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The Amazing Connection Between Your Mind and Body
How to Harness the Power of Your Mind with Neuroplasticity for Optimal Recovery
AFter My Accident, I spent ten days in the intensive care unit at Strong Memorial Hospital in Rochester before I was transferred to the Kessler Rehabilitation Center in New Jersey, a hospital that specializes in spinal cord injury rehabilitation. I was still on a ventilator, which meant I was unable to speak. I was paralyzed and terrified at the thought of leaving the town, colleagues, and medical center I knew so well. I was lucky that my wife was able to come with me and stay in a nearby apartment that belonged to friends of ours who were away for the summer. I was also fortunate that my twenty-six-year-old son lived in Jersey City, New Jersey, about thirty minutes away from the hospital. He had a full-time job, but he visited every Wednesday night for dinner and on most weekends.
Physical therapy at Kessler began the day after I arrived—yes, even while I was on the ventilator. Gradually, I was weaned off the ventilator and my physical therapy continued, increasing in duration and difficulty. One hundred days would pass before I left the rehab center and returned home to Rochester. Every morning at Kessler when I awoke, I was reminded anew of the reality of my injuries, how dramatically my life had changed, and how uncertain my future was. The weight of that awareness was suffocating. It took every ounce of mental fortitude I could muster to face each day. During my recovery, I found three mental tools essential in helping me regain function.
The Three Essential Mental Tools for Recovery
The expression “sound mind, sound body” is never more relevant than for individuals recovering from an ANI. To get your brain and body back takes more than courage. Although you and your loved ones will need plenty of that, you will also need to use the mental tools that make recovery possible. The three essential mental qualities you need to tap into are:
Resilience: Your belief in yourself and your ability to get through tough times. Resilience can be bolstered by your spiritual faith or by recalling how you overcame earlier challenges in life.
Focus: Focus is essential to anything important that you want to accomplish in life, and that’s especially true when it comes to the hard work it will take for you to achieve your goals after your injury.
Persistence: To take advantage of neuroplasticity and rewire your brain in ways that allow your body to perform functions that were lost by your injury, you must practice hundreds of times to become an expert. Because the path to expertise is not a straight line, you must be determined to achieve your goals, large and small, on your way to recovery; and persist during periods of little to no progress.
You and your loved ones can develop these mental qualities as individuals and as a team. They overlap and connect, each one strengthening the others. Let’s take a closer look.
Resilience
There are four essential components of resilience.
1. A belief that we control our response to adversity
2. Confidence that we can develop new approaches to solving our problems
3. Perseverance: Resilience is more than a glass-half-full attitude. In fact, one must face the negatives of a situation to be able to address them and develop solutions.
4. A team effort: Trying to do everything on your own, without asking for help, makes recovering from your injury much more difficult. Don’t go it alone.
The founding director of the Resilience Project, Hugh van Cuylenburg, cites three attitudes—gratitude, empathy, and mindfulness—that develop and strengthen resilience.1 Here are the behaviors that helped me on my journey to becoming more resilient.
Gratitude: To cultivate gratitude, keep a gratitude journal. Every evening, write down three positive things that happened during the day. Write about the best thing that happened to you, the person for whom you are most grateful and why, and what you’re looking forward to most about tomorrow. Studies show that within six weeks of keeping a daily gratitude journal, patients experience physical and mental improvements in their lives—better sleep, improved immunity, increased feelings of happiness, and fewer symptoms of depression and anxiety.2
Empathy: Every time you do something kind for someone else, your brain releases molecules called neurotransmitters that make you feel happier, more energetic, and more positive. In recovery, I realized empathy was a crucial skill that I needed to practice. No matter how severe my injury was, there was always someone “worse off” than me. I would routinely spend time with others to learn about their struggles and let them know that I understood how difficult it was to be in their situation. It’s important to be able to listen and understand without the need to provide advice.
I also discovered that my caregivers responded very positively to empathy. Early after my injury, I was very inwardly focused and didn’t think of my caregivers as having lives outside of the hospital. But I can’t stress enough how important it is, for both you and them, to be empathetic to your caregivers. They’ll respond positively to your taking an interest in them as people. Plus, being empathetic will make you feel better and more confident in your ability to help others.
Mindfulness: The ability to be completely present in the moment in a nonjudgmental state is the essence of mindfulness. Learning how to be mindful—through classes, books, apps, and more—helps you maintain focus on one task and be fully in the moment, whether it’s having a conversation, writing a letter, or participating in a sport. Mindfulness also teaches you to be more self-aware. This is a powerful tool to facilitate your mental and physical recovery because it keeps you from catastrophic thinking—unrelenting negative mental fretting about what-if scenarios.
