Thursday, October 6, 2011

Gabriella Giffords and the Wonders of Neuroplasticity

The valiant struggle of Congresswoman Gabrielle Giffords, victim of a bullet that traversed her brain "through and through," is a marvel. It is just four months since she was shot in the left hemisphere of the brain, the side most studied because injuries to it are more obvious. Even though a teaching hospital was nearby, making state-of-the art care available, neither that nor her will to recover would have mattered without "neuroplasticity."
In short, neuroplasticity, also known as "cortical remapping," is a term for how the brain can find other ways to make things work when its usual pathways are destroyed or blocked. Imagine that you are driving down a road and suddenly it stops and you have to figure out where to do. The brain has a kind of GPS that will find a way.
Doctors and scientists had believed for more than a century that brain damage was incurable. They also believed the development of the brain virtually ended after early youth.
But as early as 1890, psychologist William James proposed that brains could evolve, in what is now known as "remapping."
Wikipedia explains neuroplasticity thus:
Neuroplasticity (also known as cortical remapping) refers to the ability of the brain to change as a result of one's experience, that the brain is 'plastic' and 'malleable'. The discovery of this feature of the brain is rather modern; the previous belief amongst scientists was that the brain does not change after the critical period of infancy.

The brain consists of nerve cells (or "neurons") and glial cells which are interconnected, and learning may happen through change in the strength of the connections, by adding or removing connections, and by the formation of new cells. "Plasticity" relates to learning by adding or removing connections, or adding cells.
James wrote about this possibility in "The Principles of Psychology," published in 1890. Sigmund Freud suspected this in a phenomenon he called transference, when he observed in 1914 that memories thought forgotten could reappear as actions. For more than a century the theories of James, Freud and others were widely rejected.
Just four years ago, while researching new brain scan techniques that could accurately spot minor traumatic brain injuries in soldiers, I was told by a science writer that I shouldn't bother because there were no treatments for brain damage.
There is much more to tell, and I will elsewhere. It is worth noting that what acclaimed physician-author Dr. Oliver Sacks would have called Giffords' "therapeutic moment" came early. An emergency room physician asked her to squeeze his hand with her left hand as she entered, and she could. The right hand wouldn't respond, showing that there was much to be done.
Giffords' staff has been pushing Congress to make the same kind of care she received available to everyone. Presently, many insurance companies require patients to pay out of their own pocket for the latest in brain spect scans. Fine if you have several thousand dollars or more not being used for anything else.
And the Catch-22 is that some won't pay if depression is considered part of the equation. Wow. Which came first: the depression or the trauma?
Perhaps one of the most horrible stories in the history of medicine is that many thousands of brain injury or disease patients were considered little more than vegetables, to be fed and watered, as described in Sacks' movie "Awakenings."
Why assume the patients were completely unaware of what was going on around them? Because the alternative was unthinkable, said a physician played by Max Von Sydow in "Awakenings."
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Previously published on the Huffington Post

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