Saturday, May 2, 2009

Lateline ~ Norman Doidge discussing neuroplasticity

This week I saw an amazing interview with a psychiatrist Norman Doidge discussing neuroplasticity. The current research and experience with neuroplasticity has many implications for education. A transcript of the interview is below and a link to the video also.....


Norman Doidge discusses neuroplasticity

Australian Broadcasting Corporation

Broadcast: 01/05/2009

Reporter: Leigh Sales

For about 400 years, scientists saw the human brain as a machine. But psychiatrist Norman Doidge, in his new book The Brain that Changes Itself, argues brains can build new connections to compensate for injury or disease.


LEIGH SALES, PRESENTER: For about 400 years, scientists saw the human brain as a machine. The thinking was that it had parts that were responsible for particular functions and if one of those parts broke then the function was lost for good.

In recent years, many experts have changed the way they think about the brain and now believe it can actually reinvent itself. The theory's called neuroplasticity, the idea that the brain can build new connections to compensate for injury or disease.

Psychiatrist Dr Norman Doidge has researched the science behind neuroplasticity and he'll be at the Sydney Writers' Festival this month to discuss his book The Brain that Changes Itself. He joins me now from Toronto.

Dr Doidge, thanks for being with us.

NORMAN DOIDGE, PSYCHIATRIST: Thanks for having me.

LEIGH SALES: Let's leap straight into some practical examples. You write about the case of a woman with a bad balance impairment who wears a special cap that allows her brain to adapt to that deficiency. Tell us briefly about that.

NORMAN DOIDGE: Well, there's a form of plastic change that was invented by Dr. Paul Bach-y-Rita called sensory substitution. He was the first of a generation to start arguing that the brain could - the sensory part of the brain could readapt to devastating losses. And this woman you speak of was Cheryl Schiltz. She was given an antibiotic for a routine hysterectomy which poisoned her inner ear, so that 97 per cent of what's called the vestibular apparatus or the balance organ in the inner ear, was blown out. And one day she woke up and she had no balance. She was a woman who felt she was perpetually falling. And in fact, even when she fell to the floor, the sense of falling didn't go away. She felt a trap door opened up and swallowed her.

Now, Dr. Paul Bach-y-Rita, had been working on sensory substitution and he found a way to give her a hat that contained something called an accelerometer, which is like a gyroscope. It told her her position in space. It fed information to a computer that fed the information back to something about the size of a stick of chewing gum that had about 100 little electrodes on it that gave little sparks on her tongue - very gentle stimulation that felt like champagne bubbles, so that if she rolled forward she would get champagne bubbles rolling forward telling her the position of her head. And I was there when this cure occurred and she couldn't stand up, she put on the hat, they turned on the machine and suddenly it was as though there was total peace of mind that she had and her balance was restored. And over time she wore that hat - over the time she was wearing it they noticed that after she took the hat off there might be a few seconds of time when she was without it and she still had her balance. And they realised her brain was taking that stimulation and training itself and making new pathways. So, after about a year of wearing it from time to time, she no longer needs it and her brain rewired itself and she's completely cured.

LEIGH SALES: You write about children with learning difficulties and language impairment and one of the tenants of brain plasticity is the idea that people have to do brain exercises to help the brain adapt. What sort of exercises do those children have to do?

NORMAN DOIDGE: Well, it depends on the mental function and the area of the brain that's weak. Till brain plasticity was discovered, we found ways of getting children to go around the difficulties, but now we go right into the difficult areas. So, for instance, for children who have reading problems based on auditory processing difficulties, they have to listen to very elemental sounds. What we do is we take speech and it's slowed down so that a particular child can hear it and then it's only speeded up gradually over time incrementally till they can hear speech at a normal rate. And once they can, they can record the sounds crisply and clearly and it helps them not only with comprehending speech, but with reading, with writing and even with their mental discourse inside their heads. If they have problems recognising emotions, there are different kinds of exercises developed, for instance, by Barbara Arrowsmith, where she got people to look at certain scenes and educated them in learning how to read non-verbal cues. So, there's just a multiplicity of exercises that are now coming out for these different kinds of learning disabilities.

LEIGH SALES: Well some of the arguments in favour of brain exercises seem to back the notion of rote learning which has gone out of vogue in recent decades?