Focus
Focus is the ability to be simultaneously aware of your environment and concentrate on a specific task, using all your abilities to accomplish it. You’ve likely heard the phrase “wrapping your mind around the problem,” but how do you do that intentionally, regularly, and with positive results? Believe it or not, there’s a method that teaches you how to do this and therapies that can help you focus on achieving results. Athletes frequently refer to this method as “getting in the zone.” It’s a state of mind where you are relaxed but completely focused on the demands you ask of your body. Much of this involves practice and repetition, combined with an intense concentration on the present situation.
A good example of focus was my approach to improving my walking. The key ingredients were coaching by my physical therapist, watching YouTube videos on proper walking technique by both disabled and nondisabled people, and total concentration. The first step in focusing is to learn what skills you must master to achieve your goal. For me to improve my walking, this included a wider stance, a consistent heel strike followed by pushing off with my toes, an upright posture, and use of the gluteus maximus muscles (the big ones in your butt) to push forward. Learning each skill took several weeks, and integrating them together took several years! But the results have been gratifying compared to when I started—today, I can walk ten times farther and at least twice as fast.
To strengthen your ability to focus, you need an organized approach. You have to make a dedicated time commitment (it’s best to make it the same time every day), be in the right environment, and have a good teacher. Every day when I go to work, I schedule my three rehabilitation activities—walking, standing, and exercising on my bicycle—to ensure that I have time to complete them. In terms of environment, convenience is important. For example, I stand and cycle in my office using a computer and external monitor to enable me to work while I exercise. And, when I walk, there are no distractions. My physical therapist, assistant, and I are quiet, except when they comment on my technique.
Persistence
To achieve your goals, you need the determination to persevere. For example, learning how to walk again requires that you break the goal into component skills that you will practice hundreds of times. This can be both boring and frustrating, especially since progress is rarely linear, with successes followed by long plateaus. It is during these times of no progress that you may want to stop trying, but persistence will carry you through. At times, you may not be able to practice because of injuries and other health issues. It’s crucial that you keep going at some level, especially during times of extreme hardship. A good friend told me that the hardest time of his rehabilitation was when he developed a pressure ulcer (more on this in chapter 13) and had to lie in bed for twenty hours each day until it healed. As a result, he lost much of the progress he had made in recovery and needed to start all over again, but persistence carried him through.
How to Harness the Power of Your Mind
There are three concepts critical to this idea:
1. If the mind is a mental concept, and not physical, how does it interact with the brain? The brain is a physical object composed of 14 to 16 billion nerves and even more additional cell types, while the mind represents the product of the brain’s nerve activity, thinking. Thinking has been translated into something measurable by doctors, the state of consciousness, which is measured by the Glasgow Coma Scale (GCS, see Table 1). The GCS measures consciousness by the level of stimulation required to cause the person to open their eyes, respond to speech, and move in response to pain. Each response is graded from 1 to 5, so the lowest total score is 3 (indicating deep unconsciousness) and the highest is 15 (indicating fully awake). Importantly, the admission GCS has been linked to prognosis for ANI, especially TBI (scores of 3 to 5 are associated with very poor outcomes).
| Eye Opening | Score |
| Spontaneous | 4 |
| Response to verbal command | 3 |
| Response to pain | 2 |
| No eye opening | 1 |
| Best Verbal Response | Score |
| Oriented | 5 |
| Confused | 4 |
| Inappropriate words | 3 |
| Incomprehensible sounds | 2 |
| No verbal response | 1 |
| Best Motor Response | Score |
| Obeys commands | 6 |
| Localizing response to pain | 5 |
| Withdrawal response to pain | 4 |
| Flexion to pain | 3 |
| Extension to pain | 2 |
| No motor response | 1 |
| Total normal (fully conscious) | 15 |
Table 1: Glasgow Coma Scale
2. Neuroplasticity is the ability of the brain to “rewire” itself by building new connections between nerves. When the brain is damaged, the mind has to find another way to perform a task. This process occurs through visualization. Your mind visualizes how your body will perform a task, and your brain executes the appropriate commands.
3. Practice is critical to neurorestoration. I practiced lifting plastic wine glasses thousands of times and then practiced another thousand times with increasing amounts of water in the glass, all before I was able to try lifting real wine in a real glass.
