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Life after concussion: how plastic is the brain?
In Context
Book Life after concussion: how plastic is the brain? Concussion varies in severity and persistence of symptoms. In fact, the damage to the brain is almost impossible to predict. A computational metaphor to describe the organization and design of the brain’s software is how Clark Eliott introduces us to his autobiographical account of a concussion that stole his life, and, in his words, caused a breakdown of the machine that allowed him to feel and function as human. The Ghost in my brain offers an acutely descriptive narrative about the alienating and debilitating effects of a relatively minor car crash, an impact with long-term repercussions on cognitive functioning—memory, spatial awareness, movement—with ongoing pain, chronic fatigue, and confusion. Eliott is a highly distinguished professor of artificial intelligence at DePaul University (IL, USA), and it appears that his computer science training, together with an utmost determination to override his injury, contribute to his remarkable achievement of managing his responsibilities. He continues to work and raise his children, and appears to do this independently, with minimal assistance, although acknowledging the support from family, friends, and his employer. To understand the challenges there are many anecdotes where he describes in painful detail, with an analytical slant, the extent of his disability. The tone of this book is predominately written in this way. Eliot writes about himself like a case study—his fascination with the symptoms, the cognitive disruptions and impairments, often supersede the personal or subjective narrative. This does not compromise the emotional impact of his story, but his keenness to explore the complexities of traumatic brain injury and convey this experience to a diverse readership, makes for a compelling insight into a damaged mind, but one that can still function on some levels. The first chapter opens with a scenario (one of many), two and a half years after the accident. Following a three-hour lecture, Elliott crawls through the University hallways, taking two hours to leave the building. “I was by now shuffling along with a strange, slightly pigeon-toed gait and only managing a few inches with each step. My jaw hung down, and my head bobbed from side to side as I moved. I felt the onset of a visual impairment similar to what cinematographers call the ‘Dolly Zoom Effect’,…with each step I took forward, the distant goal toward which I was walking appeared two steps further away. Despite the frightening challenges such breakdowns engendered, I often perversely experienced a kind of existential wonder during these episodes as well, as I watched the great machine disintegrating before my eyes.” As his brain resources emptied he was eventually unable to move at all. Eliott draws on all of his experiences in order to learn, adapt, and adjust. He is repeatedly told that medical science can not fix him, and the invisibility of his illness means that
people around him can not make sense of it, creating a wall of isolation, misunderstandings, and at times hostility. He explains how the automatic sensory filtering process is affected, how doing more than one thing at a time becomes impossible, how cognitive slowing interfered with communication, and how the balance and visual system is shot to pieces. The nightmarish situations that Eliott describes provide the reader with an overwhelming sense that the functioning of the brain is inscrutable, a cryptogram that defies nature and science. Only when it stops working can you appreciate just how incredible it is. Finally, after 8 years, Eliott reaches an impasse. He then stumbles upon two inspirational and brilliant minds: a cognitive restructuring specialist of brain plasticity, Dr Donalee Markus, who refers him to Deborah Zelinsky for neuro-optometric rehabilitation. Markus is confounded by the extent of Eliott’s brain damage; “how can you possibly work at all?” she says, concluding he is the “guy that never gives up—ever!”. With his resilience, she knows she can work with him, and the “brain-plasticity miracle” begins. Markus focuses on restructuring the cognitive aspects based on neuroscientific principles, using specific exercises (included in the book) starting with simple join the dot figures and gradually increasing in difficulty. Find the rule, follow instructions, and repeat again: a task that Eliott willingly jumps into, until he reaches saturation point, complaining that they no longer present challenges. Markus, identifying attention difficulties as a weakness, tells him he must continue, however frustrating. Eliott notices that with time his ability to think is expanding; he can visualize symbols, organize visual scenes, balance background context, and solve real-life problems. Zelinksy performs extensive visual-neurological tests, and evidence-based options are presented: prescription solutions would balance the relationship between target (centre vision, attention, and peripheral vision, awareness); nonyoked prisms would affect peripheral awareness processing; yoked prisms postural mechanisms; and filters (such as tints, occlusions, and blocking tear duct drains), would help regulate body systems. Eliott is instructed to wear glasses, Phase 1 to 4, and immediately experiences a positive shift in his brain. This continues with everyday wear, and in the closing epilogue of his book he writes: “I am, except in a few small ways, free from concussion symptoms”. It is difficult to imagine how a knock on the head could take so much away, but Eliott’s book is an accolade to the cutting-edge scientists who strive towards performing clinical miracles. Eliott is to be greatly admired for this extraordinary story—the message is never give up, because the brain is plastic, and it can rehabilitated.
