Sunday 27 November 2022

Neuroplasticity and Special Needs

An important area of research underlying work with children and young people with an injury to the brain is neuroplasticity. 50 years ago the brain was believed to be permanently hard-wired and unchangeable. Once it was fully developed nothing that could be done to change it. That had implications for children with learning difficulties. However research by neuropsychologists such as Aleksandr Luria and Mark Rosenzweig and psychiatrists like Norman Doidge has shown that old view of the brain is wrong. Neuroplasticity means that the brain can be rewired at any time of life. This must give hope to parents of children with learning difficulties, not to mention an adult who has a stroke.

The Russian psychologist, Luria was the founder of neuropsychology. He combined psychoanalysis with neurology. His book 'The Man with a Shattered World' is about Lyova Azetsky, a soldier with a shrapnel wound to the brain. He writes "Great damage to the left side deep inside the brain - in a coma then awake – had very odd symptoms..." Shrapnel was lodged in the part that helps us understand the relationship between symbols.  He could not understand cause and effect, logic, or spatial relationships. He couldn’t tell his right from his left. He didn’t understand in, out, before, after, with.  So he couldn’t understand a whole word or sentence because all those things involve relating symbols. Luria however had no treatment for Azetsky. Luria worked before the advent of MRIs but he mapped out the functions of areas of the brain through his extensive work with adults with specific brain damage. By observing the symptoms of certain wounds to the brain he concluded which areas are responsible for what functions. 

The breakthrough came in the 1960s when Mark Rosenzweig, a pioneer in brain plasticity, conducted experiments on rats in the laboratory. Rosenzweig’s studies of laboratory rats at UC Berkeley in the 1950s and '60s, showed that "environmental therapy" can stimulate brain growth. Rats living in an "enriched environment" with stimulating interactive tasks performed better at learning activities than those in passive, impoverished conditions. Rosenzweig’s work was thorough and was groundbreaking. Hw wrote, "We did not invent the concept of the 'enriched environment,' but I believe that our publications introduced the concept and the term to the neuroscience community." In 1982, he was officially recognized for demonstrating that the weight, chemistry and structure of the brain are affected by environmental stimulation. 

In ‘The Brain that Changes Itself’ (2007), Norman Doidge, the Canadian psychiatrist describes the case of Barbara Arrowsmith Young, who had notable strengths, such as a remarkable auditory and visual memory and highly developed frontal lobes. But she had significant learning difficulties. She read Luria’s account of Azetsky and recognised all her symptoms in that soldier. In particular though she could easily memorize things she could not understand spatial relationships, which meant among other things she was unable to read and unable to tell the time. She saw everything in fragments. Azetsky had shrapnel lodged deep in the left temporal lobe. Luria located Azetsky’s brain injury to the intersection of the temporal occipital and parietal lobe. This is the point where visual images, spatial relationships and sound/language are all integrated. It is the juncture where perceptual information is associated. Because this area of the brain was damaged the subject could not relate his perceptions or parts to the whole. He could not relate symbols to one another.  This gave Barbara an understanding of what was wrong with her. But the answer came when she read the work of Rosenzweig. His work with rats established beyond doubt that extra stimulation helps to modify and enlarge the brain. If a brain can be modified and changed then by enriching the environment and providing the right kind of stimulation and intervention the weaknesses in her brain can be improved. Barbara worked out a scheme of exercises and worked on them intensely over a period of many weeks. The result was that she actually improved her ability in all areas. She could now tell the time. She understood what people said in real time. She grasped logic, maths, grammar and reading. 

Barbara was so successful that she started a school where the focus was on brain exercises. Examples of those exercises are tracing complex lines to stimulate neurons and memorizing poems by rote. Ironically in the 19th and 20th century educators advocated practices, which Barbara introduced extensively in her school.  At one time classical education involved learning by heart long poems and recommended attention to precise handwriting and elocution. These practices now dropped from educational programmes are acknowledged to be good for stimulating neurons and increasing the size of the brain. 

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