The Infinite Mind; No. 27; Rewiring the Brain; Part 1

I'm Dr. Fred Goodwin, and this is the infinite mind today on The Infinite Mind, rewiring the brain. We all change our minds, but can we actually change our brains? Today, we explore the astonishing new world of neuroplasticity, the ability of the brain to rewire and reprogram itself. The traditional view is that the adult nervous system has very little plasticity. That is when you injure it. It can't repair itself. That turned out to be not correct. It was a stunning discovery. And if the brain is our computer, what happens when it crashes? And I can remember slipping, slipping, slipping down and thinking very calmly I am going to die. Plus, commentator John Hockenberry. I don't know what you did on your summer vacation, but my wife and I brought twin girls into the world. In my experience, it's not about the wiring, it's about the software.

Also will visit a miniature village in a hospital which is set up to help people recover from stroke and hear why decompression chambers for scuba divers hold new hope for treating stroke and other brain injury. All this and your calls coming up today on The Infinite Mind. I'm Dr. Fred Goodwin. The human brain. Until recently, we've tended to think of it as a massive corporate office. There's a communications department shipping accounts payable each department, each part of the brain, performing a separate and distinct function. So when an area of the brain was damaged by trauma or stroke, doctors naturally held out little hope for restoring the functions lost by the injury movement. Memories, speech, much of it gone forever. We assumed. But now we know the brain is capable of making extraordinary change in its organization, rewiring, if you will, the way it files and processes information and directs the body to move. These findings are revolutionizing the way we view and treat people affected by

stroke and traumatic brain injury, which affect millions of Americans each year. We may still look at the brain as a large corporation, but it's starting to resemble a corporation of the 90s integrated, synergistic and interdependent. Today on The Infinite Mind, we'll look at neuroplasticity, the ability of the nervous system to adapt and change and remake itself. We'll hear examples of how some individuals, through sheer determination and repeated acts of will, can actually change the way their brain functions. Not only does this hold exciting possibilities for treating brain injury, it raises a new line of inquiry into learning and relearning and unlearning of old habits. And we're just beginning to explore the implications for sense, sight and hearing today on the infinite mind rewiring the brain. We begin by meeting a writer who fought his way back from the edge of oblivion. He is Peter Swet of Connecticut, who experienced a stroke at the age of 49.

I was on the phone with a pal, another writer friend of mine who lived in West Hampton and without any kind of pre warning at all, the phone just slipped out of my hand and started dangling it, hitting as a kitchen butcher block. And I could not pick it up with my left hand. And I didn't know what was wrong. Then my left hand just started flowing into kind of this little bouquet of twigs is the best way I've found to describe it, because I could not move my finger in my fingers in any possible way. And I knew something was wrong. And I thought, gee, is this a stroke? Is this what a stroke is? So I put the phone back, hung up and called another friend who was a neurologist. And he told me that this could indeed be a stroke. So he told me exactly what to do, which was to go and sit in a secure chair where I wouldn't fall and to make sure I left the door open for him because he was on his way over. And I remember so well hanging up the phone and going down that long, long dining room, which was really only about six feet,

but it seemed like forever. And then going down that immense living room where he told me to wait. The living room was probably about 14 by 18 or something like this. And it just took forever. And I got into that chair where he told me to wait for him nice and secure a chair. And I can remember slipping, slipping, slipping down and thinking very calmly, I am going to die. And you know what? It was OK with me at that moment. I don't know. I don't know what the mind does to get us through these things. But I knew I was either facing eternity and that there would be a God creator there or there would be a black hole. And I wouldn't care. I was impatient. In the primary hospital, there were two hospitals. The primary the primary hospital was that on Long Island at Stony Brook University. And my very earliest consciousness that I can recall. But I could look down at my feet and there was a sign there and the sign said, Tuscany's waiting. The sign had been placed there by my wife because

we were approaching our 25th anniversary and I had promised her a trip to Tuscany. What happens in Brain-Damaged cases like this is that the memory, old memories are really generally not disturbed. It's new memories. So I couldn't tell you what I had for breakfast or I couldn't tell you where I sat down, my keys or what the name of this hospital is. I could tell you what I had done 20 years ago. And I did know my wife and my mother and my father, my children and my dog. The first thing they do is to try and get you on your feet, obviously, so you wouldn't spend your life in a wheelchair. And I remember that distinctly. I mean, your legs had to be exercised all the time. In my case, there was no sensation of any kind on my entire left body. And only slowly, after really months and months of this exercise and constant rehabilitation, did I slowly begin to move my parts and begin to I mean, I can remember moving my toe and my mother practically crying for joy because there was a sign that there would be some motion. And I remember my practically crying for joy when I got rid of the damned wheelchair.