Neuroplasticity
Neuroplasticity has three parts: learning, compensation, and recovery.3
1. Learning is the process of acquiring knowledge, behaviors, and skills through experience or study, or by being taught.
2. Compensation occurs when a part of the brain that isn’t injured takes over the function of the injured part.
3. Recovery is improvement of function in an injured area. The body’s synapses (connections between nerve cells) can increase to change the quality and quantity of their interactions. This reorganization is likely dependent on learning and compensation, along with a heavy dose of practice.
Figure 7: Visual training to restore some of the basic vision lost to TBI and stroke
For example, if you’ve lost your ability to see the left side of your visual field after a stroke, you can regain some of this vision by practicing a phenomenon called blindsight, since you likely have visual neurons that are still alive.4 These neurons can be activated in a coordinated fashion by repetitive practice—in this case, by staring intently into a white globe with a red laser dot shining into it (Figure 7). The technician flashes the laser in several places and asks you to signal when you see it. Initially, you may see it only in one or two places, but over many hours of practice, you will steadily see it more often in the part of your visual field next to your blind spot. Through repeated practice of this activity, the living visual neurons form new synapses. Further neuroplasticity occurs by uninjured parts of the brain that exist outside of the visual cortex joining via unknown mechanisms. In most patients this “reassembled” visual sensor generates a stimulus (sufficient electrical activity) of the visual field to be detected by your brain.
The key principle in this process is that recovery and compensation depend on nerve cells being recruited to form new synapses. This is called the Hebbian theory,5 which describes how brain neurons change during the learning process. Simply put, “neurons that fire together, wire together,” or new connections between nerves that are used frequently become more stable and recruit additional nerves to form a new mature pathway. In this way, repetitive firing of newly formed synapses creates new groups of neurons that compensate for lost function. For example, I now use my left hand to pour a glass of wine and drink from it, when I was right-handed all my life. For people with ANI, this offers a clear path to recovery. In chapter 19 we’ll look at several ways that new technologies take advantage of this principle to promote functional recovery.
Rehabilitation and Neuroplasticity
Rehabilitation is focused on restoring physical functions. It teaches your brain how to compensate by altering your behavior, or how to restore function by improving the lost function itself. For example, teaching someone how to use a cane or a buttonhook is a compensatory behavioral approach for a neurological problem such as a weak leg or a lack of dexterity and strength in your fingers. It may also include work-around solutions or substitute skills, such as teaching people with right arm and hand paralysis to tie shoes using only the left arm and hand.
Restoration of function is much more difficult than recovery of function. Restoration of function involves restoring neurons at the site of damage to normal function or causing new cells to grow and differentiate into neurons (the hope of stem cell therapy). Recovery of function means that you can perform the task, but it frequently requires use of other nerves located outside the previous pathway. Both processes require repetitive use and stimulation of the paralyzed limb. To master a task that requires “restorative neuroplasticity,” Peter G. Levine, author of Stronger After Stroke, identified four components.6
1. Repetition. Mastering a movement requires hundreds, if not thousands, of repetitions; such as described above for visual restoration using blindsight.
2. Task-specific. It’s easier to rewire the brain if the task is “real world.” If you’re a painter attempting the “reach and grasp” task, for example; it’s much better if your goal is to grasp a paint brush, rather than a child’s block (an object typically used in adult occupational therapy).
3. Massed practice. The repetition and task-specific practice should occur in time-intensive sessions; two to three hours a day for one to two weeks, for example, rather than one to two hours every other day for one to two months. This time dedication may not be possible for people who work full-time jobs, as I currently do. But I was able to follow the massed practice model when I took a leave of absence to travel to China several years ago. For eight weeks, I performed neurorehabilitation six days a week for seven hours a day. There, I made the greatest progress ever in my overall health, strength, body control, and task-specific skills. (More about this in chapter 8.)
4. Novel or challenging tasks. Practice tasks that are new or difficult for you. For example, I progressed from being hand-fed by an aide (since I could only lift my arm to my mouth twice before I became exhausted), to drinking from a sippy-cup or lifting food with a modified spoon or fork, and finally to drinking from a stemmed wine glass and cutting meat with a knife and fork.
Common Neuroplasticity Exercises
Mirror box exercise
One of the oldest therapies for neurorehabilitation of the upper extremity is the mirror box (Figure 8). You place the paralyzed or weak arm and hand inside the box and the functioning arm and hand outside the box, so that you can see it reflected in the mirror. When you rotate the functioning hand, it looks like the paralyzed hand. If you rotate both hands at the same time it looks, to your brain, like the paralyzed limb is moving. Repetition is key here: When done hundreds of times, this exercise can strengthen the paralyzed limb. As the limb becomes stronger, the process can be targeted to a specific task. If the task has personal meaning, the extra motivation can strengthen your perseverance to repeat the exercise.
