THE CHANGEABLE BRAIN

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And the consequence is that the brain stays in a more passive and sensory, in a state where everything is intake but nothing is outwards oriented. So it's like an organism which is encircled in itself and has no tendency to voluntarily change anything in the outside world. And the consequence of course if you don't want anything, you are not getting frustrated. And frustration is one of the main reasons for negative feelings. And so as the consequence of this the overall quality of life in the completely locked-in state is good.

Of course all these patients are happy if they can communicate with the brain—computer interface again, but if they have some memory, sometimes they don't have much memory of what was happening, if they have some memory of what happened in a completely locked-in state, they all convey a fairly happy positive emotional state. I think you worked with one patient with locked-in syndrome whose husband hardly ever left her side.

How did you work with them and what were you able to find out using the couple together? So far we didn't succeed to change the BCI system so that she can select words. But with the yes and no questions, all are questions asked by the major family member who was related to the patient, so from these questions she for the first time asked us to bring her to the Opera House, to bring her to concert halls, she asked us to put ice cream on her lips…of course they cannot eat and swallow but they still have some taste left.

And then all these wishes which she couldn't fulfil for such a long time improved her quality of life enormously, and now she is four years in this state and we communicate to her or her husband communicates one hour a day with her, but even that is not necessary anymore, after a few months, you know what your partner wants, after a while you can read the thoughts of your partner without any brain—computer interface.

Niels Birbaumer is only too aware that if people who are locked in to their bodies can have a reasonable level of contentment, many ethical issues are raised, especially when it comes to their care. Another area where the brain's ability to learn and change can make a huge difference to people's lives is after they've had a stroke. Yes, the stroke situation is particularly interesting and successful and it's less depressing than the locked-in issue.

As you know, stroke it is extremely frequent and gets more and more frequent. It's now, at least in Europe, it's the major cause of disability these days, so the costs for our health system is enormous. And one-third of these stroke victims recover without any treatment after about a year. One-third is getting a little bit better but they cannot go back to work. And one-third is completely paralysed, particularly their upper limbs, and so they are incapacitated. So we developed particularly for the hand, for those one-third of patients who cannot move any fingers and cannot move the arm anymore after one year after stroke we developed a robotic system where they think a particular movement.

The thought of that movement creates an electric change in the brain which you can record with the EEG or you can record it with an electrode implanted in the brain. And the thought 'I want to move the hand' is immediately transmitted to an exoskeleton, to like a robotic hand which is fixed to the arm and moves the hand. So the patient thinks, and immediately after the thought the hand moves the way he wants to move it. So the brain relearns around the lesion, around the area which is destroyed from the stroke, the brain learns that the voluntary thought to move the hand is moving the hand.

Transcript

And after about 20 hours of this training you can observe that the muscles slowly regain control. And then you can transmit the control from the brain to the muscles. Not in all cases but in about two-thirds of the cases. And if they have an implanted device of course they can go home and can use that device at home.

About the Book…

If they don't have an implanted device, it's not as good but they still can move. And people who were completely paralysed now can walk on stairs, they can grab a glass. Some of them can even learn to each with a knife and fork.

So how do we learn? And why do some of us learn things more easily than others?

If you have an implanted device you can of course move anything voluntarily the way you like, directly from the brain. So I believe this is one of the futures of rehabilitation in chronic stroke.

Niels Birbaumer and his colleagues have also looked at how training might help people with epilepsy, particularly those who are not helped by medication or surgery. The situation in epilepsy is more complex. We looked at epileptic patients who were not treatable by pharmacological medication and by surgery.

The major treatment for epilepsy is medication which reduces the seizures very successfully. So there's a huge population here who cannot be helped. So we trained these people to perceive unconsciously when a seizure is coming, seconds before it comes, and then to voluntarily regulate the brain activity in such a way that the excitability of the brain is reduced. So they are sitting in front of a screen, they look at the screen and their brain activity, and they look at that part of the brain activity which causes the seizures. It will be more efficient but we haven't done it so far, you can implant the electrodes and then you can walk around.

And whenever a seizure comes they get a warning and then they have to execute that skill, which is not easy to learn.

They need 50 to hours of training to learn to perceive such an incoming seizure, and then to reduce it by a self-regulatory activity in their brain. These people are very often demented because they have brain damage because of those seizures. Some of these people have 15 to 20 seizures a day, so if you have that you cannot think much anymore.

Despite that fact, despite that these people are severely incapacitated and have huge cognitive problems, they all learn this. And what we found is that one-third of these patients get completely seizure free, one-third is getting better and one-third is not changing at all. You would think this is a fantastic result, but what is depressing with this result is that it is not used, it is published in the most prominent journal in the field, but it's not used in the general practice and I have no idea why.

And this is true worldwide. There is no alternative treatment available, but still the medical system has not accepted the fact that an organic medical disease can be treated by a learning procedure, and this is a learning procedure which uses the physiology of the epileptic seizure, and I have no explanation why this is not accepted by the medical community.

It would save…let's say, several hundreds of thousands of people would save their life if they would get such training. His book Your Brain Knows More Than You Think explores his research over 40 years into the potential of brain plasticity to help a range of conditions previously thought to be intractable.

