the neuroplasticity revolution and its implications … · norman doidge, md and ruth buczynski,...

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The Neuroplasticity Revolution and its Implications for

Health Practitioners

A Teleseminar Session withNorman Doidge, MD

and Ruth Buczynski, PhD

The National Institute for the Clinical Application of Behavioral Medicine

http://www.nicabm.com

The National Institute for the Clinical Application of Behavioral Medicinewww.nicabm.com

The Neuroplasticity Revolution and its Implications for Health Practitioners 2

A complete transcript of a Teleseminar Session featuring Norman Doidge, MD and conducted by Dr. Ruth Buczynski, PhD of NICABM

The Neuroplasticity Revolution and its Implications for Health Practitioners

Contents

The Brain as We Know it. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Adult Plasticity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

What is Plasticity? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Paul Bach-Y-Rita Researcher . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

What We’ve Learned About How the Brain Works . . . . . . . . . . . . . . . . . . . . . . 8

Michael Merzenich - Brain Maps. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Neuroplastic Approaches to Learning Disorders. . . . . . . . . . . . . . . . . . . . . . . 11

Advances in the Treatment of Stroke . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Learned Non-Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

The Role of Pleasure Systems in the Brain . . . . . . . . . . . . . . . . . . . . . . . . . . 15

The Paradox of Plasticity. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

How to Train the Brain to Stop Anxiety and Mental Obsessions. . . . . . . . . . . . 18

The Life Span of Plasticity. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Plasticity and Age-Related Cognitive Decline . . . . . . . . . . . . . . . . . . . . . . . . . 22



Dr. Buczynski: Hello everyone. This is Ruth Buczynski from the National Institute for the Clinical Application of Behavioral Medicine. And I want to welcome you to the New Brain Science Series.

We’re glad that you’re participating. We have practitioners from all over the world, from time zones across our 24 hours. No matter where you’re from, we’re glad you’re here. And we want to tell you that we appreciate you taking the time and setting aside this time to be part of this worldwide community of practitioners.

We have a multidisciplinary range of practitioners. We’re physicians, nurses, psychologists, social workers, counselors, marriage and family counselors. We’re physical therapists and dieticians and occupational therapists and physician assistants and chiropractors, stress management consultants, coaches, and clergy.

We are a wide range of expertise and whatever your profession is, including if you are a layperson, you are welcome on this call. We are so glad that you’re part of our call tonight. We have a very, very exciting lineup tonight.

We’ve been working for years to get our guest tonight. It is Dr. Norman Doidge. He is the author, I am sure you know of his book, it’s called The Brain That Changes Itself. I love this book. And once you hear this call tonight, I’m predicting that you will want to go check it out.

The work that Norman did putting this together and sharing these ideas really put neuroplasticity on the map in a way that it wasn’t before. I’m so excited, Norman, that you’re part of our call. Thanks for joining us tonight and thank you for your work.

Dr. Doidge: Well, thanks for having me, thank you.

Dr. Buczynski: I just wanted to mention to everyone that the book is available in 20 different languages in over 100 countries. Enough about that, we will get into the ideas in the book and then later on I’ll briefly mention the book again.

Norman was a keynote speaker at our conference in Hilton Head two years ago and it was wonderful to meet you there, Norman, and your lovely wife Karen. And it’s great to talk to you again.

Jumping right in, in the course of your travels, you’ve met people who have performed some pretty amazing work, some pretty amazing brain healing. Can you tell me one of the cases that stands out in your mind?

The Brain as We Know it

Dr. Doidge: Well there are many, and they are all exemplary models of different aspects of plasticity, which is the way I try to explain to people how plasticity works. It’s sort of like asking who you like better, your son or your daughter? I like them all.

The Neuroplasticity Revolution and its Implications for Health Practitioners

with Norman Doidge, MD and Ruth Buczynski, PhD



But I start the book with the complex story of Dr. Paul Bach-y-Rita. And he arguably was the first person of his generation to begin to champion the notion of late brain plasticity. That’s really important, that term late brain plasticity because inherent in the concept is the idea that the brain is plastic from the cradle to the grave.

In the 60’s, Hubel and Wiesel, had shown in famous experiments working with kittens, for which they won a Nobel Prize, that there were critical periods of early plasticity in infancy when the visual system was set up. And in the famous experiments that many people have heard of, kittens had their eyes kept closed and if they didn’t get stimulation from the environment their visual systems wouldn’t wire up properly.

The problem was that Hubel and Wiesel, based on their experience, thought that once the visual system was wired up, the circuits were formed and finalized in childhood. And therefore, the notion of adult plasticity didn’t exist.

Adult Plasticity

Now Paul Bach-y-Rita came to this notion of adult plasticity in a very personal way and that was through the story of his father. His father Pedro Bach-y-Rita was a Catalan poet and a wonderful human being. And when he was, I think, 68, he had a devastating stoke. He was completely paralyzed and couldn’t speak.

And in those days, because we believed the brain wasn’t plastic, we would wait about six weeks to see if a person recovered any function. Recovery of function meant the following, and it’s important to step back and understand what’s so revolutionary about the idea of adult plasticity. We basically thought that the brain was a machine with parts. And each part performed a single mental function in a single location in the brain.

And this meant, of course, if you were with some kind of brain defect or learning disorder, there was nothing you could do about it. And if you have something like a stroke, you couldn’t really do anything about that either because machines do many glorious things, but they don’t grow new parts. They don’t rewire themselves.

Rehabilitation was conceived of in the following way. We did know for a good hundred years or so that after a stroke or a brain injury, the brain goes into a state of shock. And in that period the circuits are disturbed. There is inflammation. There is a chemical derangement. And what we would do is we would wait for approximately four to six weeks until the shock and those derangements passed.

And this is the key point, to see what was left. Rehabilitation wasn’t really growing new brain areas; it was just basically

“I start the book with the complex story of Dr. Paul Bach-y-Rita. And he...was the first person of his generation to begin to champion the notion of late brain plasticity...the idea that the brain is plastic from the cradle to the grave.”

“...what’s so revolutionary about the idea of adult plasticity. We basically thought...machines do many...things, but they don’t grow new parts.”



waiting it out to see what was left and then priming the pump.

After you primed the pump, in other words, you gave a little bit of movement to a person; if they didn’t improve, we assumed that they would never improve. And it became a self-fulfilling prophecy of course, because as this policy was put into place over time, fewer and fewer people attempted to help people past the six weeks.

