The Brain That Can

After reading the book  The Brain that Changes Itself, by Norman Doidge (2007)  I have been convinced that my longstanding views on the capacity of the brain to change are frankly, wrong. 

I have worked in brain injury rehabilitation for a good portion of my career in neuropsychology which included stroke, brain injury and aneurysm patients.  Patient would typically spend 1 – 2 months in inpatient rehabilitation receiving cognitive remediation and physical therapies daily, then transfer to outpatient therapies for treatment several days a week for several more months.  We would typically see a plateau in functioning for stroke patients after 4 – 5 months, and between 1 – 2 years in brain injury patients, depending on the severity of the injury. 

New research has clearly indicated that localization theories were misguided.  Areas of the brain, previously felt to be ‘designated’ to perform sensory functions (vision, hearing, motor functioning, touch) or language areas, are remarkable plastic and eager to take on new functions if the information is provided to them under certain guidelines.  He describes patients years after stroke, who can begin to restore motor, sensory or cognitive functioning, under the right conditions.

 What are these conditions?  “Neurons that fire together, wire together”.  In other words, information presented repetitively, and frequently, over a lengthy duration, will create new circuitry.  So a stroke patient, using his paralysed hand in various tasks, for an hour a day, 5 days a week, for several months, in most cases improves the functioning of that hand.  The length and repetitiveness of the task, eventually causes new neuronal sprouting (which in the case of learning Braille only begins to occur after 4 months) causing permanent changes in the brain.  With the limited therapy provided in rehabilitation settings, no wonder no one saw continued progress and improvement; the duration and frequency were not enough to create the new circuitry. 

 How does this apply to ADHD?  Therapies, such as CogMed, meet such criteria due to the frequency, duration and a third factor which is also critical, the engagement or motivation factor.   One has to be attentive and actively engaged in the task for these circuits to occur, and the engaging, self-competitive nature of a therapy, such as CogMed, can provide the motivation, to improve working memory systems and enrich and enhance the circuitry. 

 I have always been on the pessimistic side, when it comes to thinking people can change personality traits, or noxious habits.  After reading his clearly presented summation of research, however, I am much less pessimistic.  If one is truly motivated to change an identified trait, therapies can most certainly help if,  there is daily work addressing the positive trait to be acquired, (e.g., through journaling, prayer, meditation, a diary, counseling meeting), and patience.  Eventually, the unwanted traits (circuits) weaken, and the positive traits (circuits) strengthen, leading to good riddance.  His successful work with obsessive-compulsive clients are a testament to this.