Neuroplasticity

AS RECENTLY AS 2002, when I had my strokes, many doctors were still saying, "You have six months to make your recovery. If you don't get better within six months, you might have incremental improvements, but that will be it." This terribly destructive, self-fulfilling, and amazingly inaccurate view still persists in some corners. If I had a giant view eraser, I would spend the rest of my life eradicating that idea from every corner of the world. It simply isn't true. And it has done more harm to stroke survivors than you can imagine.

This misguided view stems from the old notion that the brain is like a car engine, a system of fixed parts. Current brain research has recently amply demonstrated that the brain is not like this at all. If you have all the normal sensory and motor systems and all the brain formations humans generally come with, parts of your brain will specialize. Your brain will dedicate one part for hearing, another for vision, and another for speech. But the brain is a dynamic, ever-changing, ever-remapping process, always ready to use itself as fully and efficiently as possible. That's what's known as neuroplasticity in action.

If you lose your hearing or your vision, the parts of the brain dedicated to those functions don't simply sit idle and empty. Brains are, biologically, expensive real estate. Leaving them vacant is wasteful. Your body will find other uses for your brain tissue. The wonderful thing is that this process is going on every minute, not just turning on once in a while. Your brain is constantly performing a self-check, evaluating the usefulness of itself.

What's also wonderfully true is that if a part of your brain is injured, you may be able to recruit some other part to take over the function the injured part used to do. This is evident everywhere. I've seen it time and time and time again. Long before I heard the term neuroplasticity, I learned this lesson by living it. Every day I learn this lesson again from the stroke survivors I meet. But it was hard for a while to convince some people, even some well-meaning medical people, that this is true. All too often, those of us who managed to get a lot of function back were considered the exceptions to the rule, the miracles. I don't want to be a miracle. I want to be evidence to somebody else that transformation is possible.

Believe me, I jumped for joy when Dr. Norman Doidge's book, The Brain That Changes Itself, became available. Sitting on an airplane as I flew to Atlanta, I read this book and grinned from ear to ear. The research was now here. Neuroplasticity has been measured, demonstrated, and scientifically validated, and the information has become available to all of us.

Researchers are working with stroke patients. At a national stroke conference I attended in 2007, I met a medical researcher from Wake Forest University in North Carolina who conducted a study using MRI imaging of the brains of stroke survivors up to twenty-three months postinjury. A brilliant rehabilitation technique researched and made widely available by Edward Taub called constraint-induced movement therapy produced clear evidence under the imaging that new, uninjured parts of the brain were firing up to do the work required.

I didn't have all this theory to back me up when I was first injured. I had a little bit of knowledge along with real-world practice and emerging experience. For a long time I had to rely on my powers of observation and my general stubbornness and unwillingness to believe that I would have only a limited time to get better. Initially much of that practice and observation happened in the rehab gym.

The rehab gym has a free space in the center. We patients would wheel ourselves in and line up, as best we could with our various limitations, in the middle of the room waiting for our therapists to come and get us and lead us to our time with the appointed equipment, whatever that might be. As we were lined up, sometimes we would talk a little with one another and watch as patients of all sizes and ages went through their routines. We all had different appointments during the day with various physical therapists, depending on the nature of our injuries and our ability to work.

In my case, I had three daily appointments in the gym. Each day I would see my lead physical therapist, Erwin. The rest of my life, no matter how long it might be, can't possibly contain enough days to experience all the gratitude I have for Erwin. Erwin organized my PT treatment plan and worked with me individually. I also had an appointment with Julia, my sweet and patient gait therapist, and then there were the mat appointments. The mat therapists varied. They were all great, talented, and kind. They taught me many things. They couldn't help the fact that I hated mats.

Mats involve group work. They are repetitive exercises designed to build strength and coordination. Three or four patients are lined up on a raised mat, off the floor, on legs, rather like a very large, low table. The first thing you have to learn in order to do mat work is safe movement in and out of your wheelchair and onto the mat. The instructions are precise. It's important to learn them to be able to transfer yourself safely. It's scary when you have no confidence that even with help you can be momentarily on your feet, turn, feel for the edge, and sit.

The appointments with Erwin and Julia entailed a constant, moment-to-moment interaction with each therapist. These therapists became like extensions of my body, guiding it, stimulating it, helping it get where it needed to go. With them, I could experience possibility. On the mat, however, I was on my own, lying there side by side with other patients as I tried to follow instructions.

Bridging is a trunk-strengthening exercise. Having learned it, I still do bridging, although I'm much better at it than I was then. At the time it was a struggle. Most of the work was being done by my right leg, as shaky as it was. My left was largely along for the ride, and my left foot had to be wedged in place to keep my left knee bent. The object is to slowly raise and then even more slowly lower your bottom off the mat and then back onto the mat. I wobbled. I shook. I had the barest control. And I had to do it over and over and over again in sets of ten.