And so, Paul Bach-y-Rita’s younger brother, George, got a call saying, “Your father has survived the stroke, but he can’t move and he’s not going to get any better.” He was given the usual amount of rehabilitation and didn’t improve. And the doctor basically said they had to pick up their father and put him in a chronic care facility.

So George was, at that time, a medical student in Mexico. And he drove to New York City. He knew that his father would die if he was warehoused in one of those chronic care facilities. He put his very diminutive and very short statured Pedro in the back seat; he was just over five feet. And then drove this paralyzed man all the way back down to Mexico where he was living in a villa with a bunch of medical students.

And then George, who had no knowledge or rehab, no knowledge of the teachings that the brain was not plastic, which I call the doctrine of the unchanging brain, decided to wing it. And he said “Papa you learned to walk by first crawling, so we’re going to get you to crawl.”

Now there are spinal reflexes that allow animals or human beings to do a certain amount of walking. That’s why we say he is walking around like a chicken with his head cut off because chickens can do that. They initiated that.

And then they put him up against the outside wall of their villa with one hand against the wall, and they got him incrementally to move on three limbs. And then they got him standing so that he had the support of the wall with his hands and then they got him walking.

And this whole process took over a year, and they also got him typing and eventually he taught himself to speak. And at the end of this process, he was back at work teaching; he was writing poetry. He had been a widower. He remarried and he was mountain climbing with friends in Bogota, Columbia.

He was about 75 years old now, completely rehabilitated. And while he was in the thin mountain air, alas he had a fatal heart attack and he died. And it was at this point that Paul came into the picture.

Paul himself was a genius who really thought outside the box. He was trained as a physician but his heart was very much into research and he was perhaps the world expert on the muscles that move the eyes in the head. He knew a lot about physiology.

He ordered an autopsy on the body and a couple of days later; he came down to the pathologist’s office. And there on the table spread out in front of him were slices of his father’s brain. And Paul had the full range of emotions that one might have in such an unusual situation, grief, a sense of sadness, and revulsion and so on.

“Rehabilitation wasn’t really growing new brain areas; it was just basically waiting it out to see what was left...if they didn’t improve, we assumed that they would never improve. And it became a self-fulfilling prophecy.”



But when he looked at the slices, one of the things that he saw was that in the area of the brain where the stroke had obviously occurred, 97% of the tissues were damaged. This was in the area of the brain stem.

As he thought about that he had this epiphany that could only mean one thing. It could only mean that somehow the work that George and Pedro had done together, had actually rewired Pedro’s brain so that those tracks could be bypassed in some way or another.

This also had to mean that the adult brain, the brain of an old man was plastic. Then Paul went on to basically invent all sort of remarkable devices that demonstrated brain plasticity and began to help people get better. We can go into those.

He developed devices that helped blind people see and all sorts of devices to help people who had equivalent amounts of damage to Pedro, like 97% to 98% damage in an area to learn to balance. I can tell you about those if you’re interested, but that’s a long story already.

Dr. Buczynski: When was this?

Dr. Doidge: This occurred in the 60s.

Dr. Buczynski: What was the reaction when he shared the information with the medical community?

Dr. Doidge: Well, I don’t know the answer to that but in general, and we shouldn’t just visit this on the medical community because really I think nobody was thinking in terms of brain plasticity. He himself was a doctor. The first device that came out, at first people were wowed by it. But then it just seemed so far out it became hard to credit.

If I could just make one point, what was the reaction? From time to time I meet people who are in alternative or eastern medicine and I’m very interested in these fields. They say well we knew about plasticity all the time.

What is Plasticity?

And I would say with all due respect they weren’t talking about plasticity. They certainly were talking about mind/brain influences. They were certainly arguing that the mental influences the brain. But it wasn’t really grounded in neuroscience.

At some level we all know about plasticity because we all have plastic brains. And if you study the piano, if you do karate, if you try to concentrate on improving the skill you could say. “Well, I knew about plasticity.” I prefer a more rigorous discussion of it.

Let’s step back for a second and define plasticity. Because plasticity exists throughout the brain and the

“Because plasticity exists throughout the brain and the brain has many levels of systems in it, different people may have slightly different claims to what plasticity is.”

“...in the area of the brain where the stroke had obviously occurred, 97% of the tissues were damaged...somehow the work that George and Pedro had done together, had actually rewired Pedro’s brain...This also had to mean that the adult brain, the brain of an old man was plastic.”



brain has many levels of systems in it, different people may have slightly different claims to what plasticity is. If you’re working at the synaptic level, you’re very interested in synaptic plasticity. If you’re interested in genes you might say that when certain genes are expressed or not expressed, that’s a sign of plasticity.

It seems to me that the best definition of plasticity or the one that I propose is the most encompassing one is to say that plasticity means changeable, adaptable and the brain’s plasticity is that property which allows it to change its structure and function in response to mental experience.

Now mental experience here including sensing, receiving, planning or an executing motor actions, and imagination can be part of this whole planning and executing motor action.

But I also say it changes structure and function so it’s important to know a little bit about how structure and function work in the brain. To get to your question, the initial reactions to his initial invention were the following.

Paul Bach-Y-Rita Researcher

In 1969 in Nature, which was the most prestigious general scientific magazine, there appeared a picture of an old dentist’s chair which had about 100 or so vibrating stimulators on the back and was attached with big cables to a huge television camera like the kind we had in the 1960s and a computer about the size of a Volkswagen.

And the report was by Paul Bach-y-Rita as the lead author and a few others. And it said the following: people who had been blind since birth would sit in that chair and they would move the camera around.

The camera would then take the image and turn it into a black and white image with pixels like on your computer. There would be certain dots that would be turned on for light and others that would be turned off for darkness. It would send the information to the computer which then translated these pixels into signals that would turn on the stimulators.

If a stimulator was vibrating quickly that represented light and if it was not vibrating at all that would be an area that would be dark. It was more sophisticated than that though because there would be grayish transitional areas. And people would sit in that chair and with several days of training, they could make the following utterly remarkable discernments.

They could say “Oh that’s Mary; she just came into the room. She is wearing her hair down today.” And being in the 60’s they could say “Oh that’s Twiggy.” the super model of the time. And if you threw a paper airplane at the camera, even though the information was coming in through their backs, they would duck.

