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  • The Infinite Brain

  •   Health Talk: Brain Plasticity

    Abigail Trafford
    Host: Abigail Trafford
    Hosted by The Post's Health Editor
    Tuesday, September 28, 1999

    Contrary to popular belief, your brain is actually capable of great regeneration and flexibility. Brain plasticity gives new meaning to the maxim, "Use it or lose it."

    Dr. Jordan Grafman, Chief of Cognitive Neuroscience at the National Institute of Neurological Disorders and Stroke, was our guest for "Health Talk" with host Abigail Trafford.

    Please read the discussion below.

    Abigail Trafford: Hello everybody and welcome to Health Talk. Ever worry that you're losing brain cells? Here's a new view of the brain. Turns out the brain can adapt and learn new skills throughout life--with a little luck and coaxing. To learn how to best use your brain, send us your questions.

    Abigail Trafford: Dr. Grafman. Welcome to Health Talk. Today in the Health section writer Don Colburn explored the "new brain." Instead of being hard-wired like a computer and rusting out with age, the brain is surprisingly flexible and capable of changing and learning throughout life. Tell us what accounts for this new view and why it's important?

    Dr. Jordan Grafman: Both animal research and functional neuroimaging studies that enable us to view the human brain while a person performs a task has shown us that the topography of the human cortex is constantly changing when we learn something new or when the brain is recovering from brain injury. This is good news as it gives us a way to determine if a medical intervention like a drug or cognitive remediation is effective in facilitating recovery from stroke or head injury.

    Abigail Trafford: But how does one part of the brain take over from another part of the brain? Some examples?

    Dr. Jordan Grafman: We are not exactly sure yet. It may be that all areas of the brain have secondary latent functions that can emerge when the area of the brain that they are usually stored in is damaged. The damage may release the inhibition of those secondary functions that is normally present.

    Bethesda, MD: Are there any "mental exercises" one can do to increase the number and reach of our "connections?" — to improve the brain-mind's quality and length of life?

    Dr. Jordan Grafman: The answer is straightforward. Continue to learn. Take courses. Challenge yourself. Be as you were when you were in school. Choose topics that will force you to reason and problem-solve from learning a new language to learning a new skill. This intensive learning into old age is guaranteed to help your brain form new connections and improve its functioning!

    Washington, DC: My 62 year old father recently suffered a massive brain hemmorhage which has caused a multitude of physical and mental deficits. He is unable to swallow and is extremely sensitive and defensive to any stimuli around the face-mouth. Beacause he is able to speak (not to a great extent) and swallows his saliva only occasionally (not on command) doctors and therapists seem quite baffled as to why he cannot swallow. It has been one year and he is still unable to swallow. Is it possible, given his age, that the brain can relearn this particluar type of function?

    Dr. Jordan Grafman: A rule of thumb about recovery of function after a stroke is that most recovery takes place in the first three months, a little more in the next three months, slowing of recovery until one year and afterwards almost none unfortunately. You should make sure that your father has seen a swallowing specialist. Your neurologist can make a referral for you. Swallowing like so many other functions is controlled by the brain and it must mean that a specific brain area that helps to control swallowing is damaged.

    Bethesda, MD: My mother has suffered brain damage from CNS lymphoma. She had surgery a month ago, during which they removed the brain tumor and the damaged part of her frontal lobe. Since then, the tumor has grown back; we decided against chemotherapy because of the toxicity and she is having a course of radiation treatment. She is 77 years old and was previously in very good health. Is there any likelihood that she can regain any part of the cognitive abilities she has lost, in whatever time she has left? She is walking, talking, eating, and alert, but cognition related to logic, time, numbers, sequence of events, etc., is not there. Her prognosis is very poor. No neurologist has evaluated her since her surgery.

    Abigail Trafford : Is this a situation in which you should consult a neurologist? What can a neurologist do for this patient?

    Dr. Jordan Grafman: When in doubt, consult a physician concerned with brain function. In most cases that will be a Neurologist or Neurosurgeon. If the tumor is continuing to grow without much hope of effective treatment, then it is unlikely that she will regain the functions she has lost. A Neurologist can accurately evaluate her status and may be able to treat certain symptoms even if the tumor continues to grow. For example, depression can be treated and sometimes certain cognitive functions can slightly improve when the depression is effectively treated.

