The above video is about the work of Edward Taub, the man who pioneered CI therapy to help victims of stroke or brain injury regain use of the non-usable side of the body. Its a bit of an odd video since it has a couple of 30 sec breaks where nothing happens and then the video resumes – unless my computer is on the wonk, of course. Always a possibility.
Taub laid the foundations for this work way back in 1981 by experimenting on monkeys. He cut the nerves to one arm and found that the monkey could be trained to use the arm again by either putting the unaffected arm in a sling, so the monkey was forced to use the de-nerved arm. And this could done some years after the original operation, so the arm had not been in use for all that time, yet could still be brought back to life. Rather fascinatingly, he also found that if he put the damaged arm in a sling straight after the operation, so the monkey never knew the arm didn’t work, after a period of 2 months, when the spinal nerves had had time to recover from the shock of the operation, he removed the sling and the monkey used its arm as before.
And this demonstrated that part of the problem is learned non-use. Which has massive implications not only for brain damage, but for any severe pain that leads to someone not using the arm – or leg, come to that. Because trying to move the affected arm gets no where at first, the patient, be it human or experimental monkey, gives up even trying: if we don’t use it, we lose it.
And so Taub realised he had to address not only brain damage but also learned non-use. And this involved rewarding the monkeys not only when they reached the food, but also when they tried to reach for the food.
CI therapy involves intensive training for a fortnight leading to great improvements in regaining use of the lost limb. One patient, Nicole von Ruden suffered an inoperable brain tumor which was treated with extreme radiation. It got rid of the tumour, but left Nicole with a completely useless right side. Eventually she entered CI therapy and, to quote:
It’s really incredible, the amount of improvement that occurred in just five minutes! And then over two weeks – it’s earth-shattering. ………. Buttoning was insanely frustrating for me. Just one button seemed like an impossible task. I had rationalized that I could get through life without ever doing that again. And what you learn at the end of the two weeks, as you are buttoning and unbuttoning a lab coat rapidly, is that your whole mind-set can shift about what you are able to do. 1
At first to button a coat is not only frustrating, but also very hard work. When we lose the use of a limb, the key areas of the brain don’t just fade away, they merely shrink. So when relearning how to use the limb, the brain reorganises itself to find a new way to do the lost function. I suppose the closest thing we can experience is writing our names with our non-dominant hand. Extremely hard and frustrating at first. But even with a short spell of intensive practice we can see a real improvement.
There are three overall points here: one is to never give up if we or a loved one suffers brain trauma, and the other is despair that this therapy is still not front line. Here in the UK, my sister-in-law had a huge tumour removed from her cerebellum and the rehab she received afterwards was non-existant. My brother taught her how to walk again. I suggested she ask for neuro-physiotherapy, and the surgeon said it didn’t exist – despite there being a centre for it in the locality, as a brief google search showed.
The third point is the extraordinary plasticity of our brains. Just as with our body, use it or lose it. And to improve means leaving our comfort zone. A point worth bearing in mind as we age. To keep the grey cells sharp, it helps to take on new mental challenges as well as keeping physically active: a good time to get our heads around Ancient Greek and Extreme Frisbee, maybe.
- This blog is based on the book The Brain that Changes Itself by Norman Doidge. [↩]