“It seems to me that the best definition of plasticity...is to say that plasticity means changeable, adaptable and that property which allows it to change its structure and function in response to mental experience.”

“In 1969 in Nature, there appeared a picture of an old dentist’s chair which had about 100 or so vibrating stimulators...attached with big cables to a huge television camera....the report by Paul Bach-y-Rita as the lead author said people who had been blind since birth would sit in that chair and they would move the camera around.”



And if he basically moved that vibrating array of cellonoids to their tummy and threw the paper airplane at the camera, they would also duck. They were now perceiving contours, perspective, and looming objects.

Fast forward about 30 years, it was found that people who had been on that kind of device and had their brains scanned, and found that in fact, it was their visual cortex that was processing this information. They were seeing. And subjectively they described themselves as seeing.

What Paul had done was begun to apply the notion of neuroplasticity to the sensory cortexes of the brain. And as I explain in my book, he had begun to understand that this idea of localization, that there was only

one area that can process something, wasn’t quite right. There was something to localization, but it shouldn’t be taken absolutely because the brain can reorganize itself in many, not all, but in many situations. So it can change pathways.

And what would happen here is people were getting information coming in on their backs and it was going to the part of the cortex that processes touch. And somehow the brain was taking that information which it was not accustomed to doing and sending it to the visual cortex.

Dr. Buczynski: It’s kind of compensating?

What We’ve Learned About How the Brain Works

Dr. Doidge: I wouldn’t use the word compensating. There are lessons from this. The first lesson Paul said from these experiments was, “We see with our brains, not our eyes. The eyes are like data ports and they can be replaced by other data ports.” But the key thing is the brain is functioning more holistically.

And if you give it certain kinds of patterns, you give it the correct information, that information can find its way to areas which can then make use of it and decode it. But there was a replacement kind of functioning happening here.

These people were blind. The early parts of the visual system were simply not being used. And yet the brain found a way to bypass or rewire itself to make use of those signals. This is a longwinded answer to your question of what was the response. Well, the response initially was spectacular. It was a very gee-whiz kind of response.

I think either Newsweek or Time mentioned it. And I think Life mentioned it, a number of news outlets mentioned it when it first came out. But then it sort of became buried in the politics

“Paul had begun to apply the notion of neuroplasticity to the sensory cortexes of the brain...he had begun to understand this idea of localization...it shouldn’t be taken absolutely because the brain can reorganize itself in many situations...it can change pathways.”

“We see with our brains, not our eyes. The eyes are like data ports and they can be replaced by other data ports...the key thing is the brain is functioning more holistically.”

“Fast forward about 30 years...it was their visual cortex that was processing this information. They were seeing.”



of grantsmanship because this was very, very far out.

Paul, like all the neuroplasticians, which is a term I coined to describe people who work with neuroplasticity scientifically, all the neuroplasticians did their early research off grant. Money from other grants was somehow or other diverted to support the neuroplastic research.

He got support from places like DARPA which is in the United States, a very far out grant agency that’s developed by the Department of Defense, which has come up with extraordinary things.

And they approached scientists who are incredibly talented and say “What do you want to work on?” Because I think they’re aware that all human beings get stuck inside the box of their thought. And that’s, by the way, a function of the way the brain works.

We all get confused by the maps we have of the world with the world itself. And DARPA was one of these agencies, because it was involved in defense and it was very competitive, that was interested in these far out things.

He invented other sensory substitution devices, an extraordinary one for balance that I describe at the beginning of the book. But frankly, he wasn’t all that well known until my book came out.

And unfortunately Paul passed away just before the book came out. There were a small circle of neuroplasticians who knew about his work. But he was one of those people like Mosses who did the lion’s share of the work, but didn’t quite get to live in the Promised Land.

Dr. Buczynski: There is another person that’s done a lot of studying. I would like you to tell us a little bit about Merzenich.

Michael Merzenich - Brain Maps

Dr. Doidge: Michael Merzenich, sure. Well, just as Paul’s first exposure to brain plasticity was kind of an accident. He ordered this autopsy on this father’s brain. And he had no idea he would see what he saw.

Michael Merzenich was an extremely talented mainstream neurophysiologist who studied with Mountcastle and was in on early work with microelectrodes. So microelectrodes are tiny, tiny little needles which you can stick in a brain and you can stick either inside a single neuron or beside another neuron.

And in a way, we don’t think of stick needles in a brain as performing a brain scan. But these microelectrodes…there was a lot of work done with them in the 60’s, provided us in some ways with our first brain scans.

Because just imagine your brain, your neurons are networks. And they’re all firing millions of them, at once. But with the microelectrodes you could hear one neuron firing at a time.

And this allowed people to begin to do very precise maps

“Microelectrodes are tiny, tiny little needles which you can stick in a brain...either inside a single neuron or beside another neuron...microelectrodes...provided us...with our first brain scans.”

“...all human beings get stuck inside the box of their thought. And that’s, a function of the way the brain works.”



of the brain while it was functioning. For instance, you could take a person or an animal as Penfield did with grosser, large electrodes.

You could stroke their hand while the electrodes were inserted into the part of the brain that processed touch. And you could see which of the neurons lit up. And these famous Penfield maps were formed of the human brain.

Merzenich by accident, in a very complicated experiment, basically discovered to his amazement because he was mapping and remapping animals over time, that the brain maps actually were changing their contours. The famous brain maps that we see of Penfield’s epileptic patients called the homunculus where you see how the human body is represented in the brain.

I don’t believe that Penfield ever claimed that they were immutable. But because people believed the doctrine of the unchanging brain, they simply assumed they were universal, they were identical from person to person. That they didn’t change. And Merzenich discovered by accident that they did change.

And he went on to do a number of experiments which then demonstrated to a very skeptical scientific community, including Hubel and Wiesel, that in adult monkeys they changed.

In one experiment, for instance, if you imagine that the five fingers in a monkey have five different sectors, which they do in a monkey’s brain, he could do things like sew or tape two fingers together and observe over time that the two different maps for those fingers became one map. Then he could separate the fingers again and see that they resolved into five maps. And he also showed that plasticity was competitive.

And in one experiment where a middle finger was amputated, the map space for it was taken over by the two adjacent fingers. Now this was a very, very solid scientific demonstration of plasticity that persuaded even skeptics that brain maps were plastic.

