Sunday, December 29, 2013

Clinical research indicates you are smarter if you don't buy lumosity

Lumosity is a scam. It costs $15 a month and it will change your brain. What does it do to your brain? It makes your brain better at playing the lumosity games. 

(If you're interested in games and gaming that may actually help you recover, see this link.)

Really you don't need fancy software and a computer interface to do what human brains have been doing for the last 200 thousand years. 

Heck, these guys don't even use the word neuroplasticity right. Their tagline is "Lumosity is based on the science of neuroplasticity." But neuroplasticity is not science. 

(note: The previous link was to luminosity's website. But they must've gotten enough flak about the whole "science of neuroplasticity" thing that they took it off their website. However, others have found, and recorded, the same statement.)

Neuroscience is a science. Biology, chemistry, zoology -- these are sciences. Saying neuroplasticity is a science is like saying E=MC2 is a science. In fact, both E=MC2 and neuroplasticity are theories. Given the fact that lumosity has a huge stable of neuroscientists, you think they'd be able to figure the nomenclature.

The fact is, the best way to "train your brain" is to challenge your brain. This challenging of the brain -- also called learning -- changes neurons. Learning stresses out neurons which react by creating new dendrites, that then form new synaptic connections. The best way to rewire your brain to learn something new is the old-school stuff; learning a new language, learning a new musical instrument, learning a new sport, etc. I'm not sure I couldn't put it better than this: The (lumosity) scam is a pretty smart one because it melds together not just one but two classic plays in the world of conning – the idea that you don’t have to work hard for something because there’s a hidden shortcut, and the inherent belief that you could be brilliant if only you could tap some hidden skillset lurking somewhere in your brain-case.

How can stroke survivors drive this sort of change in their brain? It involves a lot of hard work. The work has to be very challenging. The bottom line is, there is no game, or machine or pill that will help you learn. And there's no game, machine or pill that will help you recover from stroke.

More up-to-date blog entry on "brain games" here.

Saturday, December 21, 2013

The Orthopedic Card

I'm about sick of what I'm starting to call "movement elitism." The idea is that, unless you move perfectly, you shouldn't move. Because… you'll ingrain "pathological movement patterns." I've railed against this before. And here it goes again...

Curious Person (CP)
Clinical Movement Elitist (CME)

CP: Why should a stroke survivor not move when they're alone? 
CME: Because they move wrong.
CP: What will moving wrong do?
CME: Make it so they'll never move right.
CP: So what should the survivor do to practice movement?
CME: Wait until there's a clinician around to tell them how to move.
CP: Won't the survivor run out of money eventually?
CME: It’s worth every penny because bad movement is bad. It will make moving right harder.
CP: Don't we all learn to move by correcting mistakes?
CME: Yes but survivors need guidance.
CP: Couldn't they sit in front of a mirror and model the movement of the "good" side?
CME: Yes, but they'd fail in the execution.
CP: So they need to be perfect right out the box?
CME: Yup.
CP: What if they can't move right?
CME: I move them.
CP: Doesn't that defeat the purpose any "productive struggle"?
CME: Survivors shouldn't struggle too much.
CP: Why should they not struggle?
CME: They'll move even worse.
CP: Survivors need lots and lots of repetitions to recover moment, right?
CME: Yup.
CP: And that has to do with forging new pathways in the brain?
CME: Yup. It takes thousands of repetitions to get the brain to regain control over muscles.
CP: How long do you typically see a patient?
CME: About an hour a day.
CP: How many repetitions do you have survivors do in a typical session?
CME: A many as we can.
CP: Did you know that the number of repetitions done in a typical stroke rehab session has been counted?
CME: I did not. Know.
CP: The average number of repetitions in a typical session for the arm is 54 and for the leg its 75
CME: It will take a while.
CP: How do you reckon the survivor will get to the thousands of repetitions they need?
The movement elitist may seem cornered, but they have an ace…
CME: Even if they could practice on their own, and even if that practice is beneficial, the bad movement will cause orthopedic problems like bad joint movement and pain. It may be good for their brain but it’s gonna be bad for their body.
CP: Couldn’t the improved movement and the better brain control lead to less ortho problems?

Monday, December 9, 2013

Spasticity reduction in dystonia and stroke

So, here's the deal. I'm a member of the FB young stroke survivors group.  If you are not, I'd suggest you join. These folks do not pull punches and most are robustly and actively  engaged in their recovery. (Many have the same posture as Dean of Deans' stroke musings. (Put his blog in your faves. Now.)  The group as a whole reminds me very much of many spinal cord injured people who I've worked with; no BS, been there done that, laid bare.

I'm also a member of the "Neuronauts" group on FB. This group has a pathology that causes a spastic pull on muscles called dystonia. The muscles that are affected can be pretty much anywhere and can jam body parts into themselves and into other body parts. I'm not generally Mr. Empathetic, but the Neuronauts will break your heart. Shocked, sad helpless is the way their stories sometimes make me feel. Stories of living with a complete and painful betrayal of their bodies. Short term excruciating pain and long term injuries often result. 

Dystonia is caused by injury to the basal ganglia (which can be caused by stroke). The basal ganglia is a "gang" of structures deep in the brain. "The basal ganglia... monitors the speed of movement and controls unwanted movements"
Examples of dystonia
Spasticity is uncontrolled reflexes. Reflexes exists in all of us all the time. But you usually never see them. They are only "unloaded" when there's an emergency. Like, when you burn yourself and you hand ends up by your ear and you wonder how it got there. Or when you step on a sharp stone walking barefoot and your hip and knee quickly bends. Or when you lose your balance and your arms fly around wildly without your consent in an effort to keep you on your feet. These are all emergency situations. There is simply no time to consult the brain. The reflexive impulse goes from receptors on periphery of the body, to the spinal cord (where reflexes reside) and back. Its about speed because its an emergency.

If there is no emergency the brain dampens the reflexes down. But if there is a brain injury the dampening stops and the reflexes are unloaded. This unloading causes muscles to fire even though there's no emergency. This constant firing of the muscles is spasticity.

There are many treatments for spasticity. Most of them fall into 3 catigories: 

1. Don't work. 
2. Work but are a band-aid (work until you take them away). 
3. Work and are permanent.

Examples of #1 above are splinting and hot packs. Examples of #2 above are drugs and stretching. An example of the 3rd category: Dorsal root rhizotomy.

Dorsal root rhizotomy (DRR)
A Dorsal root rhizotomy (aka selective dorsal rhizotomy, aka DRR) is a delicate surgery where some of the little hair-like "rootlets" that go into the spinal cord are surgically cut. (GRAPHIC: Selective Dorsal Rhizotomy...starts @ 2 min in).

And I don't want to white wash is a surgery. But it is a very small incision and recovery is quick. The reduction of spasticity after DRR is permanent. For the life of me, I don't know why it is not more often used. I've seen sores the size of steaks- life threatening sores- created by spastic limbs crushing the skin.The DRR would elevate this. It also reduces pain in the area. It is done very selectively. The neurosurgen will test ever nerve rootlet to see what it does before cutting. In this way, the amount of spasticity is gradated. If more spasticity is helpful (some people use their "tone" to help them function) it is left.

Does it work for dystonia and the spasticity that results? Yes. Will insurance pay for it? Sometimes. Does it work for spasticity post stroke? Yes, but it can be tricky in the legs.

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