Mechanics of Learning – lessons from neurorehabilitation

“Use it or lose it” – is a particularly apt description of brain function. Continuously (until death) new connections are formed between the 100 billion nerve cells which we have been born, and the 100 to 10 000 connections per neuron with others forming extensive networks makes the brain an enormously complex organ.

Probably some neuro-neogenesis (perhaps 6000 cells a day) occurs even in adulthood. Only those synapses, however, which are actively used, remain functional.

This is the basis of learning – the interaction and exchange between organism (us) and environment in problem solving tasks of daily living. Investigations on neuroplasticity in recent years have become a central topic in neuroscience, and have changed the attitude towards patients with lesions of the central nervous system.

They have also led to a better understanding of the adaptations of structures and functions of the brain according to requirements from the environment (environment being understood as the physical, psychological and social surroundings with their potentials and constraints).

In neurorehabilitation, such understanding of the interactions between organism and environment and that of learning is used and adapted in the treatment of patients with acute or chronic diseases or trauma. In reverse the observation of the changes attained during rehabilitation of such patients provides new insights into the mechanism of learning and of adaptations of brain structures and functions.

By Prof. Jurg Kesselring, Department of Neurology & Neurorehabilitation, Switzerland.

This article was first published in the Brain Association of Queensland Synapse magazine. www.synapse.org.au

Neuroplasticity

Researchers used to believe the brain pathways (for sending messages between the brain and the body) were fixed or unchangeable. This meant if a function was performed by a certain area of the brain, it could only be performed by that area. Therefore, after stroke they believed any damage that wasn’t repaired within a few months would be permanent.

Research now indicates the brain has the ability to change. This means brain pathways can change. This ability is called neuroplasticity. As a result, some stroke survivors may be able to retrain the brain by learning to use different parts of their brains to regain function during rehabilitation.

For a video about Neuroplasticity from Dr Norman Doige

There are a number of great puzzle games that can help you to exercise your brain IQ Puzzler are some great ones

Neuroplasticity is the term given to the brain’s ability to change after experience the idea that the brain is malleable and even “plastic”.

This understanding of the brain’s ability to adapt to new experience is relatively new—previously it was widely believed that the brain did not adapt, that any damage or injury was irreversible and that changes to the brain were impossible after infancy.

The term “plasticity” refers to the possibility of forming new cells and new connections after an event such as stroke. While it is still a hot topic of scientific research it is a subject that we expect will be of great interest to our community of stroke survivors.

Here, survivor Allison Bakker gives us her own review of a fascinating book, Norman Doidge’s The Brain that Changes Itself. Alison believes that she can try to retrain her own brain post-stroke by focusing activity and movement on the parts of her body that were most affected. It’s tiring and frustrating but worth it, she believes.

Book Review by Alison Bakker

Norman Doidge has written an amazing book about neuroplasticity. The simplest definition of neuroplasticity I found was by Leigh Sales on the ABC’s Lateline program: Neuroplasticity means that, “Brains can build new connections to compensate for injury or disease”.

That means to me that your brain can do the old things in a new way. In his book, Norman Doidge explores different therapies that use the brains neuroplasticity to recover from injury.

One therapy specifically for stroke-affected folk is called Constraint Induced Movement Therapy (CI Therapy) devised by Edward Taub. Basically, as far as I understand it, this involves intensive practice with your stroke-affected side to the exclusion of your unaffected side.

So your unaffected side is constrained, usually with a mitt or sling. By practicing new movement, getting better and better at it, you are reprogramming your brain to do the old tasks through a new pathway bypassing the old damaged one.

Some of the results have been amazing. The book discusses one case involving a man who recovered fine motor movement in his hand and balance skills 45 years after his stroke.

And another story is about a boy who stroked in-utero and had no use of his left hand. He did CI Therapy aged four and can now play baseball with his friends.

I heard Dr. Doidge speak at the Melbourne Writers Festival recently. His words were interesting but just as interesting were the questions that followed from the audience.

Although his theories on neuroplasticity were science-based, what was interesting was the hope he created in the audience. Brain injury is usually devastating. It affects people physically, mentally and psychologically and alters lives in irreversible
ways.

Maybe, looking at neuroplasticity, people can see hope for themselves or their loved ones. The questions involved many different types of brain injury, from acquired brain injury to cerebral palsy and even mental illness.

Dr. Taub’s CI Therapy clinic is in, Alabama, USA. Looking at the website the application demands passion and commitment from the potential patient, unwavering determination and the motivation to work hard.

The rehabilitation is 6 hours a day for 10 to 15 days and the cost from Australia would, I imagine, be prohibitive for most of us.

I can’t afford to go Alabama. I have a family to run; cricket, swimming lessons, part-time work and the rest but I will take on some of these principles as I can.

To improve my fine motor skills I’ve started to unpack the cutlery tray from the dishwasher with my affected hand, using my hand to get all cutlery round the right way before putting it in the drawer. It’s a pain really—and it annoys me—but I keep at it because I can feel it working and doing good.

Dr. Doidge’s exploration of neuroplasticity reminds us of good, old fashioned principles. Perseverance, persistence, doggedness, and practice, practice, practice!

And the way I figure it, I’ve got 40 more years of unpacking the dishwasher to go, that’s 40 years of hand rehab, so things really should improve, eventually.

Alison Bakker is a stroke survivor and sometime writer. She lives in Melbourne with her husband and two children, and works part time as a registered nurse.