And he happened to have been an expert in the auditory cortex that processes sound. He was one of the inventors and facilitators of the cochlear implant. The cochlear implant is not a hearing aid which is like a small amplifier that takes a signal and just amplifies it so that a person who is hard of hearing, meaning they cannot hear well, can now hear better.

A cochlear implant is for a person, who has no hearing at all, and what you do is have a little amplifier and then it produces an electrical signal. Then that signal passes right into the auditory nerve, in a person who can’t hear anything. And people over time can learn to adapt to this and hear

“Merzenich...discovered...mapping and remapping animals over time, that the brain maps actually were changing their contours.”

“...with the microelectrodes you could hear one neuron firing at a time...And this allowed people to begin to do very precise maps of the brain while it was functioning.”

“He was one of the inventors and facilitators of the cochlear implant...A cochlear implant is for a person, who has no hearing at all...people over time can learn to adapt and hear speech, even though they are totally deaf.”



speech, even though they are totally deaf.

This is a much more dramatic invention than a hearing aid. And if you think about it, the way that it works has to do with plasticity because normally speech comes over several thousand different bandwidths if you will, or many different frequencies. And these machines might reduce human speech to something like 7, 10 or 12 different bandwidths.

The engineering genius was how do you take these very complex signals of human speech and reduce them to the main point so people can decode them?

The real miracle in all of this is that the human brain can take these simplified signals that it didn’t evolve to hear and convert them into meaningful information. Now having shown that the brain was plastic and that plasticity was competitive, he began a series of experiments where he basically trained neurons in various ways.

He trained animals to do certain kinds of touch related experiments where they had to refine their ability to feel shapes or to detect sounds. And he was mapping them while this was happening. And he observed that trained neurons, after the animal had undergone a series of exercises, that trained neurons always fire faster, stronger, clearer signals.

Neuroplastic Approaches to Learning Disorders

Now around this time, Paula Tallal, a very important investigator in the area of learning disorders was working with children with learning disorders, she and her team and perhaps Merzenich was part of this.

Let me just step back and say something about learning disorders. It’s an area of great interest to me. It’s a very very important area because many children have them and we’ve never really understood them properly. All that we’ve done to treat them with all the existing methods, which I don’t demean, but what we’ve done is we’ve tried to teach children to work around them.

If you had an auditory processing problem you might come to class with a tape recorder or even a note taker. How practical is that? And someone would take notes for you or you would tape the lecture and then laboriously go over it, starting and stopping the tape. We’ve learned that the plastic brain is very much like a muscle in the sense that you use it or lose it.

Our existing approach to learning disorders was basically working around or compensating for the disorder, finding another way of doing the same task. And that meant the primary weak area would be getting very little input and would probably start to waste away.

Our treatment actually undermines whatever ability might be there. Now I’m not devaluing those treatments. If the best thing you can do is compensate, you should compensate. But a whole new approach

“We’ve learned that the plastic brain is very much like a muscle in the sense that you use it or lose it.”

“...learning disorders...many children have them and we’ve never really understood them properly. All that we’ve done to treat them...is to teach children to work around them.”



was developed by a few people, Barbara Smith is one and Merzenich is another, which said the following.

Paula Tallal had found that a number of kids who were called dyslexic actually had brains which processed what we would call the fast speech sounds at about a third of the rate of normal children. Here is what this means. They’re sitting and they’re listening to something and everybody else is getting the information in real time. And their brains don’t pick it up.

Here is a real example; a child couldn’t hear the difference between the word coffee and copy. If you don’t register that clearly, just at the sound level, it will be hard to retrieve the signal. It will affect not only your ability to speak. Your ability to hear is affected. Your speaking is affected. Your written language is affected.

Perhaps even the internal monologue is affected and even the semantic understanding of the word is affected because sometimes it seems like your mother is pouring something and that’s coffee. And other times she is pointing to your notebook and saying “Coffee that.”

They developed a program which basically took human speech and slowed it down to these core sounds that these children couldn’t hear; it’s called fast forward. It’s a computer based program. They would gradually speed it up as the child was able to hear it properly to the point that they could take children who were very far behind and in about six weeks of doing this training, an hour a day, five days a week, they could leap forward about two years of language development. So that is remarkable.

And this has now been given to over a million kids and there are good studies of this. There is much to be said about this approach. But this is a new approach to learning disabilities which goes in there and ambitiously attempts to fix the problem and it has many potential offshoots.

It was found to help certain children with autism. We can get into that. People with aging brains are very much like children with learning disorders. As you get older, there is a lot of noise in your brain. Children

when they hear something can make these sharp clear signals and remember most of what they hear. But as you get older, you can get to a point where you don’t remember most of what you hear because your brain is detuned.

And a similar approach can be taken with older adults. I’ve seen examples of people who do the Posit Science Program who can turn back their memory clock so that 80 year olds can now function with really good outcomes like they functioned when they were 55 or 60.

And on average, most people after about six or eight weeks of the program can function the way they functioned 10 years

“Paula Tallal found that a number of kids who were called dyslexic actually had brains which processed the fast speech sounds at about a third of the rate of normal children.”

“I’ve seen examples of people who do the Posit Science Program, who can turn back their memory clock so that 80 year olds can now function like they functioned when they were 55 or 60.”

“If you had an auditory processing problem you might come to class with a tape recorder or even a note taker. How practical is that?”



before. Merzenich is a giant, a genius and a man of great ingenuity. He has patents for all sorts of very far out applications of brain plasticity that have already helped millions and millions of people.

Dr. Buczynski: I’d like to go more into memory but before we do, I’d like to stay with stroke just a little bit longer. What are the most exciting, new neuroplastic approaches to working with stroke patients?

Advances in the Treatment of Stroke

Dr. Doidge: There are a number. The most graphic one that I think is most helpful for people to know about, a low tech intervention, apart from the incremental training that Paul Bach-y-Rita’s father underwent, is something called a constraint induced therapy.

And this was invented by Dr. Edward Taub. Working again with animals, Taub discovered the following thing. Let’s just talk about a human being right now. When you have a stroke, you have an affected right arm. You try to move that arm and nothing happens. Nothing happens for a reason I’ve already discussed.

In the first six or so weeks the brain is in shock. And even if you lost a lot of tissue, nothing around the tissue is working; the whole brain is out of whack. As you try to move your limbs you learn it doesn’t work. This is not a learning based on conscious thought.