NORMAN DOIDGE: Yeah. Well, aspects of rote learning were dispensed with in the 1960s because they were thought to be boring and irrelevant. But it turns out some of these actually are very, very good for your brain. For instance, children often had to memorise long poems. Well, this really builds up the RAM, if you will, or the auditory memory, in a very significant way. People study elocution. Well, the ability to speak clearly helps you not only speak clearly but it trains a part of your brain that turns symbols or the symbols of language into motor movements and it gives you a kind of grace which carries over into other activities. So, another thing that people frequently did is they paid an almost fanatical attention to handwriting. Well it turns out that there are a lot of children who have terrible handwriting. They print instead of writing cursively, and that's because they don't have enough memory in the part of the brain that turns symbols into motor movements. And when they go through these exercises, they, again, improve their handwriting, but they're also able to speak better in public because that requires turning symbols into motor movements, and their reading often improves because you have to move your eyes across the page and take in just the right size of eye gulps to read at a good speed. So a lot of these things actually gave a kind of mental grace and by dispensing with them, I think that there was a loss.

LEIGH SALES: Are the techniques used in neuroplasticity applicable for psychological problems as well as physiological ones?

NORMAN DOIDGE: Oh, I think so. I mean there are - on many levels. You know for the longest time, for instance, psychiatrists often felt that - some psychiatrists felt that, you know, there was serious work that was done with medication and then there was talk therapy, which was just talk. But we now have brain scans that show that psychoanalytic, cognitive, behavioural and another form of therapy that's based on neuroplasticity as well lead to the same kind of changes in the brain that you can get with medication - changes in different areas, but significant changes. We know meditation leads to changes in the brain and there are also some brand new treatments that began by analysing problems, by looking at people's brains with problems and scanning them and then concocting exercises to help them shift mental gears, for instance, so that they could get rid of worries and obsessions and compulsions. So, it's - I'm a psychiatrist. I got into - my interest in brain plasticity was triggered by a sense that there was more that we could do by using our thoughts to basically change the structure and the function of our brains.

LEIGH SALES: So it seems we've come a long way then from Rene Descartes' view that the mind and the brain are made of different substances and are governed by different laws.

NORMAN DOIDGE: Well, what Descartes did is he was trying to solve a problem, which is that it seemed that the rules of mind were different, would follow logic or maybe the rules of emotion, and the brain seemed to follow, you know, the physical laws of Galileo and the mechanical laws of movement. And he argued that the mind will influence the brain, but he could never persuasively show how that happens. And we still haven't totally solved that problem. But what we can do now, which is very, very exciting, is we can actually see a person in the process of thinking and the number of brain cells - the number of connections between brain cells being altered. The Nobel Prize in the year 2000 went to Eric Kandel who showed that when animals learn, when we learn, you can double the number of connections between nerve cell A and nerve cell B. And the way that it works is your thoughts actually turn on genes inside the nerve cells in the brain to make new proteins to sprout new connections. So, I would say that the line between mind and brain is still there, but it's more like a dotted line than a solid line at this point.

LEIGH SALES: If it's correct that the brain is plastic, why then is not every person who has a stroke or every person who has a learning difficult able to be cured?

NORMAN DOIDGE: Well that's a great question. First of all, there's certain things that have to be in place for a person with a stroke to even be able to do exercises. They have to be able to attend to those exercises. Attention turns out to be very, very important for speeding up plastic change. And many people with strokes have a problem with attention. You know, you have to be living. If you have a stroke in your brain stem or a part of your brain that governs breathing or a basic function, you may not live to do those brain exercises. There's the size of the lesion. But what we're finding is that the work of a doctor Edward Taub in Birmingham, Alabama, has shown that with very common strokes such as the loss of the use of an arm or even the loss of speech, a new kind of brain exercise can bring it back. What he ingeniously determined was if a person loses the ability to move their right arm, they'll try to move it and their brain will learn it doesn't work and so it'll stop working. Now, we have learned that in thousands of experiments now, that it's a use it or lose it brain. So when you stop using something, whatever potential you had to help or heal yourself withers away. So what he would do is he would take the good arm and put it in a sling so you would not be able to use it and then he would incrementally train the arm that wasn't working. And he's had fantastic results, actually. And we've done brain scans - the royal "we" of science, that is - has done brain scans on these patients and we know see that other areas of the brain - of the grey matter of the brain are actually now taking over the function of moving the right arm in - because if you look at the people's - inside the heads of the people who've had the strokes, the original area that was harmed is still dead.

LEIGH SALES: How much do you believe we have yet to learn about the way the brain works? Are we at the beginning of an era of understanding or are we close to the end?

