I am barely a quarter through, “The Brain that Changes Itself” by Norman Doige, and am find it a most illuminating scientific read.
As a physiotherapist of some 28 years, the issue of neural plasticity has been both an exciting and a frustrating one at the clinical level. Exciting because, as Doige’ book explains, the idea of neural plasticity has been around for all of my career, but a clinical understanding how to utilise it for the variety of brain defect that are seen. Whether as a ‘minimal cerebral dysfunction’ of a child suffering a complexity of intellectual and motor learning issues or an elderly person suffering a stroke, there has long been a certain faith among therapists that neural plasticity holds the answer to better rehabilitation. Physiotherapists working with sufferers of chronic pain have also expected that re-learning at the neural operational level will provide significant breakthroughs. While we have all been aware of the fabulous outcomes of cochlear transplant technology, and now there is a product nearly on the market to help the blind to see through tongue sensory reception technology, the more common rehabilitation work is yet to reach those lofty heights. Some research has provided small fruits over the past 10 – 15 years, such as the constraint induced (CI) therapy mentioned in Doige book, yet neuroplastic programs which can consistently provide much better outcomes across the spectrum of motor disorders are yet to be designed for widespread use in Australia. Perhaps it is more a case that the budget for rehabilitation in the public sector is so poor compared to the requirements of approaches such as CI.
Now Doige’ book gives us all a look at where the field of neural plasticity has gotten. It gives an overview of the fascinating ability of the brain to ‘re-wire’ to improve function across the range of brain problems – learning disorders, mental health disorders such as anxiety and ocd, and motor disorder such as stroke, providing the appropriate learning program is in place.
Doige book helps us to postpone any early judgements on a ceiling of neuroplasticity, as there are implications that neurochemistry manipulations (drug therapy) may enhance neuroplastic training potentialities.
I work mainly in the field of injury and musculoskeletal pain syndromes. Occupational related pain syndromes continue to show cause in the habitual approach of the body to a task. Like lots of things in our life, I see that brains take us on a path of least resistance in the solution of a problem. Once it has ‘solved’ the problem, it will tend to stick with that solution. The difficulty we often see in chronic pain or chronic inflammatory disorders, is the difficulty to re-train a new solution, or even to re-train the brain so it has access to a number of motor solutions to the one task problem.
Functional re-training has become the cornerstone of occupational rehabilitation. This is a cognitive approach which relates to the physical change of environmental conditions, work timetables and routines. They don’t change motor habits as such, but are more designed to pre-empt the worsening of the pain syndrome by minimising the stress levels cause by the motor habit. It also doesn’t do anything about the habitual attitudes and emotional underlay that contributes to motor activity and even physiological and biochemical changes in the body, even though psychologists acknowledge that management of anxiety may relieve arthritic pain.
Doige work suggests that we are on the verge of a massive change in our approaches to rehabilitation by adaptive brain training.
Not to be mislead that neural plasticity applies to ‘disability’ but will begin to underpin the educational life of everyone. In the new world, the educational life will commence from preparations that would be parent make to add to their family to the end of that new addition’s life, so neuroplastic techniques will becom a constant companion.