The brain is a pattern detecting device, multiple attempts are made, and it doesn’t work. What most people do is they start to use their nonaffected arm, their good arm. And basically I think it’s very important to describe these experiments because people often don’t understand what’s at stake in experiments and they think that they’re gratuitous, violent or whatever, but this gave great insight into the nervous system.

Even for those that think experiments with animals are immoral, I would say, of course it does inflict suffering, but it is important to understand that there is another issue here which is the incredible suffering of people with strokes and their families, too.

For the sake of historical accuracy, I’m telling people what happened. For a variety of reasons there was an experiment which involved cutting the nerves in monkeys so they had no sensory input into their brains. There is a long story as to why this developed. And these were called the afferentation experiments.

What would happen is a monkey would have its sensory nerves, let’s say for its arm, cut and would be unable to move that arm. And it was not always so clear why they couldn’t move that arm because the motor nerves were not cut.

To try to understand what was happening, what Taub did was he put a cast on the monkey’s good arm so it couldn’t use it during the period of spinal shock. And then he attempted to train the monkey’s weakened arm to see if it would work.

And to his surprise, he didn’t think it would work, the arm came back and the monkey was able to, by somehow rewiring his brain, use the weakened arm. He called this learned nonuse. He basically argued that it was these attempts and failures that basically taught the brain not to use the damaged arm.

“In the first six or so weeks the brain is in shock. And even if you lost a lot of tissue, nothing around the tissue is working; the whole brain is out of whack.”



Then in a very brilliant experiment he did the following, which you have to fasten your seatbelts if you’re sitting in a chair if you try to think this through. He cut the nerves for both arms in the monkey so it couldn’t use either arm. But before it had a chance to try to use its arms, he put casts on the arms. I think it was four to six weeks, something like that.

Then he took the casts off and the monkey was able to use both of its arms. That’s a staggering unanticipated outcome. It was a pivotal experiment.

What it basically showed was by putting the casts on the arms he had prevented the monkey from developing learned nonuse. This was the pivotal demonstration of the reality of learned nonuse.

So now if you go to Alabama, the University of Birmingham in Alabama, Taub has a clinic and patients come in and typically they have been paralyzed. Their arms, their legs are paralyzed. He will put on this constraint. It’s usually a mitt or a sling so they can’t use their arm. And in the course of about 10 days of treatment of incremental training of the weakened arm, patients in general can make rapid progress. They can get 50% improvement of functioning.

This is often more than enough to take a person who can’t dress themselves, can’t go to the bathroom, and can’t feed themselves, from the point of complete dependence on another to independence.

And in Europe similar principles have now been used successfully to help people learn how to speak after stokes. This is a low tech intervention. I believe that learned nonuse applies to all neurological illnesses and to some degree to many psychiatric or psychoanalytic or emotional problems.

Because when we’re not using a function I do believe in the use it or lose it brain, the maps for it actually start to degrade. It’s very instructive, as a general principle. And there are good, fine studies of Taub’s work out there now. It’s still underappreciated, relative to what an important breakthrough it is.

Dr. Buczynski: Let’s talk about that. First I want to tell the audience because I didn’t mention this when we started. Norman is a psychiatrist and also a psychoanalyst. With that background let’s talk about it. I was thinking the same thing, if you’re talking about learned nonuse, how this would be relevant to depression and other things or even trauma. I would love to hear your thoughts on that.

Learned Non-Use

Dr. Doidge: In a very general way, I think that cognitive behavior therapists in a way were trying to help people overcome aspects of learned nonuse with their emphasis that human beings are very complicated.

“What it basically showed was by putting the casts on the arms he had prevented the monkey from developing learned nonuse. This was the pivotal demonstration of the reality of learned nonuse.”

“I believe that learned nonuse applies to all neurological illnesses and to some degree to many psychiatric, psychoanalytic or emotional problems...when we’re not using a function I do believe in the use it or lose it brain, the maps for it actually start to degrade.”



I do many different kinds of therapy. My core training after psychiatry was analytic. I think it’s still extremely valuable to understand people’s motivation including unconscious motivation. There are other important contributions. And I don’t think analysis solves all problems and I don’t think CBT solves all problems. We have to know a lot of different things.

What I like about analysis, to give the background of the following explanation, is its deep respect for human development and complexity and its attempt to take into account conscious, preconscious and unconscious functioning.

If you have a patient who is in a certain kind of depression, analysis to a degree, presumes this patient is functioning at a certain level where they can go about their everyday lives. But if people are so depressed that they take to bed and they are not very active socially, some depressives actually develop, I believe, the equivalent of learned nonuse.

And they start to believe they can’t do all sorts of things. The cognitive behavioral therapy on doing an inventory and finding out that even though you didn’t think you would enjoy going out that evening, and in fact you did, I think could be very helpful.

The Role of Pleasure Systems in the Brain

None of these things can be applied simplistically. I want to caution, for instance, one of the things I describe in passing in my book, is little known work on the fact that we have two different pleasure systems in the brain. We have a kind of anticipatory pleasure system with its own brain chemistry and a consummatory pleasure system.

The chemistry of anticipation is in many respects a dopamine kind of chemistry. Let’s say if you’re a runner in a marathon and you are coming in on the finish line, you can get a surge of energy, anticipating that. And it puts you into high gear and gives you a sense of reward. Just go for that and then when you cross the finish line, you see a lot of that dopamine chemistry working.

You throw your hands in the air. You run a victory lap. All of the people that you’ve defeated collapse, they go to sleep miserable. They’re depressed. And you stay up and party all night. That’s dopamine’s mystery. And it’s a combination of anticipatory pleasure.

The consummatory pleasures have to do with things like the opiates in the body. There are some depressed patients who have a defect in both anticipatory pleasure or repetitive pleasure and consummatory pleasure, so that if that person is moping around the house and you say “Look let’s go out and go for a meal. You will feel better.” And you drag them out, they won’t feel better. They can’t imagine feeling better. And

“If you have patients...who are so depressed that they take to bed and they are not very active socially, some depressives actually develop, I believe, the equivalent of learned nonuse.”

“...we have two different pleasure systems in the brain. We have a kind of anticipatory pleasure system with its own brain chemistry and a consummatory pleasure system....The consummatory pleasures have to do with things like the opiates in the body.”



when you give them that meal, they don’t enjoy it.