    Rockmart, GA: Does the "use it or lose it" work for deterring Alzheimers disease. In other words does it help in preventing cortical atrophy?

    Is it true that when people grow older if they do not keep involved in learning experiences they are more likely to develop dementia illnesses?

    My mother had alzheimers,but did not develop it until past 80 years old. Lived alone until she was mid 80's with some help managing funds, etc. Her brother also had alzheimers at about the same age. Guess that means I am highly suspect. Right?

    Abigail Trafford : Is there a familial form of Alzheimers? What percentage of Alzheimers does it account for? And can mental exercises — the use it or lose it approach — prevent damage in the brain?

    Dr. Jordan Grafman: There is some scientific evidence that more learning or education stalls the onset of Alzheimer's disease. Once Alzheimer's disease begins, however, it has the same course as it has in people with less education or interest in lifelong learning.

    Alzheimer's disease can run in families. Your best bet is to explore your family tree and see if it is there (your Mother's parents, etc.). If you find it frequently in your family, then it does make it more likely that you may develop the disorder (but it is not a guarantee). Familial Alzheimer's disease accounts for a minority of the people who have the disease. Even in familial Alzheimer's disease, mental exercises can help postpone the onset of the disease-if even only for some months.

    Portland, OR: I received a head injury several years ago. At the time it affected my life a great deal with loss of professional skill, job, relationship, etc. Today, I have either compensated for the loss or rediscovered-relearned my lost talents. Is this the plasticity that you refer to? What about football injuries?

    Dr. Jordan Grafman: Depending on the location of the brain damage, compensation can be more or less successful. Many functions or responsibilities can be performed in more than one way and often people utilize the spared cognitive process to regain their "normal" functioning. They are performing the same task but performing it differently now. A small lesion due to a head injury may allow for real plasticity to occur-where the remaining brain sector that is used to mediating the function has survived and allowed your recovery. Football players can get concussions, and repeated concussions can result in a dangerous injury. New guidelines for evaluating athletes who play football or soccer are being instituted to prevent more permanent damage.

    Queens, NY: I am 54.Two years ago I was mugged by someone using a japanese choke hold that cuts off blood from the carotid arteries. After I woke, i found I could not navigate even two blocks from home and had to go to a nearby bank to get my bearings. I also saw double. These deficits only lasted a half a week but what upset me most was I could not do arithmetic anymore.-for 6x22 I'd say, 6x2 is 12, now what do I do with the 1?- It was mortifying. But I tried. Every time I looked at a clock, I'd try to factor the time in my head-i.e. if it was 5:11, i'd divide by 2,3,7;7's a factor, then divide to get 73 which is a prime- I'd try to get it done before the digital clock left that minute. Then I'd do the next and keep at it for half an hour. After a year, my brain came back, sort of; I was no great genius to begin with. The point is, you can only heal if you make a great effort, it's important to you, it's humiliating not to be whole. I think that's the key.

    Dr. Jordan Grafman: Motivation to strive to recover from a brain injury is a real key to successful rehabilitation. It enables you repeatedly practice skills and abilities and as I have said that will facilitate plasticity and recovery of function. You have to start with the motivation to succeed.

    By the way, injuries to the left parietal lobe of the brain (shown in the article) can sometimes lead to a selective problem in arithmetic!

    Paris, France: Do you believe that the latest findings and research on brain plasticiity could apply on finding a how multiple sclerosis evolution and spreading?

    Dr. Jordan Grafman: Multiple Sclerosis causes plaques in the white matter that disrupts and degrades transmission between brain sectors. It is possible that rewiring to some degree could take place in MS patients but that has not been studied. Plasticity is most often studied in human patients who have suffered a stroke.

    Waldorf, MD: Our daugther suffered a severe TBI approx 12 yrs ago as a result of an MVA. She was 15 at the time. At the time we were told what you see is what you get! Her biggest disability is that her brain doesn't tell her eyes what she is seeing (layman's definition). In fact she doesn't even recognize her mother or I, only by voice. This seems to apply only to people or objects and does not affect her navigating around the house etc. Is there any treatment for this we should be looking into? Thank you!