NORMAN DOIDGE: Oh, I don't think we're close to the end. I mean, the brain - if you just calculate the sheer number of connections that - and states in which these - our many, many brain cells can be in, the brain can put itself into more states, if you will, than there are known objects in the universe. So, it would very arrogant to assume that we're anywhere near the end. But that much being said, I mean, it's been a just spectacular, spectacular 20 years.

LEIGH SALES: In the field of brain science, is neuroplasticity mainstream?

NORMAN DOIDGE: I think it's fair to say that finally, in hard-core brain science, neuroplasticity is not only mainstream, it's not a theory, it's a fact. And it's a fact that applies to all level of brain functioning. What we're trying to do is understand the limits of plasticity and the possibilities of plasticity. That's being sorted out. The key thing that we have to do now is translate the knowledge we have in the basic science literature into all the different clinical practices. I mean, it's already begun in, you know, in psychology and neurology and in parts of psychiatry, but we have - there's so many areas that stand to benefit - physiotherapy, speech therapy, again, dosing in education: how fast can we learn? How fast can a brain change as its learning? So, that's what's going to happen over the next 50 years.

LEIGH SALES: There's a statistic in your book that if you live to age 85 you have almost a 50 per cent chance of developing Alzheimer's disease.


LEIGH SALES: Science has made a lot of inroads into expanding our physical longevity, but has enough study gone into making our mental faculties match that?

NORMAN DOIDGE: Well, I mean, I don't think so. But we're - it's - we're just beginning to understand these core property of the brain's plasticity - to know about it. There are people who focus on aging and, you know, in the ageing business, the business that's trying to help us age well, what you aim to do, basically, is - macabre as it may sound - is create a situation for people so that their organ systems all crap out at the same time, if you will, they all collapse at the same time, but that you have a functioning brain up till that point in time.

And, there are two - several major causes of cognitive decline in old age, OK? The first one is Alzheimer's that you've spoken of. That is clearly a disease and we know a fair amount about the disease, but we don't really have significant treatments for it yet. Then there's something called age-related cognitive decline. That is more common than Alzheimer's and that's what almost everybody in this culture begins to get in their 30s when they occasionally forget something. By the time they're 50, they're really kind of worried about how often they will walk into a room and forget why they were there. And age-related cognitive decline ties back into what I talked about of one of the major epochs of plasticity, this long period in middle age when all that we do is replay mastered skills.

Now, if you want to keep a brain in shape, you can't just do what you always do. If you want to get your heart in better shape, at a certain point you want to do some interval training, you want to get your heart rate up. And you have to do the same for your brain. So, spending all middle age reading the newspaper, watching television or dancing the old dances will not give your brain enough stimulation. You need novelty. You've got to learn new dances. You've got to tax it - the way you might've had to tax your brain when you were trying to learn a French vocabulary if you're an English speaker in high school. And some of the programs I describe are put together by, you know, 50 neuroscientists and they have a fantastic - fantastic effects on the brain 'cause they're based on the latest plasticity research. There's a program by Posit Science that we now know can actually turn back the memory clock, if you will, from between 10 to 25 years, so that people who are 80 now have the memory capacity they had when they were 70, and in some cases even, you know, 25 years younger. We also know that these same programs can double your ability - double your mental processing of language, double the speed of your mental processing of language. And not only do they work on people who have normal ageing brains, but these programs have been helpful for people who've developed chemo-brain or chemo-fog after chemotherapy for a cancer treatment, some people with multiple sclerosis who've had language and memory problems have benefitted, veterans coming back from Afghanistan or Iraq who've had memory concentration difficulties have benefitted, people with lime disease, even HIV. So we're seeing that this brain stimulation is just an overall health booster for the brain.

LEIGH SALES: Dr Doidge, thank you for joining Lateline.

NORMAN DOIDGE: Thanks very much for having me.

1 comment:

  1. Hello Scott.

    Doidge's book -- the Brain That Changes Itself -- is excellent. It's full of examples of brain plasticity.

    I agree that this new way of seeing the brain has huge implications for education. With all of those studies showing that working memory capacity predicts academic success, we now have a tool that can help children and adults strengthen and build working memory capacity.

    My company publishes brain training software that makes use of these findings with techniques to train working memory for children and adults. Mind Sparke Brain Fitness Pro is the most effective and affordable brain training program of its kind.

    Best wishes,
    Martin Walker