There are other people who just have a defect in the anticipatory pleasure system. So you say to them “Let’s go out and have a meal and go for a walk. You will feel better.” They say “I don’t believe so.” You say “Look you’re coming with me.” You drag them out, they will feel better.

Now those people, I think, benefit from the more cognitive behavioral approach. And they have learned nonuse, but they also

have a defect in that repetitive pleasure system. I’m giving you a complicated answer because different people are different. But there would be an application of it.

I would just say to you as a general principle, it’s a use it or lose it brain. And what that means is that our brain maps require an ongoing active engagement with the world to stay highly tuned. And if they’re not getting it or they’re getting the wrong kind of input, as what happens for instance in chronic pain syndromes where the sensory areas of the brain are literally high-jacked by the incoming pain signals, other maps begin to degrade. And in a very real sense every person who has a significant chronic pain problem is developing a kind of brain disorder.

Alas, I hate to say it, but I think it’s true because their maps are starting to degrade under the onslaught of that. And then of course, the lack of sleep which is necessary for consolidating plastic change affects the functioning of their brains and their ability to learn new things and in other words sleep is a very important contributor to helping our plasticity.

And the same thing goes for trauma where a person is caught in re-experiencing a traumatic event. The sensory components in their brain, their perceptual components, their reasoning components, they’re all sort of high-jacked by the flashbacks or they’re kind of turned off in the numbing phase. And they begin to degrade.

If any of your listeners have ever been involved, this would probably be psychologists and medical doctors doing insurance assessments. You will often come across people who have had an accident, trauma, an emotional problem many years ago and they started to be chronically anxious and then lose sleep and so on.

And they almost look like organic brain patients in some ways. They’re so blunted cognitively and I think now we understand plastically why this is happening. It’s a combination of learned nonuse. It’s a combination of absence of normal input. And it’s a combination of another aspect of plasticity which I talk about in the brain called the plastic paradox. I want to take a second to talk about this.

“...our brain maps require an ongoing active engagement with the world to stay highly tuned.”

“...sleep is a very important contributor to helping our plasticity.”

“You will often come across people who have had an accident, trauma, an emotional problem many years ago and they started to be chronically anxious and then lose sleep and so on. And they almost look like organic brain patients in some ways.”



The Paradox of Plasticity

Every now and then people hear about my book and perhaps they’ve heard about it through an advertisement or they’ve listened to someone’s summary of it and so on and so forth. And they will say things like “This book is very hopeful.” And in many respects it is.

But I’m quite emphatic at the very beginning of the book, at the end of the book and in the book that plasticity has both positive and negative outcomes. At some level plasticity is not our friend. It is what it is.

But what is our friend is understanding plasticity because the same neuroplasticity, the same ability of the brain to get better at things allows it to get better at experiencing pain signals, for instance.

And many of the up till now inexplicable central pain syndromes for chronic neuropathic pain syndromes are simply a function of the brain’s plasticity. The brain becomes hypersensitive to pain signals and it takes over.

Many of the addictions and bad habits that your listeners are dealing with in their clients are a function of brain plasticity. The plastic paradox as I have defined is that our brains give rise to both more rigid and more flexible behaviors. It’s not just flexible behaviors. And that’s because trained neurons fire stronger signals.

So be careful how you train your brain because if you develop bad habits you are going to pay for it.

This whole area of habit is something that Aristotle emphasized a lot; he said character is related to habit. The things you repeat over time, you become. The character becomes destiny.

To some degree a lot of the modern psychotherapy language doesn’t talk very much about habits. My gosh it’s important. The way you understand plasticity…if I dare, I’ll use a metaphor …they can be very problematic because they’re not quite the same thing, but it would be something like this.

Plasticity is like snow on a hill in winter and when you want to ski down that hill, because the snow is plastic and pliable you can take many different paths down the hill the first time you do that.

Now being human, if you had a very good run down that virgin hill the first time, you’ll probably want to take a path that’s very close to that original path. It’s not the same path and over time as you repeat it you’ll develop tracks in the snow. And you keep it up and you’ll develop ruts because plasticity is competitive and that path will become the preferential path. And

“...plasticity has both positive and negative outcomes. At some level plasticity is not our friend.”

“Many of the addictions and bad habits that your listeners are dealing with in their clients are a function of brain plasticity. The plastic paradox as I have defined is that our brains give rise to both more rigid and more flexible behaviors...And that’s because trained neurons fire stronger signals...So be careful how you train your brain because if you develop bad habits you are going to pay for it.”



the problem is you can get stuck in that path.

Now what human beings have done, I believe, is we have looked at our own behavioral rigidities which are the product of plasticity, the product of plasticity exercised in an imprudent way, and we’ve projected that rigidity back onto the brain and said simply “This patient, this client’s brain, my brain is rigid. I can’t change. I can’t alter this. My brain is not plastic.” And that’s where the category error occurs. It’s not that your brain isn’t plastic. It’s that you’ve used it in such a way to give rise to rigid behaviors.

Dr. Buczynski: Alright, that is fascinating. I want to have us spend a little bit of time talking about an approach to treating anxiety and OCD. Can you give us some thoughts there?

Dr. Doidge: Sure. Along with talking about how conventional psychoanalytic therapy and CBT engaged plasticity and how practitioners can use the understanding of plasticity to better apply the forms of treatment they’ve been trained in, I also describe a new form of treatment that was developed by Jeffrey Schwartz.

And this treatment is arguably the first psychotherapy that was based on brain scans. And it was, as I recall, in the 1990s that people, researchers at UCLA and in California, took patients who had severe OCD, pretty significant OCD and put them in brain scans and compared them to patients who didn’t and got both groups to think about things that they worried about.

And what they found is that there was a normal worry circuit that we all have. And that worry circuit involves three brain areas working together.

The first is what you might call an error detection mechanism. And that’s in the orbital front cortex, just behind the eyes. If you are at dinner with someone you’re trying to impress and you spill wine on the tablecloth and his suit and so on and so forth, the first thing that happens is you detect the error.

Or if you say the wrong thing to your boss or your lover, you detect the error in the orbital frontal cortex which then sends the signal up to the anterior cingulate which makes you very anxious about the error. And those two brain areas firing in the subjective experience of them firing gives rise to the kind of feeling or what Schwartz calls the mistake feeling, there is something wrong and I’ve got to correct it.