And I could then I knew I'd be getting around on my own. And as I as I do now, the biggest problem I have now, I have some mild things, a slight limp. I can't use my left hand and a couple of other minor things to which I have adapted. The thing that troubles me mostly is the confusion that I experience every now and then. It's like I have two motion picture screens in my head. It's the cinema cerebellum, one in the cinema, cerebellum two. And they're both playing movies and I never know which one to watch. And sometimes it is just immense. I just have to hold my head and stop what I'm doing. The confusion is just immense. Some days I have to eat, sometimes I have to give up a day. This is one of the things I'm very proud of, by the way, that I was happy that I managed to write this book in spite of that confusion which got in my way every single day. Some days I wrote a bunch of nonsense and I'd go back to it the next day and recognize and throw it out and start all over. But finally, finally, after four and a half years of doing this, I finished a book and I'm prouder about than I am of anything else I've done in my life.

Peter Swet's book "Cracking Up: Nice day for a brain hemorrhage," is published by Hazeldene. Our first guest today is Dr. Edward Taub, professor of psychology at the University of Alabama in Birmingham. Dr. Taub is one of the nation's leading researchers into the ability of the brain to rewire itself after stroke and other kinds of injury. Dr. Taub, welcome to The Infinite Mind. Thank you very much. I'm very pleased to be here and we're pleased to have you. We've been hearing a lot these days about the plasticity of the brain and how this might relate to the kind of work you do. Could you give us some definition of that term and what does it mean in your work? The traditional view goes back to the very origins of neuroscience is that the adult nervous system has very little plasticity. That is, when you injure it, it can't repair itself. It can't reorganize itself.

The immature nervous system. It has always been known to be capable of repairing itself, of reorganizing. But until the middle 70s and perhaps over into the middle 80s, it was an axiom in neuroscience that there was little or no plasticity in the adult nervous system that turned out to be not correct in a part of the brain called the somatosensory cortex. There is a sensory representation of each part of the body and this is arranged in the rough form of a map of the body. It's called a little man or a homunculus on the motor side. That is the part of the brain that controls movement is also a motor homunculus. Now, when you carry out a procedure such as amputation of a finger, the part of the brain that used to represent

that finger is now invaded by the cortical representations of the two adjacent fingers that are still intact. And this phenomenon came to be called cortical reorganizations and represented a substantial plasticity of the central nervous system. So when the brain, the area that's supposed to get the sensory stimulation from a particular limb, let's say for some reason like injury, can no longer get that sensory stimulation, what the brain does is make up for that in some way by enlarging areas that receive sensory stimulation from another area. That's exactly what happened. Okay. And the input or the parts of the brain that are enlarged are typically those that are adjacent to the now absent part of the body or the part of the body not providing sensory input into the brain.

Was this a surprise when this was found? It was a stunning discovery and still is. Now, let's go to the in a sense, what's the most immediate and practical and I think quite exciting area of your work, which is working with physically rehabilitating people who have been affected by stroke. And it seems to me that you've come up with some novel approaches that are not sort of counterintuitive, that don't fit the mainstream of of rehab medicine as we know it. Could you tell us about that work? As I'm sure you know, chronic stroke patients are largely untreated population. And the reason is that the traditional view is that whatever mode of function patients have at the end of a year, usually six months, actually, that's it. They're not going to improve for the rest of their lives. Whatever they have in terms of ability to move their limbs, they are not going to advance very much from that. So currently, there is no treatment available that can

help chronic stroke patients. Over the last 12 years, my colleagues and I here at the University of Alabama, at Birmingham and also at the Birmingham Veterans Administration Hospital have developed a set of techniques that are really quite effective in greatly increasing the amount that a chronic stroke patient will use and that has been affected by a stroke. The signature therapy, the one that we use most often involves putting the arm that has not been affected by the stroke. Stroke, of course, affects one side of the body and the other side is relatively unaffected. We put the good on the arm unaffected by the stroke in a sling which restricts its movement for approximately 90 percent of waking hours for two weeks. Fourteen days. OK.

