Symptoms Not Characteristics

" I need a lot more rest than I used to. I’m not being lazy. I get physical fatigue as well as a “brain fatigue.” It is very difficult and tiring for my brain to think, process, and organize. Fatigue makes it even harder to think.
My stamina fluctuates, even though I may look good or “all better” on the outside."  http://braininjuryknow.blogspot.com/2015/08/i-need.html

This sounds like rewirlng. It also sounds like a lot of brain injuries.

The brain uses energy. "It is well established that the brain uses more energy than any other human organ, accounting for up to 20 percent of the body's total haul." http://www.scientificamerican.com/article/why-does-the-brain-need-s/

Take away that energy, or put it somewhere else, of course one

will get tired. Fatigue can be a symptom of brain loss or rewiring. It is not safe to assume it is due only to brain loss.

"My stamina fluctuates" is my Socially Awkward Penguin's comment. (He really is called "The Socially Awkward Penguin".)

As the skill is repeatedly performed, the neuropathway gets stronger. "In order for the brain to rewire an activity, the activity must be done repeatedly. Norman Doidge gives a description of this when he likens it to snow skiing, but uses it to explain a bad habit. "Plasticity is like snow on a hill in winter. If we want to ski down the hill we can take many different paths because the snow is so pliable and plastic. But being human we tend to favour one path and pretty soon we´ve developed a grooved track, which ultimately becomes a rut that is hard to get out of." http://thoughtfulveg.blogspot.com/2013/03/groove-me.html  This process of rewiring can take a long time. This process can also be called neuroplasticity.

It can be completed when this new neuropathway is used. The body has to be trained to use it. 

This video shows two neuropathways.The top one is the old damaged way. The bottom is the new  one that works. On days you can do your task, you are using the new neuropathway, or bottom. When you can't, it's the old.
 

These two "characteristics" of brain injury (fatigue and doing/not doing ability) can be "symptoms" of rewiring. This process can take a very long time. It can take years, and a lucky survivor of brain injury won't take as long. "Something" is going on and it should be tracked. Self-report in the form of a yes/no question on a social security form is not enough. (Obviously, if I am still vegetative.)

"So, come up to the lab,/ and see what's on the slab!/ I see you shiver with antici... [3-second long pause] ...pation./ But maybe the rain/ isn't really to blame,/ so I'll remove the cause.../ [chuckles] but not the symptom." The Rocky Horror Picture Show

They Are Neuroplasticians!

For a long time I have been torn by the job of the Early Interventionist, the Infant Development Specialist (IDS). That person is both an educator and a therapist, which gives way to clinician, but they are not seen that way. Often they are "just the teacher." Yes, quite often it is the pre-school special education teacher.

These people are a little different, though. First, they have to take what the doctor said and put it in simple terms for the family. So they have to know a lot. There is a lot of parent education. Not only do they work with the child, but they work with the family. They have to know the physiology and biology and the major workings of the brain. They then have to take that knowledge and be able to relay it to someone who may have only had high school biology...or worse, that person who needs to know doesn't speak English and the interpreter must also understand in order to interpret.

Another big issue is these people will do therapy. Say one of them has 10 children and only 1 receives OT. The others need it. So the IDS arranges for his/her visit to be at the same time as the therapist. After observing (the IDS watches and learns from the therapist), the IDS can then use those same techniques on the other 9 children. Not only does this person learn what is needed for the child being observed, but learns techniques that can be applied across the board. The same goes for speech and PT.

So you can see at least half this person's job is clinical. They do more than "just teaching".

Recently I saw something on neuroplasticity, and it occurred to me. They are neuroplasticians! They don't even know it. They work with babies to minimize disability. They are actually helping to re-wire the brain around the disability.

Of course a child with a moderate disability will end up with a mild disability. That has been documented, but it wasn't known why. Well, here's why-the current neural pathway met up with the disability. The IDS made a new pathway around it (or as far away from it as possible). The child uses the new pathway and either doesn't appear to have the disability or the disability is greatly reduced.