    Abigail Trafford : Jordan, is this a "traumatic brain injury" from a "motor vehicle accident"?

    Dr. Jordan Grafman: The kind of impairment you are describing is called agnosia. It can be quite selective for faces and objects. People can sometimes see the objects well but they don't know how to use them and they don't recognize a familiar face anymore (prosopagnosia). These deficits usually are caused by brain damage in the parietal and temporal lobes of the brain. There may be some help for your daughter's problem. You need to have her seen by a neuropsychologist who will be able to determine whether teaching her a specific strategy would be of some help. Even a traumatic brain injury from a car accident can cause this problem.

    Goshen, IN: I am a 49 year old female.I have problems with memory.One time -only once did this happen- I was asked my address and couldn't remember it, I had to look at my drivers licence. I was totaly embarrased. When I read, I have to re-read several times in order to comprehend. Is there any hope? For the most part I do ok, but there are these few times every now and then when it happens and it scares me.

    Dr. Jordan Grafman: Make sure you get seen by a Neurologist so they can evaluate your problem pronto.

    Bethesda, MD: I read in the article about how one girl had one hemisphere of her brain removed, and had recovered almost fully. If one half of her brain can take over all the functions that a whole brain can do, it seems strange that the man with only a small part of his brain damaged cannot talk and paint at the same time because both functions are in the same place. If a half brain has enough space to do what the removed half did, why is it that there is no space in another brain for one extra function? Does it have to do with the age of the person?

    Abigail Trafford: Great question!

    Dr. Jordan Grafman: It is absolutely not the case that a half a brain can assume the complete functions of the whole brain. In these instances, the fact that someone can recover a great deal is highlighted and the deficits they are left with tend to be overshadowed-particularly when a news reporter has a limited amount of time to report the story. We all cheer for recovery though. As we develop, the cortex and other regions of the brain compete to store knowledge. Each part of the brain has a genetic command to store a certain type of knowledge but at least in childhood that command can potentially be overridden to account for learning a special skill or to help recovery of function. Usually after the age of 5, this plasticity diminishes a bit and after the age of 14 it becomes much more difficult to see new areas of knowledge storage emerge.

    Washington, DC: Last year, a 37-year old relative became severly disabled, mentally and physically, due to a seizure that caused a loss of oxygen to his brain. He's better than what was first predicted--in fact his memory and comprehension often surprise us--but he seems to have plateaued now. Do you see any of the new findings on plasticity being able to help cases like his? If so, what is the best way for us to pursue this?

    Abigail Trafford: This is a frequent question. People make a certain amount of progress and then seem to hit a wall. How does the brain get itself charge up again to go over the wall and keep making progress?

    Dr. Jordan Grafman: There seems to be a normal recovery period where the biological capacity of the brain is most critical to restore neural functioning. That can be helped by therapy. When to intensify therapy remains a question of great interest to scientists. After that recovery period (usually by one year), changes that occur are related to changes in thinking induced by skill learning or the development of new cognitive strategies. This cognitive remediation is usually administered by neuropsychologists. The trouble is that we have very few scientific studies that show a particular approach to cognitive remediation is effective of not. Most of the studies are clinical and observational and cannot prove the effectiveness of a remediation therapy.

    Herdon, VA: I have always believed the conclusions that your studies are leaning towards. I would like to take it to another level. I would like to know what studies are currently under way concerning the management of controlled brain affixiation to force the brains ability to reach out to unused portions and have synapsis take place in these regions. I have had this theory and have successfully force plasicity to take place in unknown regions of the brain. Certain abilities that were currently unknown but obiously present in sertian people can be explained. I would also like to know if these "NEW" developments in this theory are being applied to autism and hyperactivity in children. Is this being studied?


    Abigail Trafford: In autism is there a treatment based on training the person to use a different part of the brain to overcome the barriers of autism? Is there a particular part of the brain that's involved with autism? In hyperactivity?

