There is hope for neurological recovery: Redirect behaviors of habitPosted: February 23, 2013
Although many neurological disorders appear to be structural and the result of neurological dysfunctioning, recent research suggests that there is much more hope that people can learn to restore function. Even people affected by stroke, cerebral palsy, or epilepsy can regain function. The observed symptoms and dysfunctional movement patterns can be understood as the nervous system’s best strategy to solve a problem at that moment and is the best response the person could perform under the circumstances. For example in the case of stroke, a spastic movement is the best solution that becomes a conditioned habit pattern. It may occur because the person tries to achieve the previous motor behaviors which can no longer be performed because of the neurological damage. With cerebral palsy, the initial damage at birth changed the motor patterns as the child attempted to walk. While in cases of epilepsy, the spreading of the seizure across the brain is not inhibited. Despite the neurological damage, improvement is possible as demonstrated by Jill Bolte Taylor’s presentation of her experience and remarkable recovery from a left hemisphere stroke.
Application to stroke rehabilitation
A useful premise underlying neural regeneration and development is that it healing follows developmental movement sequences which cannot be skipped. Thus after a neurological injury such as a stroke, the movement sequence needs to be re-integrated. It is not relearning what was lost; it is learning the new skills as if the skills are being learned for the first time. This includes an attitude of acceptance, non judgment, fun, play and exploration concurrent with many, many, many training practices until the skills are mastered. Thus stroke patients sitting in wheelchairs may try to repeat movements which were present before the stroke but which are now beyond the biological developmental stage due to the neural damage. The person instead needs to learn anew the movement sequences that a baby mastered (lifting the head, rolling over, cross crawl moment, crawling, etc). This takes lots of practice. Compare the many hours a baby/child practices in order to be able to stand to the limited time people with strokemay spent performing their prescriptive exercises. Thus, children usually show mastery while many people with stroke demonstrate limited improvement. It is practice, practice and practice; it is not mindless practice, it is practice with awareness and intent.
Dysfunctional patterns can be understood as over learned conditioned chained behaviors which occur automatically. A superb explanation of this process is described by Charles Duhigg in his book, The power of habit-Why we do what we do in life and business. Clinical success is to identify these chains and the sequential steps and then teach the person to redirect the behavior.
Application to epilepsy
Some people with epilepsy can learn to identify the initiation of the seizure and then interrupt the cascading sequence by doing something different. In this way the seizure process is interrupted and no seizure will occur. For example, one man hyperventilated before a grand mal seizure. When the therapist taught him to become aware and change his breathing pattern each he began to hyperventilate, his epileptic seizures did not occur. Similarly, a young woman with epilepsy turned her head to the right and slightly lifted her chin upward just before an absence seizure occurred. Teaching her to interrupt her initial head movement and looking straight ahead while slowly exhaling inhibited her seizures. The efficacy of this type of behavioral analysis for the treatment of epilepsy has been described by psychologists, Joanne Dahl, PhD and Tobias Lundgren, PhD in their superb article, Behavior analysis of epilepsy: Conditioning mechanisms, behavior technology and the contribution of ACT.
Another powerful treatment approach to treat seizures was developed by M. B. Sterman, Ph.D. at UCLA who taught people with epilepsy to control their own electrical activity of their brain with neurofeedback. Many people benefited from neurofeedback training and significantly reduced their seizures.
Application to cerebral palsy
To appreciate the power of interrupting the chained behaviors and the possibility that there is hope for people with cerebral palsy. This is illustrated in the remarkable TEDx Winnepeg talk, Baby brains DO recover, but habit hides it, by Karen Pape, MD.