The IDS doesn't start seeing a child with the intent of re-wiring the brain. Understanding and coping may be the beginning, and it can be a long process (years even). But, what is the 1st few years of life compared to the next 60-80?

So these people (the IDS's) are both, teacher and clinician. They are neuroplaticians. It would take a biological understanding as well as an ability to teach. I'd venture to say that many special eduction teachers of older children are the same. It's just by nature that this age group is the most plastic, therefore putting that demand on the involved person, the IDS.

Neurogenic Therapy

Is Angela's Rest Technique (ART), http://thoughtfulveg.blogspot.com/2011/06/angelas-rest-technique-or-art-of.html, neurogenesis? It basically puts movement where there was none. And it does so by working on the brain.
 

Now in order for this to work, there shouldn't be any spinal cord damage. Also, there shouldn't be any physical impairment in the desired area. Something like a straight forward brain injury would work best.
 

I'm thinking that the area that does not move is not paralyzed, but most likely needs re-wiring. "But there's no movement at all." Well then, take and move it. Train it. Use your good hand to move it, or have somebody else do it.
 

I don't remember which, I believe it was a video, Edward Taub described micro movements that we couldn't see were behind his Constraint Induced Movement Therapy.  (CIMT). This would take that theory one step further. I'm proposing there doesn't need to be any movement at all. Not even micro movements. I believe all there needs to be is a working brain and working parts. The desired movement had to exist prior to injury, thereby laying the foundation for the new movement. (The movement isn't actually new. Just getting it done is.)
 

The reason ART works is the brain is constantly bombarded with natural information, but in a way that the brain has to deal with it. ART uses body weight and gravity. Those forces cause the brain to re-wire/make neuropathways to deal with the information coming in (gravity pulling body weight against an area that does not have neuropathways). Also, the involved area must not be impeded such as Spinal Cord Injury or physical deformity.
 

Because gravity is involved, it also develops proprioception. The person would develop their sense of their body in space. http://dictionary.reference.com/browse/proprioception
 

Again, I will use myself as the example. I have pretty much been doing ART and there is now movement. Instead of it being a miracle, the blueprints were already there, it just needed wiring. The basis for movement was there as I was able to perform the desired action prior to injury.
 
Because this process works on the brain, quality of movement would continue to improve. The neuropathways involved would become stronger. If this is used after movement starts, movement will improve. I also recommend adding physical therapy at this time. (I continue to do this and the quality of the movement improves).

"I'm not a doctor, but I play one on TV."

Actors memorize the lines. Doctors do the critical thinking needed to solve the problem.

Learning by repetition, this is rote learning! Memorizing those lines, that's also rote learning. As seen, this is also the best method for re-wiring.

Rote learning is a learning technique which focuses on memorization.. The major practice involved in rote learning is learning by repetition. The idea is that one will be able to quickly recall the meaning of the material the more one repeats it. (http://en.wikipedia.org/wiki/Rote_learning)

I've stated this is the best method of learning with a brain injury. Here's why. Input is the same. When building a neural pathway, repetition of information/stimuli coming in is the same. It has even been shown in mice, you get the better response for repetition. "The results indicate that neuronal network activity including inhibitory interneurons rather than exclusively the input or spiking activity of the principal neurons determine a BOLD response to repetitive stimuli." ( http://www.jneurosci.org/content/29/8/2428.full ) This repetition makes a stronger pathway.

I'll make this a lot easier by likening it to Norman Doidge's metaphor of skiing down a hill of snow. The first time down you make the path. Each trip thereafter makes your tracks deeper. Repetition is the act of going down the hill again. This deepness makes the path more likely to be used.

Rote learning is needed to make a neuropathway.

It's A Critical Time

I remember long ago something about a critical time for learning. I looked some and found http://en.wikipedia.org/wiki/Critical_Age_Hypothesis. This is in speech. "The hypothesis claims that there is an ideal 'window' of time to acquire language in a linguistically rich environment, after which further language acquisition becomes much more difficult and effortful."