    Dr. Jordan Grafman: In the case of autism, there are reports that many brain areas are not well developed or functioning normally. In particular, it is thought that frontal lobe dysfunction is partly responsible for the difficulty that autistic people have in social interactions. There problems tend to remain into adulthood and there is currently much work in trying to understand why certain developmental disorders are not prone to plasticity while acute events like a stroke may be.

    Phoenix, AZ: If the brain can redesign-restructure itself, there must be sources of control within the brain that knows how to do all this. What are those sources of control in the brain? The science of genetics has done a marvellous job finding those little controllers in living systems, but what about at the next higher level? Are there parts of the brain that control other parts?

    Dr. Jordan Grafman: Genetics certainly control the brain's biological capacity to a great degree. The frontal lobe, however, controls our ability to manage our behaviors-what we call social cognition, planning, problem-solving. The frontal lobe by virtue of storing critical components of these functions has a great deal to say about how we guide ourselves through life-including whether we spend much time engaged in mental exercises and new learning.

    Arlington, VA: I am 26 and have always been better at right-brained things than left. For example, I love reading, writing, art, etc. Math, while I still test above-average, comes much harder. What can I do with my own children if anything to make sure they make robust connections on the left-hand side so they can be better than I at things like logic, statistics, math, etc? PS Does map-following have anythign to do with this also? I tend to navigate by experience and object familiaritiy; my father, who is much better at math and who is very logic, gets his kicks out of looking at maps and finds it frustrating that I have trouble and dissatisfaction with them. Thanks.

    Abigail Trafford: Is this also a male-female thing?

    Dr. Jordan Grafman: Developing specific skills has everything to do with whether your environment promotes learning those skills, natural ability based on genetic predisposition, and your own curiosity. There does seem to be a gender difference, however slight, in that women have superior verbal skills while men tend to have superior spatial navigation skills fore example. No doubt your cortical space in your brain reflects these differences. Your brain has made space for the skills you see yourself doing better in and therefore practicing more whereas the skills you do less just have less cortical space committed to them.

    Arlington, VA: My son was diagnosed with having a stroke in utero at 7 1-2 mo.. Since then, we have seen a lot of doctors regarding prognosis and reason for the stroke in utero, and have started occupational, physical, and (soon) speech therapy with him. He is a mild right hemiplegia. One of our big questions, so far, is that if this, indeed was a stroke in utero shouldn't this have shown up on the sonograms that were done? -I had a very detailed one -level II- done at 8 mos. gestation.] Is there anything we should watch for in particular in terms of development -e.g., spatial perception problems- other than the general problems associated with Cerebral Palsy--this being a right hemiplegia rather than left? Are there any new treatments that you know of that are worth exploring?

    Dr. Jordan Grafman: You should identify the area of the brain that shows the damage. Each area of the brain has been assigned a difference cognitive process. If your son has a right hemiplegia, it suggests a left hemisphere injury. The left hemisphere is very important for language and arithmetic functions. You will want to watch out for problems in these areas and make sure a speech pathologist is consulted if you see problems in development.

    Falls Church, VA: A friend suffered damage to right frontal lobe as a result of being struck by an auto. He now has short term memory loss, among other things. Is it possible for him to do anything to improve this memory problem?

    Dr. Jordan Grafman: There are many books in your local bookstore that have to do with improving memory. Most of them will suggest that the person utilizes strategies to help organize information in memory. Frontal lobe injuries don't affect our ability to encode new information but they may affect your ability to search for that information in memory. Practicing how to organize new information in memory may help improve this problem. These days with new technology, palm computers can be a very effective therapeutic device for reminding.

    Rockville, MD: My son suffered a massive brain hemorrhage (right parietal) at age 21. Subsequently a PXA tumor was discovered and completed removed after two more surgeries. During his neuro rehabilitation, his math skills only minimally returned. He is now back in college full time. His major is financial information systems. He had completed (A's) his high math classes prior to all of this. He is now having problems with a programming class. He use to excel in this. He is close to graduation. Can he recover enough of his math skills to continue in his chosen field. How?

    Dr. Jordan Grafman: Parietal lobe injuries, usually on the left, do cause math problems. The right parietal lobe may contribute to number processing by helping us to get close to a math answer and then the left hemisphere allows us to get the precise answer to the problem. It is not likely that he can recover much in the way of his arithmetic skills without have received targeted therapy for dyscalculia. There are only a few such places in the world and they are at academic centers. These days with HMOs limiting formal therapy in hospitals you like many others are having to struggle to find methods on your own.

