of experience.Over the centuries,these experiences have been repeatedly and systematically described in clinical phenomenological reports.It is their curiousness that makes a uniquely productive ingress into epistemological and ontological questions about the body.By means of the reciprocal constraint of the clinical phenomenology cases, Merleau-Ponty＇s phenomenology of perception and the recent neuroscience evidences,we attempt to provide a framework for neuropathological phenomenology.It reveals that the body of the phantom limb— not just the K9 rper（physical body）but the Leib（living body）-is the same as that of the normal person.The phantom limb is genetically attributed to the reorganized or remapped sensory product of the somatosensory cortex.The cause of learned paralysis of the phantom limb is related to the plasticity of the body image,and proprioceptive impairment in symptoms of the phantom limb syndrome is related to the distortion of the body schema.Based on this framework,mirror visual feedback（MVF）training for the treatment of phantom limbs provides a new approach.