As I landed in the nation's capitol on friday, a flight attendant announced on the intercom "Welcome to Washington, D.C. On behalf of American airlines we would like to thank you for flying with us, and a special thanks to our members of service today for Veteran's day". Between the war in Iraq, political unrest in Afghanistan and surrounding Middle east countries in addition to all the locations our troops are stationed, brain injuries and disorders related to warfare are becoming quite prevalent. These issues range from psychological unrest, anxiety, and depression to post-traumatic stress disorder (PTSD) to traumatic brain injury (TBI). With the increasing number of brain related traumas comes the need for increased attention on how the brain responds to injury from both a psychological and physiological perspective.
In an article in the New York Times entitled "Turning to Software to Help Treat Brain Injuries", Gordy Slack explores a recent investment by the U.S government into brain health software created for the public and designed to aid soldiers and victims of TBI on regaining memory and attention function. With a $2 million dollar grant from the Department of Defense bolstering it, Brain Plasticity Inc. has come up with a software by the name of Posit Science that potentially has the ability to help TBI patients in regaining skills in memory, attention, language skills and visual-spatial abilities. Michael Merzenich at the University of California, San Francisco, the co-founder of the program and a leader in the field of neuroplasticity, has great hopes for the programs capabilities and uses. (Slack, 2011)
As the article went on, it eluted to great strides in neural plasticity in the past 30 years that have opened up new possibilities in the treatment of TBI and PTSD. Though it is true that neuroplasticity was a concept of fiction in the early 1980's, and since then the idea has proliferated in the field, it would be premature and naïve to say that the brain is entirely plastic, and that all injuries are repairable. So the question begs, where is the border? How much injury is too much injury? Additionally, is the brain's ability to heal itself ubiquitous in every part? These questions explore a large breadth of topics within neuroplasticity, but specifically in the war setting, the reparative capabilities of the brain rely on where the insult occurred, and to what degree. The NYT article's summary of the of the Posit software was brief, so I decided to do some investigating. According to the Posit Science website, the software focuses on utilizing the brains plasticity by increasing the amount of stimuli to train the patient's brain in handling large quantities of information while still understanding the quality of each new piece of information. The program is based off of theSAAGE Design Protocol which stands for Speed Accuracy Adaptivity Generalizability Engagement. I've provided a link below, but essentially the paradigm focuses on the "root" as Posit Science put it of the problem instead of compensatory mechanisms or the "fruit" as they put it.
http://www.positscience.com/science/how-training-works/SAAGE
http://www.positscience.com/science/how-training-works/SAAGE
In delving into this software and the supporting research I think it is difficult to say how much injury is too much injury? Yes, incorporating training that increases stimuli could help someone who has sustained an injury to a part of the brain allocated to perceive. So auditory stimulus could perhaps have regenerative effects in a temporal lobe injury, in the same way that a visual stimulus may have positive effects in the occipital lobe. But what ofhippocampal injuries? In my current research on neuroplasticity the greatest reported amount of neuroplasticity in all forms has been reported in the hippocampus, but does this hold true when there is a combination of PTSD and TBIwhere not only is there physical damage to innervations of the hippocampus but also the software, so to speak, of thehippocampus is damaged. What really stands out to me here is the principle question of how far can we reverse the effects of serious injuries due to warfare. If a capsule goes off and induces a severe trauma to a patients left temporal lobe, what subsequent language deficiencies can be repaired with stimulation and practice?
Moreover, if there is a TBI to the frontal lobe, say in the orbitomedial cortex as in the case of Phineus Gage, how could such a program reduce the damage simply by stimulation. My question to my fellow scientists then is, would it not be beneficial to first assess what kind of damage was induced, the severity, and then given our knowledge of possible comebacks in cognition...what appropriate programs are appropriate to try to harness the neuroplasticity that has come under such hype?
The article: http://www.nytimes.com/2011/06/17/us/17bcbrain.html
A link on VA TBI rehab programs :http://www.youtube.com/watch?v=tq1NgtjDRFY
I'd like to think that they perform some sort of brain scans to assess damage, because otherwise the only means of figuring out which part of the brain was lesioned is through behavior. But I agree, that should definitely be examined first before prescribing any treatment. Of all the articles I've seen regarding neuroplasticity they seem to bring up the point that this ability to mend certain lesions leaves us at some point in life. That children are most capable, because the associations have not been hardwired yet, and they can use what they have to a larger extent than we typically would. Research has also shown that when lesioning brains in mice that if a portion of the brain is removed adruptly often times the function cannot be restored, however if that same amount of neural matter is taken out bit by bit the brain can somehow account for it losses slowly and eventually transfer that function to a different area. Either way, really interesting stuff, and I hope that this research leads to something big seeing as the Armed Forces are funding it.
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