In addition, on the ten weekdays during that period, we bring the patients into the treatment center and we train them to use the affected arm. And how did you come up with the idea of putting the opposite arm, the good intact arm in a sling that was developed in my research with monkeys? I'm not sure that we ever would have done this with human beings because it is fairly contrary to what is typically done with stroke patients, which is to do some rehabilitation with the affected arm and then after three or four months have passed to then train the unaffected arm, the good arm to do the work of two arms. Right. First, if we should hear what happens at the level of the brain and then what happens clinically, behaviorally to these people. Recently, what we found is that the intervention, the therapy produces a extremely

large what we call used dependent cortical reorganization. That is the area that is responsible for producing movements of the effect that arm increases enormously. It more than doubled in size. And in addition, parts of the brain that are not normally involved. This is adjacent areas around what we call the infarct, the the part of the brain that has been destroyed by the stroke. In the adjacent areas, you get a doubling of the size as compared with normal individuals responsible for generating movement. So these are motor areas that are regenerating that you're giving them more work to do and you're giving them more sensory stimulation on the damage side. And that results in the increase in both motor and sensory areas. That's exactly right. And we have data now with respect to both motor and sensory areas.

You get a very large expansion. In addition, you get a recruitment and involvement of parts of the brain that are not normally involved in innovating or generating movements of the affected areas on the other side of the brain. Let me ask something about the clinical situation here. How do people feel about and how their relatives feel when you you sort of tie up their good arm? That might seem not a very nice thing to do. How do you explain it? Well, it turns out that patients who have had a stroke are almost uniformly, extremely strongly motivated to be able to increase the function of the arm. You rarely get a person for whom this doesn't seem as if it were a reasonable way to try to improve the use of their affected arm. I think it's time to go to a caller. We have Howard, who is calling from California, who's actually from Oregon, but I think vacationing in California. Howard, are you on the line?

Yes, I am. Well, welcome to The Infinite Mind. Well, thank you. I was I've been listening and taking copious notes. OK, do you have a question or comment for us? Well, I'm I'm ready for my wife to go for the experiment. My wife's seventh year of a stroke and she has come a long way thanks to her positive attitude. And I think what she has been doing is as part and parcel of what Dr. Tubb has been doing because people are motivated to get better. Yeah. He pointed out the motivation is critical after Tolba with a person like that, like Howard's wife, who's had seven years in between the stroke and now is that still is there still good rehab possibilities with the technique you're talking about? At the beginning, we thought that chronicity, that is the length of time since the stroke would be an important factor because there was the potential for there being secondary changes, like shortening of muscles do non use and deconditioning of muscles

and shortening of tendons in the kind of patient that we work with, which is about 50 percent of the chronic stroke population. This simply doesn't happen. And we have worked with patients who are 20 years post stroke, 20 years after their event. And we have gotten just as good results with them as patients who are one year. That's very good. Could I do it myself without your help, Doctor? I wouldn't recommend it because it is very good to have a clinical authority requiring compliance with wearing the sling or some other devices that we have. How could Howard and his doctor? How could they get further information about your work? They could call the project area code 205 nine seven five nine seven nine nine. This is a research project. So we don't charge any fees

for the rehabilitation services. But if you call the project, there's a telephone screening protocol and they'll be able to tell you whether your wife and your wife should be there when you're calling. And there are a couple of tests, very simple ones that they'll ask her to form. And we treat people from out of town all the time. No problem. Well, thank you very much for calling The Infinite Mind. You bet. Good luck to your wife. Thank you very much, both of you. OK, bye bye bye. Let's let's go to Beth in West Virginia. What can we do for you? I'm a neophyte to this this realm as a consequence of a personal head trauma, closed major closed head injury and coma several years ago. How that happened, automobile accident. And fortunately, things are going well. However, I have I am a professor at a university clinic teaching people how to clinically diagnose reading and learning disabilities