And under normal circumstances if you don’t have OCD, once you correct the mistake, a third part of the brain that has to with what we will call mental shifting of gears, the caudate fires and allows you to go on to the next thing.

“If you are at dinner with someone you’re trying to impress and you spill wine on the tablecloth and his suit... the first thing that happens is you detect the error...in the orbital frontal cortex which then sends the signal up to the anterior cingulate which makes you very anxious about the error.”

“It’s not that your brain isn’t plastic. It’s that you’ve used it in such a way to give rise to rigid behaviors.”



How to Train the Brain to Stop Anxiety and Mental Obsessions

Now in people with OCD this worry circuit, these three things basically start firing and get locked together and they can’t go on to the new thing. Now some of this may come about because of habit.

We also know that there are some children who develop in sections and have an autoimmune response which actually attacks the caudate and they can develop OCD out of the blue. But whatever the cause of the OCD, people who have it, have a sticky gear shift in there.

So they think about something, how they did on a test, did they make a mistake, did they really lock the door, are my gears symmetrical or whatever they’re going to worry about and they try to switch out of it and it doesn’t happen.

Now let’s take a common OCD thing. Let’s say a person goes to a party. They have OCD, and they shake someone’s hand and then they notice as they turn away that that person sneezes and obviously has a bad cold and maybe even the flu. So they go to the bathroom and they wash their hands.

Unfortunately the gear doesn’t shift. Then they wash their hands again. They get a little bit of relief as they’re washing their hands thinking “I’m doing the right thing.” But a few minutes later they’re still worried and they’ll wash them again and again.

So over time what happens in those people is neurons are fired together, wired together, that’s one of the core laws of plasticity as I try to explain it. They develop the following circuit in their brains; if you wash your hands you will get a very quick relief of anxiety.

The next thing you know they’re spending seven hours a day washing their hands, using more and more aggressive chemicals on them, they’re bleeding at the knuckles and their lives are out of control.

Fast forward that because they’re reinforcing that false sense of reward with plasticity here being used in a non-skillful way…

Now the existing treatments for this kind of fairly severe OCD, psychoanalytic, cognitive behavioral, behavioral, all have the following thing in common. Schwartz observed that they all actually get you to think about the obsession. And they all have some success but it’s not particularly impressive success with the more severe forms of it. I mean I did a literature review on that. And we analysts basically get people to try to understand the triggers for some of these obsessions. And in fact, sometimes they’re very meaningful psychodynamically.

Analysts have more success working with children who develop obsessions, for instance, out of the blue and haven’t been in place for a long time. Let’s say a sibling is born and suddenly your angel is obsessed . . . And those would be sort of classic sibling rivalry issues.

“Now the existing treatments for this kind of fairly severe OCD...all have the following thing in common...that they all actually get you to think about the obsession.”

“Now in people with OCD this worry circuit, these three things basically start firing and get locked together and they can’t go on to the new thing. Now some of this may come about because of habit.”



But basically you get the person to think a lot about the obsession. The cognitive behaviorists traditionally get the patient to make a list of what’s sensible and what’s not sensible about the symptom. And they’re thinking about the symptom.

And the problem is that most people with OCD, not all, but the overwhelming majority actually know their symptoms don’t make sense. And behaviorists often will get a person to undergo exposure therapy. If you’re afraid of germs you get more and more exposed to them.

For a variety of reasons Schwartz himself was dissatisfied with the outcomes so he basically, working from the brain scans, developed this very simple approach to it. Phase 1 is simply recognition that you have a problem, but it’s not germs. It’s your OCD acting up.

That may not sound very impressive, but it’s actually very important for patients to retrain. It’s crucial. “You have a big problem right now, my friend, but it’s not the germs. It’s that the OCD is acting up.”

And then Phase 2 is you have to manually shift the gear shift. That shifts automatically in most people by having prepared some action which is all together different from washing. So it might be when you get this, you re-label it and then you go in the garden and you do gardening.

Or you get on your exercise bike. Now there are more subtleties to it than this, but these are the main points. And I’ve seen patients with pretty severe OCD undergo what I would call an internal civil war where over a period of four to six weeks, every moment that came up, they did that switch.

I’ve seen them beat it (OCD) because they basically developed that manual gear shift in their brain that didn’t exist before with all of the practice. And what really matters is not whether you succeed in getting your mind away from the wish to let’s say go and wash, but the actual effort to push it away when it comes up. That’s how you build up the new brain connections.

Now that’s part of the picture of the treatment of OCD. There may be other brain things going on that can supplement this approach. In general, what it does is it takes people who have no control in their lives and when it’s working, gives them that control back. They still tend to have a bit of an obsessive tendency. They have to keep on top of it.

But again, it makes a difference between a person who - I am thinking of one person who is completely housebound for fear of infection for about a month who was able, with this technique and just the rigorous application of it, to resume a fairly normal life, meeting people and shaking hands and so on.

“What really matters is not whether you succeed in getting your mind away from the wish...but the actual effort to push it away when it comes up. That’s how you build up the new brain connections.”

“...it takes people who have no control in their lives...gives them that control back. They still tend to have a bit of an obsessive tendency. They have to keep on top of it.”

“Schwartz...developed this very simple approach to it. Phase 1 is simply recognition that you have a problem...It’s your OCD acting up...Phase 2 is you have to manually shift the gear shift.”



Dr. Buczynski: That’s remarkable.

The Life Span of Plasticity

Dr. Doidge: The applications of plasticity I’ve described thus far are all pretty rigorous. Now they’ve involved application over time with a lot of mental effort. One of the things Merzenich was able to show is why mental effort is important here from a sub-neural physiological point of view.

There are many epochs across the life span of plasticity. There is the extraordinary plasticity of the womb; of the embryo to the fetus, when the nervous system is being laid down.

And then there are the critical periods of plasticity and they differ for each mental function, in timing, the visual plasticity that Hubel and Wiesel described and so on and the language plasticity, which extends longer than visual plasticity.

And during the critical period of plasticity, there is a part of the brain which is called the nucleus basalis, which is always turned on and it’s as though the intentional system in a way is always turned on.

And when a baby experiences a new word or sound or lights or contours, the nucleus basalis sort of fires off a signal that says “Save that” and consolidates all of the connections in the nerve cells that allow the baby to recognize the color blue or a line or mommy’s voice or whatever.

