The brain, multimovement therapy, neuroscience, pedagogy and education: part 4

A number of significant contributors to John’s recovery included the inherent neural repair processes and neurophysiological renewal at the very moment that the brain damage (for detail see Nudo, 2013) occurred in August 1991. These natural internal processes were added to by the initial medical emergency intervention. This was then followed by all of the subsequent medical and rehabilitative interventions over the following 2 years that included the initial four-week emergency hospital stay in Sydney, which was then followed by the three different hospital stays in Melbourne that also included medically directed physiotherapy. And then following John’s release to home care with Glenys, this then also included hydrotherapy and physiotherapy. The end result of all of this, after nearly two-and-a-half years, was that by early December 1993, John’s severely incapacitated condition continued to remain in place. However...

Click here for part 1, part 2 and part 3.

Incapacitated to recovering

From December 18, 1993, as a result of John embarking on a new type of multimovement therapy, his condition began to change from incapacitated to recovering. The research suggests that this was mainly due to changes in John’s neurological and neuromuscular condition that, as noted above, appear to have mainly stemmed from the time that John commenced his multimovement therapy intervention in late 1993.

Crucially important

However it is crucially important to point out that all of the initial and previous medical interventions (from August 1991 through to December 1993) played a significant role in John’s recovery. All of which impacted constructively on John’s brain and body (the hólos). And yet, we also need to empirically recognise that even with all of these previous interventions taking place, the axiomatic observable fact remains, and that is that most of John’s recuperated condition (which is about changing from being totally incapacitated to that of being almost holistically recovered) took place when John began his multimovement therapy in the middle of December 1993.

Holistic complex brain-based development and power

All of the brain-based neurophysiological changes that took place were complex, that the neuroscience research suggests that this process is what prompted and fostered deep, rich, think, strong, and fast changes to take place in John's brain. In combination with all of these brain and body (hólos) changes, all of the brain-based alternations created immense complex connections, neuronal assemblies, which then also changed and even developed new brain maps; all of which eventually combined to be able to produce all of the necessary neurological, neuromuscular and holistic brain and body processes, which only then became powerful enough to change John’s holistic presenting condition from incapacitated to recovered. In comparison, and using the same premise as above, what that then must mean is that between August 1991 and December 1993, there were not enough holistic connections to create the power that was necessary for John to walk.

Unbelievable and even miraculous

Several who knew John during this time, which included his personal physician, described John’ recovery as being unbelievable and even miraculous. John continued with his weekly therapy for the next four years. John married Glenys on March 16, 1997, where they walked arm in arm down the aisle. John had sworn that he would not marry Glenys unless he could walk down the aisle. This wedding was a big celebration in more than matrimony alone. It signified a clear milestone to John, and all who knew him, and especially his now new wife, Glenys.

Holistic brain support

Further to the brain-based research, the thesis directed multimovement therapy investigation, suggests that John’s recovery may have been further supported and assisted by holistic areas of the brain that had not been damaged by the initial acquired brain injury. Plus, at the time of the acquired brain injury incident, the MMT research indicates that some neurological restructuring may have already started to take place in the damaged areas of the brain. This immediate neurological recovery, in response to brain trauma, includes the process known as collateral sprouting.

Collateral sprouting

When the brain is damaged, the brain immediately begins a process of neurobiological regeneration (close to where the damage occurred), by initiating new axon collaterals, i.e., the process of collateral sprouting. These new axonal collateral sprouts commence their development at the very instant that a brain trauma happens. The purpose of this axonal collateral sprouting phenomena is an attempt by the brain to try to re-establish new axonal, dendritic, synaptic and associated neuron connections. The purpose of this is to try and bring about a normal brain homeostatic function, or as close to normal (that existed before the onset of the injury), as quickly as possible.

Physiological recovery

This process of collateral sprouting has similarities to the process of blood clotting. When, for example, the skin is cut, the body immediately tries to stem the flow and potential loss of blood by initiating the process of blood clotting. Collateral sprouting appears to act in a similar physiological protective manner. When there is trauma to the brain, the brain initiates an immediate response by activating and creating new neural sprouts. The purpose of these neural sprouts is to ty to minimise the damage that has now taken place. This process aims to maximise the brain and body’s (hólos) inbuilt mechanisms. The intention of which is to ensure that firing, repairing and rewiring of the damaged brain will bring about and lead to a more permanent recovered condition of homeostasis. That is an equilibrium that existed prior to the trauma taking place, as quickly as possible. This typically involves neurological regeneration.