    Arlington, VA: I had a celebellar infarction nearly two years ago that required removal of necrotic tissue from the cerebellum. Now I am left with residual dizziness and a perceptible -at least to me- deficit in my left hand. I recently read of experimental surgery in Pittsburgh that reimplants neural cells in stroke areas. Do you see a combination of plasticity and reimplantation as a possible salvation for stroke victims? Thanks.

    Dr. Jordan Grafman: Yes, the hope is that a combination of implantation or stimulation of stem cells into a damaged region along with the regions natural plasticity will help in recovery.

    Monterrey, Mexico: I am interested in bettering my own mental faculties, adn those of my sub-5 aged daughters. I have read that some study or another proved that listening to Mozart before a math exam improves analytical abilities and the score....this is a temporary stimulation? Are there specific activities or exercises that one can do to improve artistic or analytical skills? Can you reference specific books or sources?

    Abigail Trafford: Ah, the Mozart effect. . . It's supposed to make people perform better on tests. And for pregnant women, listening to Mozart is supposed to instill a love of music — even music ability — in the fetus. Jordan, is this nonsense? Or is there some evidence that certain types of brain stimulation can improve mental ability?

    Dr. Jordan Grafman: Forget Mozart-that has been discredited by recent scientific evidence. Just listen and enjoy.

    Megta-vitamine B-balanced complex have been known to heal tissue faster & more completely in human body since 1930's. There are many nutrition stores throughout the United States. Any information on curative doseage levels; recommendations; etc.; appreciated!!!S:TSVD M.D.

    Abigail Trafford : We've also heard a lot about vitamin E and the prevention of Alzheimer's. Any evidence to support the use of vitamins or minerals to help brain function?

    Dr. Jordan Grafman: Its good to be healthy but there is no compelling evidence that it can help plasticity in the short time. Perhaps it forestalls the onset of the effects of old age or can partially contribute to reducing the effects of strokes. Many studies are underway now to look at Vitamin E and other compounds that may help reduce the effects of secondary brain damage.

    Washington, DC: You mentioned a theory earlier that when the brain is damaged , perhaps other, previously inactive, areas lose their "inhibitors" and come on-line, so to speak, in order to compensate. Do we know what chemicals are responsible for the release of the aforementioned inhibitors, and could those chemicals be synthisized?

    Abigail Trafford: In other words, are we getting close to developing a "brain pill?"

    Dr. Jordan Grafman: Yes, many scientists are conducting studies using drugs that can facilitate recovery and at the same time reduce the effects of the insult to the brain. No magic bullets yet.

    Alexandria, VA: I have a daughter who is currently 10 years old. We adopted her from Russia at age 6. She has a central auditory processing disorder from — we think — untreated ear infections as a baby and lack of stimulation. She does very well considering — but I often wonder how much should we focus on coping (i.e., accepting her limitations and learning alternate ways of getting information) and how much on "curing-i.e., challenging her weak areas to stregthen them. Any ideas?

    Abigail Trafford : Are there any learning centers or programs that specialize in children who need this kind of support? And what works?

    Dr. Jordan Grafman: There are many Universities and learning centers in the Baltimore-Washington metro area that can help you. You might want to try the Kennedy Center at Johns Hopkins University.

    Evergreen, CO: If you surgically removed an entire hemisphere of the brain, would the remaining hemisphere be able to compensate? Could it "learn" to do the tasks that were lost?

    Abigail Trafford: Johns Hopkins surgeons have performed a hemispherectomy — removing half the brain — on about 80 children who suffered from severe epileptic seizures. The operation enabled the children to function much better. Explain how this happens? And can you get by pretty well with just half a brain — if it takes responsibility for the other half's functioning?

    Dr. Jordan Grafman: The younger the person, the more the remaining hemisphere can compensate but it IS NEVER complete. People are left with deficits. If many functions are moved to the remaining hemisphere, it can be crowded over there and you have some limits as to what can be transferred. You can get along with just half a brain but you will have permanent impairments.

