Reading 4- The Disembodied Lady Flashcards
What is proprioception and how did this term (‘proprio’ + ‘ception’) come about? Consider Sherrington’s original description.
-Proprioception can be distinguished from exteroception and interception.
-Means sense of ourselves: it is only through proprioception that we can feel out bodies as our property/ own (Sherrington’s original description)
-“Proprius” meaning “one’s own”
“Capio” meaning “to take or grasp”
“-ception” meaning “to seize or take hold of”
When you put it all together, “proprioception” refers to the body’s ability to perceive and take hold of its own position and movement.
Give a concise summary of Christina’s case:
- Why did she go into hospital?
- What happened pre-surgery, in terms of symptoms?
- How did the attending psych diagnose her symptoms?
- How did the attending physiatrist diagnose her symptoms?
- How did the attending neurologist (the author, Oliver Sacks) diagnose her symptoms?
-Christina was 27 and lead a normal happy life. Went into the hospital to have her gallbladder removed due to the presence of gallstones. As part of this was put on microbial prophylaxis.
-The day before surgery Christina had a disturbing dream where she was swaying wildly/ unsteady on her feet, she couldn’t feel the ground beneath her and her hands kept failing to and fro, dropping whatever she picked up.
-The attending psych was called after she had the dream and said it was just pre-operative anxiety and that it was natural.
-Then her dream came true. Christina started being unsteady on her feet/ hands were failing about: not sure of her movements.
-The attending psych was called again and he said it was anxiety hysteria
-Christina’s symptoms got worse and worse closer to the surgery. She came to have no control of her movements/ zero coordination and her face was expressionless and slack +vocal posture disappeared. She described her condition as feeling ‘disembodied’
-Oliver Sack the authour/ neurologist came in at this point. He alongside residents got Christina to undergo sensory testing. What is revealed was the parietal lobe was still in function but had nothing to work with- getting no proprioceptive information.
-The attending physiatrist (psychical medicine specialist) was called and agreed with Oliver Sacks. There had been a complete lost of proprioception from toe to toe- no muscle or tendon or joint sense whatsoever.
-Back to Oliver Sack the Neurologist to work out a cause. Spinal tap revealed acute polyneuritis (inflammation) but of exceptional type- sensory neuritis- effecting the sensory roots of the spinal and cranial nerves. He had no idea whether Christina would ever get her sense of proprioception back.
Compare and contrast Christina’s case with Ian Waterman’s. What similarities are there? What differences? Consider the following: biological mechanisms of injury/loss of function. The specific sensory information lost by each of them; Rehabilitation, regain of function, strategies used by each. Ongoing difficulties likely to be incurred in each case.
Biological mechanisms for injury/ loss of function:
-For Christina it was polyneuritis i.e. inflammation of the sensory roots of the spinal and cranial nerves
-For Ian Waterman he had a rare neurological illness that resulted in his immune system attacking his own sensory nerves
The specific sensory information lost by each of them:
-Christina had a complete lost of proprioceptive information and felt ‘disembodied’. She still had a sense of light touch (only slightly impaired).
-Ian Waterman had a lose of all sensation below the neck. This was for tactile/ touch information but also for proprioceptive/ kinesthetic information. Interestingly, pain + heat was retained.
Rehabilitation, regain of function, strategies used by each, ongoing difficulties likely to be incurred by each =
-Both Christina and Ian Waterman learnt to modulate their movements via vision and had to remain highly attentive otherwise they would fall
-Christina also used high amounts of auditory feedback to guide her speech as this is generally controlled with proprioceptive information. Ian also had troubles with speech (slurred) so potentially he used similar strategies.
-Christina stayed in the psych ward for almost a year and although has learnt to live her life still has ongoing issues
-Ian after 18 months learnt to control his movements and walk again but again every day is a struggle/ requires conscious effort
Both cases are extreme examples of individuals losing sensation that is so essential to how we live our everyday lives that we take it for granted. Christina described extreme difficulty in getting people to understand her condition. She doesn’t even have a community she can have a sense of solidarity with as she was the only one with her condition at the time. I imagine Ian probably has similar experiences.
What does Christina mean when she says: “there is a general feeling of deficiency in the egoistic sentiment of individuality”
I think it means that because of her lost of proprioceptive information it is very hard for her to feel a sense of self. She feels disengaged from her own identity.
What modalities do we usually rely on to give us our sense of body/self? Where do these modalities merge in the brain?
Vision
Balance organs (the vestibular system)
Proprioception
Usually if one of these fails then the other systems can compensate but it’s a lot more effort (take Ian Waterman and Christina for example- they use the visual system to guide them)
Note: these three were the one’s explicitly mentioned in the reading but other modalities could come into play such as audition.