This nucleus basalis, because it’s always turned on makes babies a great audience because they’re always attentive. And we kind of sense that. We’re always stimulating them and stroking them and tickling them and making funny sounds and moving our heads back and forth and they soak it all up.

Now at a certain point the baby has received enough of our damn-fool stimulation. And let’s say the stimulation we’re talking about is the mother tongue. It has heard those sounds of the mother tongue enough times that the brain says “Okay we don’t have to spend more information hearing the same sounds over and over. We’ve laid out a brain map that includes all the sounds of whatever language your mother tongue is.”

And so the critical period comes to an end. And thereafter you can still learn new words and sounds but you will have to make a conscious mental effort to do so. Anyway, that’s where the plasticity research is at the moment.

It’s conceivable to me, and this is what my next book will be about, but I can’t talk about it in detail until I finish the investigations, that there might be some ways around this. But in general, where the

“There are many epochs across the life span of plasticity. There is the extraordinary plasticity of the womb...then there are the critical periods of plasticity and they differ for each mental function...”

“During the critical period of plasticity, there is a part of the brain which is called the nucleus basalis, which is always turned on...This nucleus basalis, because it’s always turned on makes babies a great audience because they’re always attentive...We’re always stimulating them...and moving our heads back and forth and they soak it all up.”



plasticity research is at the moment, all the exercises and approaches I’ve described, and this includes the psychotherapy as well, require paying conscious attention and effort.

Let’s say a person is post critical period. The next period of their life, they’re basically refining their maps with that mental effort and at a certain point, we will call this middle age, your maps have been refined for years. And you’re never really exercising that nucleus basalis because for the last 10 years you’ve had pretty much the same job.

Reading the newspaper isn’t going to turn on the nucleus basalis. That’s just too easy. The kind of thing that would turn it on would be learning a new language. And so what happens in our brains in middle age is they get out of shape because they haven’t been challenged with intensive enough learning activities.

And we go to parties in our late 40s and we swear that we will remember everyone’s names. And we don’t. And there are signs of memory loss - we show up in a room and we say “Why did I come into this room.” And we can’t remember where our keys are and so on and so forth.

Plasticity and Age-Related Cognitive Decline

This is a new epoch of plasticity and it is called age-related cognitive decline. It is not the same as Alzheimer’s or dementia. It’s basically an epidemic in our world that is a function of how we have used our brains.

We basically stop intensive studying at a certain age. And it looks like Alzheimer’s, but it isn’t. And unlike Alzheimer’s this is a reversible process depending on how you live your life. If you take up a new language or take up some of the exercise programs I talk about, that will be helpful and there are other things that will be helpful, of course.

Exercise is very important in maintaining the brain because the brain runs on a fuel supply that is coming from the heart to the blood vessels. That’s one reason; number two exercise triggers brain neurotrophic factors which allow us to consolidate connections better.

So, exercise is very important for that and as most people know by now, exercise does stimulate the growth of new cells in a small but important area of the brain called the hippocampus which turns short-term memories into long. That is probably very protective for your short-term memory which is what you’re worried about losing when you go to a party and when someone says “My name is Ruth.”

Dr. Buczynski: Interesting. We are out of time. I’m so sorry because any one of these topics we could’ve gone into in much more detail. This has been so fascinating and to everyone, I’m going to be sending you,

“This is a new epoch of plasticity...called age-related cognitive decline. It is not the same as Alzheimer’s or dementia. It’s basically an epidemic in our world that is a function of how we have used our brains...We basically stop intensive studying at a certain age.”

“...what happens in our brains in middle age is they get out of shape because they haven’t been challenged with intensive enough learning activities.”



very soon, an email.

And in that email I’m going to give you a link to the comment board. I want you to go to the comment board and talk about how you’re going to use what you heard tonight. When you do, please put your first and last name, your city and state or country and your profession and then talk about how you’re going to use what you heard.

This is our community board. We can all learn from each other, we can continue this dialog. We can move into applications. We can continue to provoke thought about these ideas. Do go to the comment board and share your thoughts.

And I’m also going to give you a link to Norman’s book. The book again was called The Brain That Changes Itself. I think this is one of the best books written on this topic. And I’m very excited to hear that Norman is working on another, but until that comes out, this is the book I would recommend. And I will send you a link to Amazon. You can check it out there, get your library to buy it or buy it yourself.

You may want to use this book as something to suggest that your patients read that would perhaps get their attention and help them to be more compliant to your interventions. At any rate do check both those things out, the comment board and the link to the book.

And meanwhile, thanks to everyone for taking the time to be part of this call and especially to you Norman, thank you so much. This has been very rich. I really appreciate it.

Dr. Doidge: Thank you.

Dr. Buczynski: Good night everyone.

“...exercise does stimulate the growth of new cells in a small but important area of the brain called the hippocampus which turns short-term memories into long.”

“Exercise is very important in maintaining the brain because the brain runs on a fuel supply that is coming from the heart to the blood vessels...exercise triggers brain neurotrophic factors which allow us to consolidate connections better.”



References:

Bach-Y-Rita, P. (1995). Nonsynaptic Diffusion Neurotransmission and Late Brain Reorganization. Demos Medical Publishing; 1st edition.

Hubel, D.H., & Wiesel, T.N. (2004). Brain and Visual Perception: The Story of a 25-year Collaboration. Oxford, NY: Oxford University Press.

Penfield, W.G. (1990). Speech and Brain-Mechanisms. Classics of Psychiatry & Behavioral Sciences Library.

Schwartz, J.M., & Begley, S. (2003). The Mind and the Brain: Neuroplasticity and the Power of Mental Force. New York, NY: Harper Perennial.

Stark, R.E., & Tallal, P. (1998). Language Speech and Reading Disorders in Children: Neuropsychological Studies. Pro ed.

Syka, J., & Merzenich, M.M. (2010). Plasticity and Signal Representation in the Auditory System. New York, NY: Springer; 1st Edition.

Taub, E.A. (2000). Balance Your body, Balance Your Life: Total Health Rejuvenation. New York, NY: Pocket; Pocketbooks Trade Paper Edition, 1st Pri edition.



About The Speaker:

Norman Doidge, MD, is a Canadoam-born psychiatrist, psychoanalyst, medical researcher, essayist, poet, and author of the popular science book The Brain That Changes Itself. He is on the Research Faculty at Columbia University’s Center for Psychoanalytic Training and Research, in New York, and the University of Toronto’s Department of Psychiatry.

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