I recently watched the BBC programme Horizon called ‘My amazing brain: Richard’s War’ with very mixed emotions. It was first shown 9pm 5th Feb.
If you didn’t see it, Richard suffered a massive bleed in his brain which lead to almost complete incapacitation. He survived, did regain movement in his left arm and leg, but was bed bound, had no movement in his right side and he’d lost the power of speech. The programme followed his rehabilitation to a good recovery, which was an extraordinary achievement: 2½ years later, Richard dressed himself in his military uniform and attended The New Zealand Armistice Day ceremony.
Richard underwent intensive therapy, the early stages in the hands of the NHS. Later stages had to be paid for privately – through funding from elsewhere.
If he made such an excellent recovery, what is there to gripe about? Why am I extremely frustrated?
Two months after the bleed to the brain, he was slumped in a wheelchair with physiotherapists assisting him to sit up unaided, saying that by now, for a good prognosis, he should be able to do this. And he clearly couldn’t.
Poor Richard! As far as I could tell there had been no rehabilitation to any part of his brainstem: the brainstem governs posture; this is the part of the old brain that helps us stand up straight against gravity. It can be rehabilitated initially with things like sound, smell, light, swallowing and so on. This not that hard to do!
Time went on and we watched him relearning how to walk. Again I could see no evidence of his movement maps being rehabilitated first, or, even more primal, the sensation maps! The rule is extremely simple and basic: sensation before movement. Also information travels through the cortex from bottom to top and then from back to front. You can see in the picture to the right that the somatosensory cortex lies immediately behind the motor cortex. So if movement is lost, you first need to stimulate this sensory cortex for the signals to be able to reach the motor cortex. Hence sensation before movement; there are very many nerve endings carrying tthe very many types of sensation we need to be aware of, for example, warmth, cold, pressure, light touch, deep touch, sharp, dull and so on. So much could have been done to help Richard, despite his right side floppiness.
Also with the loss of speech, this points clearly to the damage being to the temporal and parietal lobes caused by the obvious physical damage to the left side of the brain. Richard was back home before speech therapy was even considered. Again look at the brain: in the parietal lobe we go sensation association area, speech, the main sensation cortex and THEN motor cortex – followed by another speech area, Broca’s area, in the frontal lobes.
But even before that we have the Occipital lobe, the first processor of vision. Following the simple rule of neurology, we need to stimulate the visual system first. And here it was that my blood pressure rose. Presumably because it was a programme for the Beeb, they brought over one of the leading lights in the neurological world: Professor Michael Merzenich. Now this man led the discovery that the brain is plastic: which means far from the brain cells slowly dying off after we hit 18 years old, they do indeed regenerate and the brain is plastic, which means it rewires itself through out life according to what we ask of it until the day we die. Prof Merzenich said this discovery is very exciting and he was sure the neurological world would take it up and run with it – only it didn’t and hasn’t. And here’s little me battling on my own here in UK to spread the word.
Prof Merzenich examined Richard and said the right side of his visual field wasn’t there. And Merzenich saw Richard about 2 years after the brain bleed. Two years!!!! So they forked out money for art therapy to bring back this visual field, whilst Prof took him to a race track where Richard drove a simulator race car – and indeed, at first the car kept veering to the right and crashing into things, but because Richard had loved driving, his brain rapidly rediscovered how to drive a car – at speed and in race conditions. His right visual field snapped back to attention.
When Richard dressed himself in his uniform at the end of the programme, I saw he did the buttons up with his left hand, which suggests to me that there is more rehab that could be done to his right side so he can make even further gains. Brains are plastic and respond to the right stimulation.
And this is why I have such mixed emotions. It was wonderful to see how a determined man can make such a good recovery with, frankly, cack handed rehabilitation. It was very depressing to see how little our top neurologists/physiotherapists seem to have understood the very basics of neurology, even if this knowledge is relatively new.
It seems that it will be many, many years before what I currently know becomes more common knowledge. Until then, what I do seems weird and wacky, rather than the obvious first steps to regaining the brain and body of younger years.