Could sensation return after years of profound loss?

Warning: medical specialty jargon ahead

Complications of diabetes

20 million Americans live with diabetes. About 1 in 4 will experience diabetic neuropathy. For millions, their neuropathy progresses to a loss of protective sensation in their feet. This impairment leads to a cascade of falls, injuries, wounds, amputations, and early death.

Current interventions may help relieve pain but are not intended to restore loss of sensory or motor functions. There is little expectation that protective sensation can return.

Rarely, energy-based therapies prompt the return of sensation. Without real-time recordings, the such unexpected events are easily dismissed.

Also missed, the patient’s pain and loss of sensation may resolve at different times. Could these complications be independent?


Testing the new algorithm

PhotoMed’s team developed its Instant Feedback System™ to make its algorithm more efficient.

Testing the algorithm for seemingly disparate disorders yielded unexpected responses and outcomes. The abrupt “awakening” of numb fingers or toes sparks surprise for nearly everyone. Could the return of innate sensation break the cascade of complications?

Brenda is surprised to feel her right hand fingers after surgery to her right elbow more than a year prior. No one anticipated this event. The therapy aimed to relieve pain, which was only partially relieved. This image is from a real-time video of the visit.

Brenda is surprised to feel her right hand fingers after surgery to her right elbow more than a year prior. No one anticipated this event. The therapy aimed to relieve pain, which was only partially relieved. This image is from a real-time video of the visit.

 


Could brain-map errors lead to experiencing pain?

Neuroscientists report mapping errors induced by amputations. For some patients, pain is reduced by using “mirror therapy” or virtual reality goggles over several to many visits. The therapies require the patient to intentionally participate with the hope that neuroplasticity might“rewire” their brain to relieve “phantom” and other apparent sources of pain.


PhotoMed’s algorithm provides the practitioner with a more efficient therapy:

  • Works passively without the patient’s intention or expectation

  • Prompts the return of sensation bilaterally after treating only one side

  • Two visits are enough to learn if the therapy likely won’t work.

Could errors in brain-maps of touch or temperature be an “ordinary” perceptual process that got stuck? Is the correction of a map a neuroplastic event? Want to find out? PhotoMed’s tools are available for rent or purchase.

Observing events in real time

Clips from PhotoMed’s real-time recordings demonstrate the what and when the events occurred. Perhaps now, neuroscientists might learn the why and how of the as yet unknown mechanisms.

Replaying recordings from cases with a rapid restoration of touch sensation suggest that alignment of cortical touch maps (search: homunculus) may occur while skin sensations are disrupted. After “reawakening” of sensation, cross-sensory feedback from vision or self-touching prompts the realignment of the perceived touch locations. Could touch-map misalignment errors “explain” pain at scars, reconstructed skin, and central nervous system pain?

“George” could feel being touched upon the “awakening” of both feet after being missed for 8 years. This was his second visit. The algorithm suggests treating one foot while observing that both feed respond. Where he perceived being touched was misaligned until he opened his eyes and observed the location. George previously could not feel his feet. In a matter of minutes, he was able to feel the 5.1gm von Frey monofilament.

“George” could feel being touched upon the “awakening” of both feet after being missed for 8 years. This was his second visit. The algorithm suggests treating one foot while observing that both feed respond. Where he perceived being touched was misaligned until he opened his eyes and observed the location. George previously could not feel his feet. In a matter of minutes, he was able to feel the 5.1gm von Frey monofilament.

These events are no longer rare. 2 in 3 patients have little or no response. The 1 in 3 who respond are typically startled throughout their entire body. A gasp, flinch, or spontaneous remark confirm that something unexpected happened. We thank to William Conard, M.D. for being the PI of this IRB study and his staff in Sacramento, California.

Could mapping errors account for pain at scars, post-surgical pain, or phantom pain in reconstructed skin?


What happened during testing?

“George” experienced diabetes and its complications for 42 years. He experienced a profound loss of sensation in his feet for 8 - 10 years. He arrived looking at his feet to maintain his balance. George volunteered to learn if PhotoMed’s algorithm might relieve his back pain. George and his wife had not considered the possibility of his regaining sensation in his feet.

During his first visit, George’s back pain was partially relieved. Therapy was also applied to his left foot (only). He regained slight awareness of heavy pressure on his left foot.

One week later, George looked at the operator as he walked in. When asked, he reported that he hadn’t noticed much change in his feet. His wife suggested that he now walked more confidently. Von Frey monofilament testing found weak sensation at 19+ grams force. While an improvement, this level is not considered “protective” to prevent falls, etc.

Therapy, during his second visit, was applied only to his right foot. George complied with the request to keep his feet still and to NOT look at his feet. The goal was to avoid cross-sensory perception during the testing.

Within 6 minutes of the first treatments, monofilament testing found significant sensation at 5+ grams force. Video clips show the importance of real-time recordings of unexpected events. These may be the first recordings of an event that we hope will become commonplace.

Demonstration of touch mapping errors & corrections upon the restoration of sensation lost to diabetes. (0:45)

 

You might be wondering how family members react to the sudden return of sensation that has been sleeping for years.

Operators of PhotoMed’s algorithm frequently observe family dynamics through their responses, questions, and doubts. The focus on restoring function avoids some of the problems faced by patients when their pain vanishes.

“George” describes his lack of sensation in his feet and the low expectation of his doctors for its return. His wife bends his toes to confirm that sensation has returned. (1:01)

 

Questions?