Neurological regeneration

James Kalat notes that there is widespread agreement that a neuron will generally die completely if the cell body (soma) is severely damaged or dies. Both Kalat and also Mark Rosenzweig, S. Marc Breedlove and Arnold Leiman indicate that there is also a possibility that neuron and axon regrowth in the peripheral nervous system may still be possible, even after a trauma has taken place. That is, the ongoing process of brain plasticity. A seminal work on the efficacy of this is from Paul and George Bach-y-Rita whose father, Pedro, suffered a catastrophic stoke that led to only about 3 per cent of his brain being left intact. And despite this catastrophic condition, Pedro returned to teaching at the university where he was, as well as recommencing his favourite hobby of trail walking – a normal life was now in place (see overview at Bach-y-Rita, 1987; Cause Effect Psychology, n.d.).

Pushing the limits using MMT

For success, the application of MMT has the client, in this case John Famechon, taken close to the limit of their physical and cognitive functioning at each session – as often as possible. This limit is, as noted above, referred to in MMT terms as the individual’s ‘event horizon’. It is at this ‘event horizon’ where there may be the possibility of additional ‘whole brain’ and even ‘whole body’ recruitment taking place.

Neurological and muscular recruitment

Such neurological recruitment is likely to be similar to muscular recruitment. For example, when a person is lifting a weight, which is beyond their normal range, other muscles from different parts of the body are recruited into this lifting action. So, when a person is lifting a barbell from the floor in a ‘dead lift’ action, what is required is for the person to bend their knees, keep the back straight, and to then lift the weight with straight arms until they stand vertical with the weight held horizontally at thigh level. Whilst this entire process occurs, the muscles respond to the weight trying to be lifted.

If the weight is light, there will be little muscle recruitment, however if the weight is increased then more muscle fibres will be recruited into this lift. And if the weight increases even further then even more and more muscle fibres – even those not directly involved with the lift – will be recruited into the lift to cope with and to try to make the lift successful. For example, the muscles in the face will cause the face to grimace and contort, the muscles in the neck will become taut and red with blood, the muscles of the jaw will cause the teeth to clench, and there will most certainly be grunting and groaning as well. All of these ‘non-direct’ muscles have now been recruited into the lift, so as to allow the individual to successfully lift the weight in question; that is, there has now been an ongoing process of muscular recruitment taking place.

The brain will recruit

By and through the application of MMT, the hypothesis is that a similar recruitment principle may occur at the neurological level in the brain, especially when the client is taken to the ‘event horizon’ of his or her cognitive and physical potential. The brain, in its attempt to cope with the immense overload of the physical and cognitive activities, will then try to recruit and/or even try to create new and/or additional neurological connections, in all parts of the brain, in order to be able to cope with and to complete the required ‘event horizon’ tasks.

Weekly session

During the weekly sessions with John Famechon, he would be asked by Ragnar Purje: "Is it okay to rest?" John’s usual response over the 4 years of MMT was: ‘If you must” or, “What’s the matter, can’t you hack it?” However, as John later confessed to Grantlee Kieza, an Australian multi-award-winning journalist and boxing writer:

Ragnar visited Fammo every week. He increased the difficulty of his cognitive tasks.  Sometimes Fammo had to dodge light punches while pedalling slowly on an exercise bike. More complex movement stoked the fire inside the champ’s grey matter and it gradually thawed.

“It was like doing 15 rounds. We would finish every session exhausted,” Famechon told me at another sportsman’s dinner at Yatala.

“Ragnar kept coming back and I kept getting better.”

Within 12 weeks, Famechon took his first steps out of the wheelchair and within a few more was able to run a few tottering steps while supported.

“When that happened we just cried,” Glenys says.

“The three of us had a big group hug. John had come out of a very bad place.”

That concludes part 4 of The brain, multimovement therapy, neuroscience, pedagogy and education. Part 5 will be examining the importance of understating how failures can help to contribute to eventual success. There will also be a presentation of other case studies who have experienced and recovered from their injury conditions by participating in the process of multimovement therapy.

Dr Ragnar Purje is adjunct lecturer in the School of Education and the Arts at Central Queensland University. Under the supervision of Professor Ken Purnell, Purje’s doctoral dissertation focused on the success of his neurologically focused acquired brain injury rehabilitation therapy.

Professor Ken Purnell is from the School of Education and the Arts at Central Queensland University.

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