Jeremiah Andrews (not his real name), a fifty-three-year-old lawyer, had his stroke forty-five years before he went to the Taub clinic and was still helped, a half century after his childhood catastrophe. He had his stroke when he was only seven years old, in first grade, while playing baseball.
"I was standing on the sideline," he says, and all of a sudden, I dropped to the ground and said, 'I have no arm, I have no leg.' My dad carried me home."
He'd lost feeling on his right side, couldn't lift his right foot or use his arm, and he developed a tremor. He had to learn to write with his left hand because his right was weak and incapable of fine motor movements. He got conventional rehab after the stroke but continued to have major difficulties.
Though he walked with a cane, he fell constantly. By the time he was in his forties, he was falling about 150 times a year, breaking, at different times, his hand, his foot, and, when he was forty-nine, his hip. After he broke his hip, conventional rehab helped him reduce his falls to about thirty-six a year.
Subsequently he went to Taub's clinic and had two weeks of training for his right hand, then three weeks for his leg, and improved his balance significantly. In this short period his hand had so improved that "they had me writing my name with my right hand with a pencil so that I could recognize it — which is amazing." He continues to do his exercises and continues to improve; three years after leaving the clinic he has fallen only seven times. "I have continued to improve three years after," he says, "and because of the exercises I'm in better shape than when I left Taub, by a huge, huge margin."
Jeremiah's improvement at Taub's clinic demonstrates that because the brain is plastic and capable of reorganization, we should be slow to predict how far a motivated patient with a stroke in a sensory or motor area may progress, regardless of how long the patient has lived with the disability. Because it is a use-it-or-lose-it brain, we might assume that the key areas of Jeremiah's brain for balance, walking, and hand use would have completely faded away, so that further treatment would be pointless. Though they did fade, his brain, given the appropriate input, was able to reorganize itself and find a new way to perform the lost functions — as we can now confirm with brain scans.
Taub, Joachim Liepert, and colleagues from the University of Jena, Germany, have demonstrated that after a stroke the brain map for an affected arm shrinks by about half, so a stroke patient has only half the original number of neurons to work with. Taub believes that this is why stroke patients report that using the affected arm requires more effort. It is not only muscle atrophy that makes movement harder but also brain atrophy. When CI therapy restores the motor area of the brain to its normal size, using the arm becomes less tiring.
Two studies confirm that CI therapy restores the reduced brain map. One measured the brain maps of six stroke patients who had had arm and hand paralysis for an average of six years — long after any spontaneous recovery could be expected. After CI therapy the size of the brain map that governed hand movement doubled. The second study showed that changes could be seen in both hemispheres of the brain, demonstrating how extensive the neuroplastic changes were. These are the first studies to demonstrate that brain structure can be changed in stroke patients in response to CI treatment, and they give us a clue as to how Jeremiah recovered.
CI therapy is now being assessed in national trials throughout the United States. Taub is also on a team developing a machine to help people who are totally paralyzed with amyotrophic lateral sclerosis — the illness Stephen Hawking has. The machine would transmit their thoughts through brain waves that direct a computer cursor to select letters and spell words to form short sentences.
Taub also wants to find out whether stroke patients can develop completely normal movement with CI therapy. Patients now receive treatment for only two weeks; he wants to know what would happen with a year of the therapy.
Excerpted from her book: The Brain That Changes Itself
Stories of Personal Triumph from the Frontiers of Brain Science
By Norman Doidge, MD, Penguin Publishing, December, 2007