The Brain That Changes Itself by Norman Doidge, MD – Chapter 5 – Midnight Resurrections – Stroke Victims Learn to Move and Speak Again

“Stroke is a sudden, calamitous blow. The brain is punched out from within. A blood clot or bleed in the brain’s arteries cuts off oxygen to the brain’s tissues, killing them. The most stricken of its victims end up mere shadows of who they once were, often warehoused in impersonal institutions, trapped in their bodies, fed like babies, unable to care for themselves, more, or speak. Stroke is one of the leading causes of disability in adults.” P. 135

Doidge tells of Dr. Edward Taubs, “constraint-induced” movement therapy that operates on the principle of neuroplasticity. Doidge gives the example of Dr. Michael Bernstein, an eye surgeon who suffered a stroke, went through the Taub Therapy, and was able to return to his busy practice. This intensive two-week program went non-stop from 8:00 a.m. – 4:30 p.m. five days a week. p. 132-135

Using a surgical procedure, Taub worked in an experimental lab where they were cutting a monkey’s afferent (sensory) nerves allowing no sensory input. This caused test monkeys to not sense where their limbs were in space, feel no sensation or pain when touched. Also working on this area, Nobel Prize winner, Sir Charles Sherrington, in 1895, “supported the idea that all of our movements occurs in response to some stimulus and that we move, not because our brains command it, but because our spinal reflexes keep us moving. This idea was called the ‘reflexological theory of movement’ and had come to dominate neuroscience.” P. 138 Spinal reflexes do not originate / involve in the brain. (example: knee reflex) F. W. Mott found that when he cut sensory nerves, not motor nerves, the monkey could not move that limb. “…he proposed that movement is based on, and initiated by, the sensory part of the spinal reflex, and that his monkeys couldn’t move because he had destroyed the sensory part of their reflex by deafferentation.” “Other thinkers soon generalized his idea, arguing that all movement, and indeed everything we do, even complex behavior, is built from chains of reflexes. Even such voluntary movements as writing require the motor cortex to modify preexisting reflexes.” p.139

Taub took this one step further, by putting the monkey’s good arm in a sling, the monkey was forced to use the one that had been deafferented. He wanted to apply this information to stroke patients who could not move their limbs. After further tests and much controversy, Taub laid Sherrington’s reflexological theory to rest. P. 141 Once there has been a trauma when sensory nerves have been disabled; there is a period of “spinal shock” that lasts from two to six months.  During that time, an animal may try to use affected limbs, but without reinforcement, it stops trying – learned nonuse. P. 141 Further, he learned that he could correct learned nonuse in monkeys. He, then wanted to apply this to stroke patients – addressing both massive brain damage and learned nonuse. After six years defending himself against PETA, he was then given a job and a grant to work at the University of Alabama in 1986.

The Taub Clinic – treatments:

  1. Grown-ups wear mitts and slings on good hands and arms for 90% of their waking hours.
  2. Many small rooms and one large room for exercises developed by Taub and physiotherappist, Jean Crago. “The Taub clinic always uses the behavioral technique of ‘shaping,’ taking an incremental approach to all tasks.” P. 147 For example:
    1. games that appear to be for children – as they relearn tasks
    2. pushing large pegs into pegboards
    3. grasp large balls,
    4. pick pennies out of a pile of pennies and beans
    5. 6 hours a day – 10-15 days straight (conventional – 1 hour – 3 times a week)
    6. patients get tired and nap
    7. mild stroke patients – nearly all recover; severe stroke patients – 50% recover

“What rewires patient’s brains is not mitts and slings, of course. Though they force them to practice using their damaged arms, the essence of the cure is the incremental training or shaping, increasing in difficulty over time. “Massed” practice – concentrating an extraordinary amount of exercises in only two weeks – helps rewire their brains by triggering plastic changes. Rewiring is not perfect after there has been massive brain death. New neurons have to take over the lost functions, and they may not be quite as effective as the ones they replace. But improvements can be significant …” p.  149-150

Doidge also tells of a young woman who had brain damage due to radiation treatment for a brain tumor. She also benefited from the Taub clinic. P. 150-154                Taub’s clinic uses “Constraint – Induced” therapy or CI. It also has been used for patients with speech aphasia (Broca’s area of the brain) — when an individual can not find words. Mitts and slings do not constrain the good side when the damage is to the speech area. “The ‘constraint’ imposed on aphasics is not physical, but it’s just as real: a series of language rules. Since behavior must be shaped these rules are introduced slowly. Patients play a therapeutic card game.” P. 154-155 Key elements:

  1. 4 people – 32 cards – 16 different pictures
  2. 1st – not point, but use language in any way they can
  3. Discard matches. Winner – one who gets rid of cards first.
  4. 2nd – must ask for by name, “Can I have the dog card?”
  5. 3rd – must ask by name politely, “Mr. Schmidt, may I please have a copy of the sun card?”
  6. Later – more complex cards are used (colors and numbers).
  7. Beginning – praised for simple tasks; Later – praise for more difficult tasks only. P. 155

Taub’s training principles:

  1. The closer to everyday life, the more effective.
  2. Training should be done in increments.
  3. Work should be concentrated into a short time. “massed practice” (like immersion for foreign language learning)

Taub’s methods have successfully treated other difficulties – children who had strokes in utero, those with cerebral palsy etc. Merzenich, Taub and others later demonstrated that neuroplasticity could affect larger areas than first seen. P. 159-163

This research and these activities are foundational to the neurodevelopmental approach. Read more about our work on our website: www.centerforneurodevelopment.com

 

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