and therefore how to remediate those who experience such disabilities. Having experienced that myself, obviously my teaching has altered a bit based upon my experience on a personal level. I'll tell you how things have worked for me on this kind of thing. A certain part of my brain was damaged. I do a lot of writing and a lot of administrative work and I whatever I write, I have to put down, come back three days later and read it again and take the poetry out, because that is not the way I wrote before. However, the part of my brain that has taken charge of my writing processes are functioning in a different area than they had functioned before, and they have taken on a more poetic abstract representation of things rather than the concrete analytical side. And you're complaining? No, I am not complaining at all. I'm not complaining at all. But it led me to understand what you're talking about. I think and it's a major question, is there a possibility

that if an alternate area of the brain assumes the responsibility of the damaged area, the responsibility that all that area had formerly fulfilled, will that be diminished? Is there a possibility of that? Very good question. Our group in Germany is very interested in what one might call the functional significance of cortical reorganization, but there isn't a great deal of other research on it. And so that when there is damage and a area of the brain that has lost its sensory input is invaded. Mm hmm. It ought to be possible to demonstrate that there is a loss of sensory ability for that sensory function that was mediated by the part of the brain that has been invaded. I would lay heavy odds that does occur, but no one has demonstrated that yet.

OK, thank you very much for calling a friend of mine. Thank you. Now I'd like to go to Debbie in Kansas. Debbie, are you on the line? Yes, I am. Welcome to The Infinite Mind. What can we do for you? I have a brother who has had a traumatic head injury in 1985 and we've been working with him and he has recovered significantly. He recently asked me about a ERBE, I believe it is called ginkgo biloba. And he had heard from a a doctor or read it somewhere that this medication would maybe help his memory and help some of the other functioning stuff, his brain. I just wondered if the doctor could speak to that as he does he have any concrete research that that really occurs or not? Khatab, what do you think about ginkgo biloba? I don't know how strong the evidence is for it. It's supposed to increase the circulation in the cortex. I don't think that's ever really been demonstrated in Germany. They've studied it because there's a regulatory agency in Germany that regulates these compounds, um, when they don't regulate them in this country.

So they do have to get data. And Ginko has been shown in mild Alzheimer's to have a modest enhancement of cognition. It doesn't seem to show that effect until the person has taken it for about three to four weeks. And it does seem to be related to an increase, a modest increase in what's called micro circulation in the brain. OK, I hope that was responsive to your question. And thank you very much for appearing on the other side. Thank you. Now, I'd like to go to Georgene in New Jersey. How can we help you? Hello, Dr. Goodwin and Dr. Talab, welcome to The Infinite Mind. Thank you. Well, I'd like to say that your work sounds very exciting, I'm always looking for new types of therapies to improve my son's skills. My son had a right temporal lobe infarct and his left side of him précis as a result. And my question is, have you worked in your research project with children? In my laboratory, we have. And there are two other laboratories that have using the approach that we developed here at

UAB in the VA hospital, and they've gotten very good results. One of the problems with children is compared with adults is getting them to comply with the instruction to where the movement restricting device is more difficult and you have to enlist the parent. But the results that have been gotten are actually quite good. And we think that we're going to be beginning perhaps in about eight months with a project involving brain injury in children with Amy paresis. Actually, you'd expect the results to be good. I mean, putting aside the issue of getting kids to cooperate, but certainly the plasticity of the brain is better than the plasticity of older brains. That is what we anticipate. Well, Jane, thank you very much for calling in front of mind. Thank you.

OK, Dr. Taub, I wanted to. We're running short on time, but I just want to ask you about a couple of things which are I find especially fascinating about the current work you're doing in Germany. One has to do with the changes you've seen in musicians who are string instrument players. Could you just very briefly describe what you found there? This work has been done in collaboration with Professor Thomas Elbert. He's primarily responsible for it. What we found is that the left hand in string players, which has the very arduous task of fingering the strings, it makes the pitches and is a great deal of manual dexterity involved. And string players will practice for hours a day. And when you compare that with the right hand, that bows the strings. This is a difficult task, but it involves largely timing and very subtle differences in pressure. There's much less manual dexterity there. And we found that there was a substantial cortical reorganization,

expansion of the representation in the somatosensory map in the brain of the fingers of the left hand. And this, of course, was based on brain imaging studies where you could actually trace with radioactive tracers or with magnetic images. You could trace the expansion of that area. Right. Magnetic source imaging. Right. Using a magnetoencephalography. Our most recent research we've just written up and submitted for publication has to do with a phenomenon encountered in a fair number of musicians called focal hand dystonia. And that is a condition in which the musician loses control over one or more, usually two or three of the digits of one of the hands. And that terminates their professional career or greatly degrades it. And there have been a number of famous cases of this.