For example, he's studied how people with extreme personality disorders such as psychopathy might be treated effectively. The psychopath is a person who has no fear of the consequences of his or her social behaviour. So these people have a learned or inborn defect, which is a defect which we want to induce in people with anxiety, but these are the people who have exactly no anxiety.

We have very successful psychopaths, those who are intelligent, who had a good education and have that problem that they don't feel the consequences of their behaviour, particularly in others they don't feel much empathy with others, these people are in a competitive society extremely successful. Meaning that in our leading positions we will find a substantial percentage of psychopathic personalities.

Now, that wouldn't be too bad if they are intelligent, but the problem is that their behaviour is not guided by the social and emotional negative consequences of what they do, meaning they just don't care about the consequences. They are interested in profit and they are interested in sexual pleasure and they are interested in achieving satisfaction but they are not interested in the negative consequences of what they do.

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The problem in this research, and that's why we gave it up after a while, is that these intelligent successful psychopaths are not willing to participate in research, for obvious reasons. So the information we have is mainly from criminal prisoners, murderers, mass murderers, rapists, and of course this is very biased information and these people are in prison and we have shown that even in those people we can reshape the brain so that the brain experiences anxiety again.

Now, we trained these people by giving them feedback, information from those brain areas who are activating the fear system. So we trained them to reduce the brain activity in an area of the brain which is called the insular which is producing negative thoughts, which is producing fear, which is producing negative expectancies, and they all, basically all of them after a long training of about 20, 25 sessions, they all learn to increase their fear.

Now, in prison they became less aggressive, they became more positively social, but then of course the prison director comes up to you and asks you, 'Okay, now what should I do with this person?

I cannot say let him free because if we would let him free, and one consequence in the next few days is a dead woman…usually these are men, psychopathic people are men and women the same amount but of course the men end up in prison for many reasons and they are much more violent than women, and women have other forms of psychopathy. But in any case, I cannot measure the success of what I'm doing here.

And in these cases I cannot risk a confrontation with reality in these cases, and that's the reason why we gave it up. We know now how the brain works in these people, we know how we could treat them, but you see in prisons I think also in Australia, everywhere in the western world, you see that the relapse rate in psychopathic criminals is constantly reduced, and one of the reasons for this is that in the prison the treatment approaches are going in that direction. So I'm very hopeful…it's not eliminating crime and it's not eliminating psychopathy, and the real danger is sitting in freedom, the real danger is sitting in the banks, the real danger is sitting in clinics, in hospitals, in university, in business, anywhere.

And that danger we cannot cope with. You conclude your book with a discussion about what you lightly refer to as bunga-bunga, or the human inability to stop doing something, even when it's no longer in the person's best interest. Addiction really fits into this category. What have you found about the potential of neuroplasticity to help with these urges?

Frontiers of the changeable brain

To eliminate addiction is a very difficult task. As long as the person is living in the same environment where it acquired the addiction, and by environment I also mean that when the person is living in the same social but also in the same cognitive system, it is virtually impossible because the brain is such a plastic and learning organ, if you have learned to activate the most pleasurable areas in your brain, and you stay in that situation, it is extremely difficult to get rid of that urge because any stimulus in your environment is stimulating those areas in the brain which tell you 'take me', 'do it', 'make this', 'eat that', 'get that', and that is a wonderful mechanism which drives us forward which is the basis of our careers and of our daily life.

In that sense it's a natural…love and any positive emotion and family, all these things are consequences of the activity of a brain area which tells us 'do this because it has a positive consequence'. And this brain area can be stimulated not just by positive experiences but also by drugs or whatever it is. So that's the reason why this is difficult to eliminate because if we eliminate drug addiction we have to eliminate the dependency of that brain system from the outside world where it has learned to be drug dependent.

To try to treat this disorder in the environment of the patient, most of them fail. Meaning that whatever you do after two years, if the patient stays in the same environment, he or she will relapse. And the only way to get out of that vicious circle is to change the environment in a fundamental way. It is easier for them to direct that mechanism of self-regulation to a new environment.

So any treatment of this disorder has to accept that fact, and it doesn't make any sense to invest an enormous amount of public money in treatment, devices, where these people return to their original situation, because they will relapse. I know that this is causing a huge social and financial and societal problem, but still, I think we have to you face that problem and we have to do something about it.

We are witnessing a revolutionary discovery that the human brain can in fact change itself, but what does this mean? Your brain can be trained and learn new skills by improving cognitive functions such as strengthening memory. An increased number of branches drives the neurons further apart, leading to an increase in the volume of thickness of the brain. This discovery formed the bases of the direction and structure for many popular and successful psychotherapies such as Cognitive Behavioural Therapy CBT.

CBT aims to help you manage your problems by changing how you think and act. We must remember that the brain relies on our senses for input. It is that information we allow into our brain that will structure it and wire it.

To challenge the structure of our brain we must challenge our perception. CBT encourages you to reflect and understand yourself both physically, emotionally and psychologically. It encourages you how you think about yourself, the world and other people. For four hundred years the notion that the brain could alter its structure and primary functioning would not have been discussed. This was as a result of mainstream medicine and science believing that brain autonomy was fixed. People who previously had been told there was very little chance of improving or rehabilitating from their conditions and illnesses.

People can now pursue recoveries and have the positive mentality that they can retrain or, reprogramme their brain.

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