On the mat there was nothing to distract me from my miserable thoughts. I inevitably compared myself with other patients who could "do it better" than I could, which left me feeling even more helpless. But on the mat I was learning to work even if I couldn't see the success of what I was doing. I didn't like mats, but learning to work without an assurance of success proved to be a very powerful tool in my recovery.

I now know that walking is not so much performed by the legs but by the trunk muscles. These are the muscles of the back, the abdomen, and the chest. Surprising, isn't it? But it's true. Try strengthening your core, and see how much more easily you'll walk. My core was weak, and my trunk muscle control was poor. I needed a lot of strengthening. I lay on the mat thinking about how fit I'd been. How easily I had walked. But there was bridging to do. Day after day, I lay on that mat and did the bridging exercises.

During my first few days at the rehab hospital, I was strapped to my wheelchair with a seat belt. I felt like a little kid in a car seat. It wasn't easy to accept the fact that without the strap I might slide out of the chair, like a baby who hasn't learned how to sit up. But with weak, uncoordinated trunk muscles, this result was likely. Bridging changed that. After many days of spending time on the mat, I could sit up on my own without the seat belt.

It wasn't that my muscles had suddenly stopped being strong when I had my strokes. My muscles weren't much different than they had been ten days earlier - a little weaker from inactivity but not all that much. What had changed was my brain's communication with my muscles. What I was bringing back was the link between my trunk and my conscious decision to do something.

In his book Musicophilia, the famous neurologist Oliver Sacks tells us that if a musician temporarily loses the use of a finger, the area of the brain devoted to operating that finger shrinks. And if the musician exercises one finger more than the others, the area devoted to that specific finger expands more than the others. This is the way the brain works. When we put our effort and intention on something, the brain responds.

If I wanted to regain the use of my body, I would have to recruit new brain tissue to take over from the injured parts. The more I worked, the greater the likelihood that expensive brain real estate would be diverted to accomplishing what I was trying to accomplish.

I now know that within the limits of our anatomy and experience, we're the architects of our abilities. Neuroplasticity can create amazing opportunities for change.

Some changes are harder to make than others. Speech-center injuries are among the most difficult to work with. I have a friend named Rita Martin. I met her two and a half years ago. Rita is one of the most remarkable people I know. Rita had a stroke in 1996, nearly thirteen years ago - a left cerebral hemorrhage. Rita's speech center was wiped out, gone. She had no ability to speak. She could think, but she couldn't say anything. The speech therapists told her that with extensive speech therapy she might, just might, be able to say yes and no someday. Rita didn't give up. Rita never gives up.

For a year and a half, Rita didn't talk, not a word. And once she began to talk, her speech was aphasic. Nonfluent aphasia is the ability to think a word without the ability to say the word you think. You think apple. You say "window" or "road" or something else totally unrelated, or only vaguely related, to what you're thinking. Amazingly frustrating, right?

In response to that frustration, many people give up the attempt to talk. Remember what happens with neuroplasticity when you stop trying? No effort, no brain real estate devoted to the task. As I said, Rita never gives up. When I met her in 2007, Rita could already carry on a great conversation and she has continued to improve since. Sometimes it takes her a while to find the way to the word. She may say, "How do you say...?" before she finds it. Some days are better than others. But Rita isn't finished yet. She's still working on her speech.

When I first had my strokes, I had no idea that I had the power, the built-in biological ability, to become the instrument of my own recovery. I'd never thought about my life that way. At first I nourished my own personal version of the "I've been pushed around by life and it isn't my fault" story. It's one thing not to like being told what to do. It's another thing altogether to take real responsibility for the process of my own life. But the stroke was offering me this lesson in a way that I couldn't avoid. What I did, and the choices I made, registered in my brain tissue. In the rehab gym I could see in myself and in other patients that change was possible. If I'd decided not to work and to just sit and feel sorry for myself, nothing would have changed. I'd still be unable to move. I watched and saw that those who worked at it seemed to make the most changes. Those who were passive seemed to make fewer changes, no matter how hard their therapists tried.

Deciding to be the architect of my future was not such a simple decision. I didn't just lie on the mat and in great clarity of mind and heart say, "No problem. I'll do this." There was a lot more I needed to learn first, which brought me to the next lesson.

© 2009, Alison Bonds Shapiro, All Rights Reserved
Excerpted with permission from Healing Into Possibility © 2009 by Allison Bonds Shapiro. Reprinted with permission of New World Library, Novato, CA. www.newworldlibrary.com or 800-972-6657 ext. 52.

ABOUT THE AUTHOR

Alison Bonds Shapiro received her MBA from Golden Gate University and has had an extensive career in investment real estate. To pursue her lifelong dream of developing her art, she left the corporate world. When she had completed four of the finished paintings for Just for Today, Alison suffered a major stroke that left her unable to write her name. After what doctors term a “miraculous recovery,” she went on to complete this book. Alison lives in Marin County, California, with her husband, Bob. To visit her website please go to www.alisonbshapiro.com.