I won't mention names. One of the things that we found is that there is a fusion in the fingers of musicians who have developed focal hand dystonia. That is, the representation of the fingers are much closer together than in the non dystonic hand and those same individuals or in control musicians or normal patients. Why does it develop that? We think it has something to do with simultaneous stimulation of the fingers. When a person does a great deal of practice and it's forceful and they play rapid passages forcefully, there's no data on exactly why. But you asked me what I think. Yeah, but so you could over practice. Perhaps that's a problem. You can certainly over practice. We've developed a therapy based on these observations from the neuroimaging that has been effective to date in six out of six musicians

who had had to terminate their career. Three of them have our concertizing now, and it's a small sample. But these are conditions that have gone on for many years in these individuals. And what we do is we restrict the movement or actually we restrain the movement of one or more of the fingers of musicians with vocal hand dystonia. And we have them carry out a variety of different exercises with the remaining fingers, and our suspicion is that we are breaking apart the fusion of the correct representation of the fingers in the brain. Let me ask you, we have to wrap up, but you had mentioned a couple of new directions as we went along and in response to the caller's. But are there other areas that you wanted to mention where you think this whole area of your work and others work is leading in the future? Yes, and we're doing some of it, and I'm encouraging other people

to do it. You mentioned the phenomenon of learned on use, and I haven't talked about it. But we believe that after damage to the nervous system or in fact, damage to virtually any system in the body where there's slow healing, the person during the healing or recovery period learns to not try to use the affected part of the body because that part of the body doesn't work. But then there's a slow recovery of function by the time it has gone to completion. And the person really could use the extremity, even though in an impaired fashion they have learned not to try to use the limb. And they don't potentially they could, but they don't. And we call this phenomenon learned and non use. We believe that it occurs in the legs after stroke as well as in the arms.

We've worked primarily with arms up to this point. We began working with the legs of stroke patients about six months ago, and we're getting just as good response to the therapy as the upper extremity. And we view this or we talk about it as the gateway to the future, because since this works, one of the things that we're going to start working on this fall is spinal cord patients and also patients with broken hip. We think that at least for some of these patients, not all of them, certainly, but there may be a component of learned unus which can be overcome by the application of an appropriate modification of our basic approach. The excitement in this in this area was picked up very nicely by all of the callers. They were all very excited and very responsive. And I think that reflects what this is about. I think you're being a little modest. I think the kind of stuff you're doing may actually

end up having more generalizable applicability to problems of learning in general and problems, for example, of athletic training and how we teach our muscles to do things. And I think that you may find that people in these areas that aren't even related injury are picking up on this work. I hope so. And thank you very much for your very kind comments. Well, thank you very much for appearing on The Infinite Mind, Dr. Top. It's been my pleasure, Dr. Goodwin. You can reach Dr. Taub at the University of Alabama Psychology Department for 15. Campbell Hall, Birmingham, Alabama, three five to nine. For more information is also available from the National Stroke Association at one 800 seven eight seven six five three seven, or the Brain Injury Association at 800 four four four six four four three four. Easy access to information about stroke, brain injury or anything else you hear in the

infinite mind. Visit our award winning Web site at w w w dot the infinite mind dot com. If you'd like to be a caller on an upcoming program, call us toll free at one 888 three five oh mind. That's one eight three five oh six four six three. Upcoming programs will explore issues including pain, sports psychology and manic depressive illness. Coming up in our second half hour, researchers who are treating brain injury in a very unusual environment, simulating conditions under the ocean. Plus, John Hockenberry tells us how he spent his summer vacation. Stay tuned.