Doidge has done a remarkable job across time, bringing The Brain that Changes Itself to us previously, with marked acclaim and certainly promoting the miracles of the brain to the lay audience out there. Mostly, the works of those he highlights continue to inspire people till this day. And so his second showcase offering will impact those looking for inspiring ways to understand what the brain in capable of, both in healthy terms, and in terms of compensating for acquired injury.
His first chapter here is no surprise in that regard, choosing to focus on the work of the Sausalito medics who tackle the pain that brings people from all over to their door. In the guise of Michael Markowitz, who suffered his own chronic pain for years until he began to challenge the assumptions he had made as a psychiatrist and pain specialist, and reversed his approach from solely the judicious use of medication, to the visualisations that competed for the neuronal real estate that pain had hijacked.
As in the case of John Ratey, the psychiatrist whose foundation now seeks brain health via exercise, we learn in chapter two of the value of exercise in fending off degenerative illnesses such as dementia, in this particular case, Parkinsonism. The man he is speaking about developed the illness decades ago, but has fended off the symptoms using exercise and concentration. The setting for this is the Boulder's beach in the Western Cape of South Africa, where strangely enough, I was running around myself just last month. Its not a fertile ground for PD sufferers, but the main in question here has, he believed, sponsored his glial cells to produce the growth factors that have kept him free of his otherwise disabling symptoms since 1968. Underlying this is the well-accepted principle that lack of movement results in a drop in cognitive capacity, since the brain is dependent on the growth factors that exercise promotes. Doidge was interested in any claim that exercise could alter the clinical pathway, and with new science coming out of Australia, he was determined to expand his knowledge. What the Australians had found in Huntington's mice, was the ability to prolong healthy life by a decade in human terms, via fast walking on the treadmill. The patient in South Africa was no loony: the intro to his book was written by my old colleague, Dr Colin Kahanovitz who certified the man was on the money. What was significant here was the Run/Walk for Life program which demanded a progressive approach to building up capacity, while emphasizing recovery as a major feature of his training. It also becomes clear while reading that nonuse is what causes much of the decay, with Hannan's work and that of Taub (recorded in the earlier Doidge work), and so becoming inactive is paradoxically what causes much of the resulting loss of movement function. Both Brain and Glial-derived neurotrophic factors result from exercise and movement. Strapping up a limb and thus immobilizing it will lead to a loss of use secondary to splinting. So as we know, disability can easily arise from over-resting, or sedentary behavior. This is true of pain syndromes as well, as we saw in the first chapter. Dopamine is also involved in the motivation to move, so bicycle riding is possible in patients who cannot otherwise move. A recent study described by Doidge has confirmed that walking as the patient here had done, must be an important part of the treatment of Parkinson's as well as Huntington's and other movement and motivation disorders. The follow up section on dementia here is also telling: a 30 year study demonstrated that dementia was significantly reduced as a risk by sustained exercise across the lifetime. Normal weight, low alcohol consumption, non-smoking and healthy diet were contributors to the 60% decline in risk.
Doidge goes on to describe more widely the elements of his approach to neuroplasticity, literally a moving field with the brain perpetually rewiring itself to carry out actions, but at the same time slipping into non-use when attempting to overcome disruptions. One of the more interesting fields he looks into is the use of low energy lasers, particularly in brain injury, literally focussing on the areas outside of the skull which overlay the internal lobes of interest. Picking up on the work of the Russians during the cold war, he describes how experts in Canada in particular as well as the USA following, have begun to use various forms of light to address a host of issues, including wound and orthopedic healing apart from brain injury. This might include using LED light to start and then penetrating up to more than 20cm into the body with intense light, having shown how deeply light can enter the body, and confirming Florence Nightingale and even earlier writing on the value of light, now neglected.
More fascinating is the role in history of Moshe Feldenkrais, who escaped Germany and worked in Paris with the Curies and others before fleeing the Nazi's. His Functional
Movement based treatments are explored stretching even further than his multiple miracles to the restoration of vision in even the blind, via Webber's work.
The revelations here are startling, and one would question the sanity of many medical interventions and dire predictions of disability that Doidge debunks with the work of these innovators. Scoffing would be the standard approach of any medical practitioner in most Western countries, but here is Doidge again, as he did with Moskowitz, and Pepper the Parkinson man, extolling the well-documented miracles he has observed in these healers. The approach he takes is to examine each element of the treatments, e.g. the value of focusing on the blue-black colors seen when you close your eyes and cover up with your palms, as instructed by Feldenkreis, Webber and multiple earlier healers in Buddhism, using this technique to evoke parasympathetic dominance as well as relaxing the whole visual system.