Figure 8: Mirror box
The BIONIK InMotionARM
To develop accuracy and strength for my reach and grasp, I used a state-of-the-art robot that was designed for the arm and hand (Figure 9). This robot has sophisticated analysis tools, which allow you and your therapist to see exactly how many repetitions you did, at what speed, and with what level of strength and accuracy.
Figure 9: BIONIK InMotionARM
There were two tasks I practiced extensively. The first was the wagon wheel. In this exercise, you move the joystick from the center to the lighted circle at the rim while trying to stay on the spoke and move as fast as possible. The baseline test is to perform one circle of eight “out and back” movements against no resistance (Figure 10). This is much harder than it sounds, because it’s easy for the hand to wander. It reminds me of figure skaters tracing circular patterns on the ice.
Figure 10. Robot wagon wheel progress
After the baseline test, I would perform the exercise by repeating the out-and-back movement eighty times, then resting for one to two minutes and repeating the exercise three more times, for a total of 320 movements. As shown (compare 10B & D to 10A & C), there was an obvious improvement in my speed and accuracy after the exercise. Because of my schedule, I could spend only one hour, three times a week, using the robot. But I still made rapid progress in just four months (compare 10D to 10B)—I was able to move in straighter lines, which I performed 50 percent faster. While not as effective as massed practice, this was sufficient repetition to show measured improvement. This translated into better dexterity for eating, typing, and handling objects, such as my phone.
I also performed a strengthening exercise in which the robot tried to pull me off the center hub every two seconds for two minutes. Over the first six months, I made significant progress in strength; the robot’s ability to move me off the center hub was reduced by 50 percent. My strength improved to a level that enabled me to hold my coffee mug with my right hand and twist the top with my left hand to open it.
It should be noted that not all neuroplasticity is beneficial. Many ANI survivors have chronic pain in their paralyzed limb because the mind interprets the loss of information (both sensation and movement) as pain. I experienced an increase in pain in the biceps of my right arm two years after my original injury. This progressed to complex regional pain syndrome (CRPS; see page 83), in which I had changes in blood flow, temperature, skin color (from white to purple due to poor blood return via my veins), fluid accumulation (edema), and pain, even without exercise or injury. To combat the pain, I use skin patches that contain an anti-inflammatory drug, like ibuprofen or diclofenac, because the underlying problem is inflammation. Relaxation techniques such as breathing control and self-hypnosis are also quite effective, although I’m often left with some residual pain (a 2 on a scale of 0 to 10). You’ll find more information about pain management in chapter 4.
The Mind Made Visible
Your mental efforts are instrumental in your physical recovery. If you’re reading this book, you have what it takes to tap into the astounding power of your mind to help you get back to your life. You can’t see your mind when you look in a mirror, but it’s there, ready and waiting to help you on your path to recovery. The techniques and practices in this chapter will help you throughout your recovery and beyond, in the hospital and at home—which is the subject of our next chapter.
Everything You Need to Know
Your mind and your body are inextricably linked. Once you recognize that you can (and should) use your mind to help your body heal, you are heading toward a better recovery and a better quality of life. Begin a regular practice of what you’ve learned in this chapter and build “mental muscle” in the same way that a physical workout regimen builds stronger muscles.
• Start your gratitude journal today. That daily activity will nourish your resilience, sharpen your ability to focus, and strengthen your persistence.
• Develop your empathy by finding ways to show compassion for someone in need. Besides being the right thing to do, it’s a habit that will replenish your energy. It will also remind you that when you need to ask for help, you are not burdening someone; rather, you are allowing that person to feel the reward of acting with empathy and compassion.
• Learning mindfulness will have one of the biggest impacts on your recovery. The ability to be present in the moment in a nonjudgmental state greatly improves your quality of life and your efforts in therapy. Mindfulness can be learned, but usually not simply by reading a book or watching a video. Let your health care team know that you want mindfulness training; most hospitals offer it on an outpatient basis. Or, contact a local yoga studio—they may offer mindfulness classes.
• Our understanding of neuroplasticity—the ability of the brain to create new neural pathways to restore lost function—continues to expand every day. Be sure to let your team know that you’re eager to challenge yourself with functional goals that require repetition and, therefore, dedicated regular occupational and/or physical therapy.