The remapping of peripersonal space after stroke, spinal cord injury and amputation: A PRISMA systematic review

Abstract

Peripersonal space (PPS) is the body-centered area where interactions occur and objects can be reached. Its boundaries are dynamic, modulated by ongoing sensorimotor experiences: limb immobilization shrinks PPS, whereas tool use expands it. However, consistent clinical information on PPS alterations remains limited due to methodological heterogeneity, varying types and severities of sensorimotor disorders, and diverse experimental paradigms. This review explores the causal mechanisms of PPS processing by integrating findings from brain-lesioned patients and individuals with body deafferentation, such as amputees and spinal cord injury (SCI) patients. By comparing the effects of brain lesions and sensorimotor deafferentation, it clarifies how PPS is encoded, maintained, and reorganized following central nervous system damage, bodily changes, and the use of assistive devices. A systematic search of Scopus, Web of Science, and PubMed identified 17 studies: 4 on stroke patients (N = 100), 6 on SCI patients (N = 104), and 7 on amputees (N = 65). Risk of bias was assessed using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Despite the limited number of studies and methodological variability, findings consistently show that sensorimotor changes significantly affect PPS. Notably, a contraction of PPS around the affected limb was observed in stroke, SCI patients, and amputees. Assistive devices were able to restore PPS after training, or even immediately in the case of prosthesis use. A shared neurophysiological mechanism across these conditions may underlie PPS as an online construct, continuously updated to reflect the body’s current state and its interaction with the environment.