Lancet Neurol 2015 Published Online October 12, 2015 http://dx.doi.org/10.1016/ S1474-4422(15)00288-4 The Ghost in my Brain Clark Elliott Viking, NY, USA Pp 312. US$27·95. ISBN 978-0-525-42656-1
Jules Morgan
www.thelancet.com/neurology Published online October 12, 2015 http://dx.doi.org/10.1016/S1474-4422(15)00288-4
1
Book Life after concussion: how plastic is the brain? Concussion varies in severity and persistence of symptoms. In fact, the damage to the brain is almost impossible to predict. A computational metaphor to describe the organization and design of the brain’s software is how Clark Eliott introduces us to his autobiographical account of a concussion that stole his life, and, in his words, caused a breakdown of the machine that allowed him to feel and function as human. The Ghost in my brain offers an acutely descriptive narrative about the alienating and debilitating effects of a relatively minor car crash, an impact with long-term repercussions on cognitive functioning—memory, spatial awareness, movement—with ongoing pain, chronic fatigue, and confusion. Eliott is a highly distinguished professor of artificial intelligence at DePaul University (IL, USA), and it appears that his computer science training, together with an utmost determination to override his injury, contribute to his remarkable achievement of managing his responsibilities. He continues to work and raise his children, and appears to do this independently, with minimal assistance, although acknowledging the support from family, friends, and his employer. To understand the challenges there are many anecdotes where he describes in painful detail, with an analytical slant, the extent of his disability. The tone of this book is predominately written in this way. Eliot writes about himself like a case study—his fascination with the symptoms, the cognitive disruptions and impairments, often supersede the personal or subjective narrative. This does not compromise the emotional impact of his story, but his keenness to explore the complexities of traumatic brain injury and convey this experience to a diverse readership, makes for a compelling insight into a damaged mind, but one that can still function on some levels. The first chapter opens with a scenario (one of many), two and a half years after the accident. Following a three-hour lecture, Elliott crawls through the University hallways, taking two hours to leave the building. “I was by now shuffling along with a strange, slightly pigeon-toed gait and only managing a few inches with each step. My jaw hung down, and my head bobbed from side to side as I moved. I felt the onset of a visual impairment similar to what cinematographers call the ‘Dolly Zoom Effect’,…with each step I took forward, the distant goal toward which I was walking appeared two steps further away. Despite the frightening challenges such breakdowns engendered, I often perversely experienced a kind of existential wonder during these episodes as well, as I watched the great machine disintegrating before my eyes.” As his brain resources emptied he was eventually unable to move at all. Eliott draws on all of his experiences in order to learn, adapt, and adjust. He is repeatedly told that medical science can not fix him, and the invisibility of his illness means that
people around him can not make sense of it, creating a wall of isolation, misunderstandings, and at times hostility. He explains how the automatic sensory filtering process is affected, how doing more than one thing at a time becomes impossible, how cognitive slowing interfered with communication, and how the balance and visual system is shot to pieces. The nightmarish situations that Eliott describes provide the reader with an overwhelming sense that the functioning of the brain is inscrutable, a cryptogram that defies nature and science. Only when it stops working can you appreciate just how incredible it is. Finally, after 8 years, Eliott reaches an impasse. He then stumbles upon two inspirational and brilliant minds: a cognitive restructuring specialist of brain plasticity, Dr Donalee Markus, who refers him to Deborah Zelinsky for neuro-optometric rehabilitation. Markus is confounded by the extent of Eliott’s brain damage; “how can you possibly work at all?” she says, concluding he is the “guy that never gives up—ever!”. With his resilience, she knows she can work with him, and the “brain-plasticity miracle” begins. Markus focuses on restructuring the cognitive aspects based on neuroscientific principles, using specific exercises (included in the book) starting with simple join the dot figures and gradually increasing in difficulty. Find the rule, follow instructions, and repeat again: a task that Eliott willingly jumps into, until he reaches saturation point, complaining that they no longer present challenges. Markus, identifying attention difficulties as a weakness, tells him he must continue, however frustrating. Eliott notices that with time his ability to think is expanding; he can visualize symbols, organize visual scenes, balance background context, and solve real-life problems. Zelinksy performs extensive visual-neurological tests, and evidence-based options are presented: prescription solutions would balance the relationship between target (centre vision, attention, and peripheral vision, awareness); nonyoked prisms would affect peripheral awareness processing; yoked prisms postural mechanisms; and filters (such as tints, occlusions, and blocking tear duct drains), would help regulate body systems. Eliott is instructed to wear glasses, Phase 1 to 4, and immediately experiences a positive shift in his brain. This continues with everyday wear, and in the closing epilogue of his book he writes: “I am, except in a few small ways, free from concussion symptoms”. It is difficult to imagine how a knock on the head could take so much away, but Eliott’s book is an accolade to the cutting-edge scientists who strive towards performing clinical miracles. Eliott is to be greatly admired for this extraordinary story—the message is never give up, because the brain is plastic, and it can rehabilitated.
Lancet Neurol 2015 Published Online October 12, 2015 http://dx.doi.org/10.1016/ S1474-4422(15)00288-4 The Ghost in my Brain Clark Elliott Viking, NY, USA Pp 312. US$27·95. ISBN 978-0-525-42656-1
Jules Morgan
www.thelancet.com/neurology Published online October 12, 2015 http://dx.doi.org/10.1016/S1474-4422(15)00288-4
1