    Monterrey, Mexico: abigail, you stated it better than I did, and there was no answer...concerning mozart...can certain types of stimulation-activities improve mental abilities....this is the big we have some control over the quality of our development...or is it all fate and so why do we need scientists? an answer to your question would be appreciated.

    Dr. Jordan Grafman: It is not all fate. Each area of the brain supports specific cognitive functions. If your learning involves one or more of those areas, it will improve its functioning and cortical imperative. Since the frontal lobe manages behavior and involves planning and reasoning, your best bet is to develop those skills. Now it may be that music stimulates your thinking and you become creative using music in the background. Well okay, but its not the music itself that is directly leading to the creativity. Its setting the mood. Fate of genetics is just one part of the recipe, the rest is experience and it is a big part of life's meal!

    Fairfax, VA: Hello Dr. Grafman,

    I am a 26 year old woman and lately have become concerned that I may have something wrong with the part of my brain that stores memories. I constantly cannot remember conversations I have shared with people a day earlier. I forget having told them stories and repeat the same story days later, only to have them tell me I already told them. Upon attempting to recollect the previous conversation with that person, I often cannot recall where I was when I spoke to this person, what we talked about, or what day it was. I cannot remember birthdays of family members, phone numbers I call regularly, or where I put something I wanted to keep in an obvious place so I would surely remember. It has become embarrassing on many occasions and makes me feel scared and unintelligent. I know I am a very intelligent woman but I feel it is getting worse and I don't know why. I am too young to have Alzheimer's, and it does not appear to run in my family. Could something be wrong? Are there any excersises I can do to strengthen my memory?

    Dr. Jordan Grafman: Go to a Neurologist and get evaluated please.

    Portland, OR: I think you just hit upon a key to my recovery over the past 8 years. The head injury I received was from ice climbing. the injury was to the right frontal lobe. Within a few months I was a math and programming genius that I never displayed before. I was a salesperson. Eventually, I have worked myself back into a technical sales role, but the social stuff was tough.

    Abigail Trafford : Does math ability sometimes improve with a head injury? How would that happen.

    Dr. Jordan Grafman: Occasionally patients with frontal lobe dementias have shown absolutely remarkable new ability in art. Maybe you have a variant of that? I have never seen a patient who had improved math after a head injury. Go see a local neuropsychologist and tell them about your experience. You can teach us. Everything we learn about plasticity and recovery of function is because patients and their families have generously volunteered their time so could study them. I am indebted to all of you who do so.

    Washington, D.C.: What are the most promising areas of research where plasticity can help lead to an actual treatment for stroke or some other brain illness? Realistically, how long will it be before we can develop a drug or other therapy that mimic or enhances the brain's natural plasticity?

    Dr. Jordan Grafman: Within the next ten years we should have a new set of drugs and other therapies to enhance the brain's natural plasticity.

    Washington, DC: What do these findings mean for child development? Do they, or should they, change the way that parents teach their children at an early age?

    Dr. Jordan Grafman: It means that the brain is most plastic during childhood. Less cortical space is committed in childhood to cognitive processes and therefore more plasticity is possible. Teach and especially teach children to reason and plan and think creatively along with basics of reading, writing, and arithmetic.

    Orono, ME: I've read that classical music helps develop math and reasoning skills in children. To what extent has the link between, say, early exposure to Mozart and enhanced congnitve skills been dosumented?

    Dr. Jordan Grafman: The link is indirect at best.

    Washington, DC: Many people have used non-prescription 'recreational' drugs as teenagers when their brain is purportedly still developing. Does the brain compensate somehow for the damage cuased by such drug use at an early age? Does this new research ad any light in terms of the brain's resiliancy to make up for the negative effects of drugs and alcohol? Thanks.

    Dr. Jordan Grafman: We don't have many plasticity studies looking at recovery from drug use. We do know that years of alcohol abuse in adults impairs memory and that when someone quits abuing alcohol, they slowly recover their memory abilities.

    Abigail Trafford : Thank you Dr. Jordan Grafman. I feel smarter already! This was really great and I'm sorry we couldn't get to all the questions. Thank you all and join us again next week — same time, same place.

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