Back-Y-RIta's name, made more well known by Doidge's first book, namely through extraordinary work in neuroplasticity, post-mortem comes up in the work of Danilov and others left behind in his laboratory in Wisconsin. This time, it is in the voice loss owing to MS of the legendary Ron Husmann, a Broadway-famed singer. Not just his voice returned, but using the rectangular electrode on his tongue caused him, over a short period of time, to dump his canes and tap-dance his way out, seeming restored. The PoNS device stimulates only 300microns below the surface, following on the team's pathway that the tongue is, as Doidge calls it, the Royal Road to the Brain. EEG results at Madison demonstrate widespread activation of the entire brain when stimulated by the PoNS electrodes, calling to mind that the tongue involved in an organism highly dependent on its input during evolution: 15-50,000 nerve endings gathering information from the environment. Activation of the brain is concurrent with an exercise targeting the lost or dysfunctional asset, and so the firing and rewiring together can progress. The tongue was not the only part of the body studied by this group: use of a tactile sensitive condom with electrodes attached to parts of the body that can feel, allow paraplegics to enjoy intercourse again. The earlier version of the tongue electrode allowed blind patients to see enough to discriminate objects, working on the basis that the brain sees, not the eyes, which are just entry portals for information which the brain detects as visual. This was again noted in the first chapters of his previous book, focusing on Bach-Y-Rita himself.
All of these revelations reflect back on what Doidge calls a noisy brain, namely that when we are damaged, our brain signals contain a lot of noise which disrupts the smooth orchestration of brain function and hedges the bets against recovery. The use of the PoNS device appears to get the attention of the brainstem reticular activating system and from there, the attention of the entire brain. This means the use of the stimulation is not confined to one type of dysfunction but rather gets the orchestration of the brain on the same hymn sheet so to speak, allowing for multiple applications depending on the exercise accompanying the stimulation, as with the earlier discussion of the use of visualizations specific to pain areas of the brain.
The use of the PoNS after traumatic brain insult, and in particular that associated with the vexing problem of mTBI, or post-concussion syndrome, is again illuminated, and as with the other revelations includes some case studies, including multiple concussions. The results are again startling and immediate.
The only explanation one can make is that the shaking up of the stimulating effect acts in some way to restore homeostasis, namely the auto-correction expected of a second-order cybernetic system as represented by the brain and it's mechanisms. In this regard, interneurons help regulate the activities of the neurons around them, and hence are part of the feedback that accomplishes homeostasis: they do this by regulating inhibition and excitation, which capacity they may lose in brain dysfunction caused by disease or accident. The PoNS machine 'spikes' in activation thus mimic the function of normal interneurons and scaffold the required functioning until natural modulation occurs. That means the functional network is firing during the required exercise and being 'wired together' to scaffold the underlying neuronal direction to successfully carry out the required movement or function.
For these researchers, functional neuroplasticity begins within 13mins of starting the first treatment, with a two hour window around that to achieve some special benefits after treatment, which would imply that the spiking effects last some time after. Synaptic neuroplasticity emerges after some more extended treatment cumulatively, with neuronal changes coming some time after that. Systemic neuroplasticity occurs down stream and may take years to hardwire.
Their recent literature, with the Omaha group, was in MS, and then other research has followed since.
Doidge is far from finished. He tells of the amazing work of Alfred Tomatis, his patient Paul Madaule rescued from a monastery, going on to heal with music in his turn. Tomatis
was in fact the first person to demonstrate the danger of noise in occupational settings, and its connection to movement and psychological problems. Opera singers, he found, had more noise in their system from singing than they would from a jet engine at the same range, hence opera singers were experiencing hearing loss at 150decibels within their skulls (jet…132dec). The lower range singers are not unique in terms of the singing apparatus, but because they can hear at lower ranges and hence can sing there! You can only sing it if you can hear it. That was the first Tomatis law. Hearing, if fixed, can fix the voice. The ear is thus only the external attribute of the cortex. These frequencies are also locally determined, so the French find the frequencies of American English easier to hear than the frequencies of British English.
Throughout, it is Doidge the storyteller who expertly combines the nuances of years of complex research with illustrative experiences of patients who have undergone neuroplastic interventions, which allows all of us to then play catch up with the clandestine world of the researchers who are not seen to be mainstream, perhaps not understood by the press that will distort their discoveries by reporting them without understanding. Doidge allows us to follow the journalism he masters in telling these stories so we understand the impact his colleagues have made, and will further make, as time goes on.
As an improvement on even the skill of his first book, this second take on neuroplasticity will find a niche on everyone's bookshelf and is highly, highly recommended to everyone.
© 2015 Roy Sugarman
Roy Sugarman PhD, Director: Applied Neuroscience, Team EXOS USA