I propose something similar. There is an ideal window of time to acquire any skill that has accompanying neuronal development. As a neuropathway is made, the skill is acquired and becomes refined.

To illustrate, the following pictures are of me performing "Pucker" and "Smile",  exercises 2,3, and 4 of  http://braininjuryknow.blogspot.com/2010/11/oral-motor-exercises.html. This my Pucker at first:

I had stopped doing the Oral-Motor Exercises after talking. I had "acquired" the skill, but not refined it. It had already taken a long time to acquire, and much more (refinement) didn't appear to be happening. Recently, I felt I may be in a "critical window" by the results of other skill development. I performed those exercises (20 reps. a day) for a week. If I wasn't in a "window", then nothing. I was amazed with the following:

This is a picture of me performing "Pucker" after a week of exercise There is more muscle tone in the area around my mouth. You can specifically see a crease starting that goes from my nose to my mouth on the left side of the picture.

I only suspected I would get this result as other areas have been doing the same. I remembered a little bit of that theory and looked. I found it only covered speech, but I see it in other areas. I see it in a cognitive test I perform regularly. I'd venture to say it is responsible for the gross motor jump  from pushing up to standing http://www.flickr.com/photos/angelar70/sets/72157626815593901/

This shows that there is a critical window of time to acquire any skill that has accompanying neuronal development.


*I don't want this confused with Speeh, so

I'm pushing up, to

seeing how long I can stay standing.  Standing is definitely not speech.

Give A Little Bit

That neuropathway I'm making, it's the whole thing. So, making it and wiring it. My body made it and now it needs to be guided through the wiring process. That would be two processes. First is making it, then using it. It's actually been seen to happen in special education-a student "doesn't get it" until years later. The people that notice are usually the student and family. School personnel may not. They may not be the originators. But records exist. There's something called an IEP.

With me doing all these things years later, I kept thinking of a kid of about 15 years old a while back. He would walk with assistance from the living room to his bedroom in a care home. His parents probably started in Kindergarten by writing walking as a goal. He probably had to wear special leg splints and have regular physical therapy. Every year, that goal would be looked at and the daily activities increased in difficulty. The staff may be different, but the paper is the same.

And so it has been with me. People will look and think, "she's getting it!" Really though, it's not a miracle. I just had a goal years ago, and did daily activities (this included therapy, exercises, etc.) that progressively got harder. "Progressively getting harder" would sometimes be a very minute change. A lot of times it would be no change at all-just maintain and get used to it. It was just a little bit. So, give a little bit...

Making A Neural Pathway

I have a BA in Psychology and an MA in Special Education so I guess I'm somewhat qualified to do this. Nobody else has been through this either. Somehow, I've managed to keep all my knowledge, it's just taken some time to get my physical ability there. This time, though, has allowed me to see a process.

There has been talk of re-wiring, and having experienced that, yes. But there is something else. When I say I'm "making a new neural pathway", I am. There is something I noticed with on-line brain injury groups: re-wiring happens closer to the injury date. I'll say during the first year. But it doesn't stop there. The wondrous brain continues to grow. So yes, it would make new neural pathways. I noticed another thing with these groups: the longer it's been since injury, the easier things get. I then thought of my Special Education background, it may take 10 years, but a student might get it. I then look at me, I'm not miraculously getting skills back, I'm providing myself intervention to eventually learn new skills. For years I did early intervention, and learned a few things. It has been very limited, though, due to my physical condition. In so doing, I'm providing my brain the opportunity to make a new neural pathway.

So I continue to make new neural pathways. I would venture to say then, ANYONE with a working brain has the ability to grow and change. They have the ability to make new neural pathways. This process of making one takes a lot longer. Educators see it all the time, and special educators deal with the problems of it. It will take the typical person 18 years to complete the education system and most of their neuronal growth. It wouldn't be that hard to say it might take another 18 years for a brain injury recovery. A person may be good enough to pass in a few years, but he/she should be given the same amount of time afforded to a child who is making new neural pathways.

UPDATED 7/26/2012