Vol. 18 •Issue 26 • Page 38
From the Lab
No Pain, Brain Gain
I talk about neuroplasticity to everyone. I do seminars on the subject, but I also use it in my life. I think everyone should.
Think about it: 100 billion neurons just waiting for us to turn them into efficient machines perfected to accomplish whatever tasks we hold dear. There are remarkable studies that show that the human brain can be dramatically reconfigured within a relatively short amount of time.
There is one study that, every time I tell it to an audience, I get shivers. The study has been done many times by scientist Alvaro Pascual-Leone, MD, PhD, an associate professor of neurology at Harvard Medical School. Here's the study.
The Amazing Brain
A participant, who is inevitably a college sophomore desperate for beer money, has an MRI to establish the perfectly predictable activation of the pads of the fingertips on the sensory cortex. She is then blindfolded for 100 hours. The researchers make sure that no light gets to the eye of the participant and they do this by slipping undeveloped strips of film into the blindfold. If the film shows any exposure, the study is ended.
During this 100-hour period, the participant learns to read Braille. Braille is read with the pads of the index finger of the right hand. After 100 hours of reading Braille and again confirmed by MRI, the sensory representation of the fingertip moves and expands. It moves from near the top of the brain and virtually takes over the visual cortex located in the occipital lobe. Why would it take over the occipital lobe? Because vision is located in the occipital lobe. The subject is then "seeing" with her fingertips-after 100 hours. Complete rearrangement of portions of the brain thus occurred after 100 hours. Shiver.
This level of neuroplastic change is also attainable in the part of the brain that controls movement. Learning how to do new movements, the focus of much of OT and PT, is weird because it is often not just learning what to do, but also "motor unlearning." That is, the neuroplastic change required to move better does not always require more activation of the brain. Sometimes this learning requires quieting areas that are too active.
There's a tendency for folks to look at an MRI image and assume that if more parts of the brain light up, then positive neuroplastic change is happening. This is not necessarily true. Imagine if they could do an MRI on me while I attempt to hit a golf ball-and it would be an attempt, believe me. My MRI would show tons of activation. My amygdala, involved with emotion and anxiety, would flash like Christmas lights. My cerebellum, the center of balance and activation of bilateral movement, would probably look like a fireworks display. But if the same test were done on Tiger Woods, his brain would show not more, but less activation. There would be a complete calming of many parts of his brain with a few pixels glowing brightly.
Work for Change
Most researchers now believe that neuroplastic change is the only true substrate for recovery after acquired brain injury (e.g., stroke, TBI, CP). If you think that neuroplasticity is the substrate of recovery, you naturally ask for neuroplastic change from your patients. Neuroplastic change takes a lot of hard work and involves a lot of learning and dedicated time.
And there is another aspect of neuroplastic change that makes it hard; we can't do it for them. There is no machine, modality, magic therapy or skill that the therapist can bring that creates neuroplastic change. Since only the patient can cause the needed neuroplastic change, therapists evolve from puppeteer to coach. Therapists provide guidance and positive reinforcement, planning and measurement. But the heavy lifting is done by the patient.
When I do seminars and explain the explosive potential of neuroplasticity in all of our lives, I challenge therapists to challenge themselves with a great neuroplastic journey. I think that is only fair given the great challenge we lay at the feet of our patients.
So what is my great challenge? Certainly if I'm asking stroke survivors in our studies to do the hard work of required for neuroplastic change, and I'm asking therapists to challenge themselves as well, I am asking the same of myself. The best way to explain how I am accepting this challenge is to relate a joke by the great Jerry Seinfeld.
"They've done studies and found that people's number one fear is public speaking. Their number two fear is the fear of death. People would rather be in the coffin than delivering the eulogy." Can you neuroplastically change your brain to be unafraid of public speaking? I don't know, but in the two and a half years I've been doing seminars, I've made great strides in preferring the eulogy to the coffin.
Peter G Levine is co-director of the Neuromotor Recovery and Rehabilitation Laboratory (rehablab.org) at Drake Center, under the auspices of the Department of Rehabilitation Sciences, University of Cincinnati. He is the author of Stronger after Stroke (StrongerAfterStroke.com) and conducts workshops throughout the U.S. for Education Resources Inc. (educationresourcesinc.com) in the area of stroke rehabilitation.
* The email address provided for contacting Peter Levine when this article was published is no longer current. He can now be reached at StrongerAfterStroke@yahoo.com