"The pain is gone"

To me, an old-fashioned human primate social groomer who has always leaned harder toward the "therapist" side of treatment rather than the "physical", but who uses manual therapy as my main intervention, the advantage of deep science-based pain models like my favorite, the pain neuromatrix model, is that one can remain connected to one's patient (i.e., in good therapeutic contact) while explaining to them what their experience of pain, or in this case radical pain relief, might mean, regardless of how strange it may seem to me or may have seemed to them.

Here is a diagram, famous by now I'm sure, of Melzack's neuromatrix model. Click on it to make it bigger, so you can read the detail.

I often haul out this little diagram and sit down with a patient, because a lot of times, simple handling isn't quite enough - they need answers.

Case in point: last week I saw a young woman for the first time. She had been sent to me by her massage therapist (who I've known for years) who had worked with her for many months. Let's called the patient Rosie (not her real name).

Rosie had had a prior history of low back pain for ten years, for which she had gone to a chiropractor semi-regularly. She had worked as a fund raiser for some outfit, until about two years ago; while nursing a sprained ankle (and on crutches) she was in a car accident. Now she had back pain, sprained ankle, and neck and shoulder pain. She was unable to do her fundraising job anymore and had had to quit.

She had endured persistent neck and shoulder pain for two years in spite of seeing 36 of the finest manual therapists, both conventional and alternative, that Canada has to offer, in two different provinces, and having attended a modern pain clinic.

Then, to her surprise, during a meditation retreat in December last year, her pain vanished. All of it. Gone.

Emboldened, she began a vigorous yoga program, and inadvertently overstretched something. Bam. She had felt instant leg pain and a lot of weakness in the quads. This had persisted beyond the massage therapist's expertise, and was why she had been sent to see me.

I learned that after she had given up fundraising after the MVA, she had become involved in an experiential psych counselling training program, where they let her learn from a physical position of comfort, i.e., horizontal.

At visit #1 I had taken her history and provided some manual treatment, some very rudimentary pain education, and showed her a neural glide to do for the leg. She'd been happy for something to do - anything.

Yesterday at visit #2, I was ready with a neuromatrix diagram and was planning more in depth pain ed.

She arrived.
I asked how she was doing, and she said, "Fine, I'm all better."

(I was thinking,... huh? Did she go on another retreat?)

I asked how she had managed it this time, and she replied that the evening prior she had invited two shamans in to work on her, and they had, with burning herbs and drumming, and lots of touching. Before they left, they had pronounced her cured.

And sure enough, she felt that way. No pain.

She really did seem better, could walk better, move better, sit comfortably, breathe better.. Wow, I thought. "Good for you," I said.

"Well," she said, "I still feel some stuff..."
"..It looks like the stuff you might still feel doesn't bother you anymore - is that how it feels?" I asked.
"Yes," she replied, "I still feel some stuff but it doesn't bother me at all. I didn't need to come today, but it was too late to cancel my appointment."

We had an hour to spend, so I decided to stick with the plan; I asked her if she was interested in learning some things about pain. She said yes, so I invited her to go through the neuromatrix diagram with me. We sat down and I began explaining how the center circle with circular arrows represented the entire nervous system, how it was always processing even at night during sleep, how it was more of a verb, therefore, than it was a noun, how the diagram depicted the movement of this neuromatrix through time... how it had three main inputs on a spectrum that ranged from mental (cognitive evaluative) to physical (sensory-discriminative) to physiological (motivational-affective) and three main outputs, one of which just so happened to be pain, which could be influenced by any of the three inputs and which in turn influenced the three main inputs plus the other two outputs...

As we wandered through the diagram, I plugged in pieces of info she'd given me, she asked questions, we talked about treatment crucibles, safe containers and catalysts, symbolism and shamanism, meditation and movement forward. During her shamanic experience she had had a great deal of novel sensory-discriminative input, through all her senses, not just kinesthetically. I told her it sounded like it had been enough to get her neuromatrix off the square it had been stuck on. I pointed out, based on the prior meditation/pain relief experience, how much more her particular pain matrix seemed to respond to shift of cognitive input than it did to sensory-discriminative input. I mentioned that for most people, sensory-discriminative input of the physical kind was often sufficient, but that she'd burned through 37 manual practitioners of various kinds, including me, without much help, and she nodded..

She told me this was all making more sense to her now.. that she was someone who just didn't "get" things through only her body, the way most people can if some reasonable sensory-discriminative input of a novel sort is provided... Instead things had to make sense to her through her emotions/mind.

Apparently long ago some other PT had loaned her the book "Explain Pain", for a few months, and she had diligently made notes and some photocopies, but it had never quite sunk in or gelled. Now it was finally starting to make sense. She said, "I wish I could read that book again. It was really good, as I recall." I replied that she could buy her own copy if she wanted.

We discussed rehab, and I told her about some options, but that wherever she went, to stay in complete control, not let anyone rush her, and to use "graded exposure" and "pacing", concepts she already knew about.

I showed her two chapters from Pain: A Textbook for Therapists and she took copies. She said this would help her learn the neurobiology for when she herself would be a therapist, counselling pain patients. I mentioned she would be able to buy this book online as well - that buying these two books for herself would be much cheaper in the long run than seeing a bunch of expensive therapists for sensory-discriminative input that her particular brain seemed to not be wired to be able to easily accept. She agreed.

I worked with her leg for a little while, and unlike the first time, this time she remarked on feeling heat and movement in the thigh, and non-painful sensation connected to the leg in other parts of her body. I asked her if she could do an active straight leg raise after, and to her surprise, she could.

She left very pleased with all the progress she had made in one week, by her own efforts. I didn't need to see her again in my opinion; her downregulation was well and truly hooked back up. She's away to her next adventure, all in one piece again finally.

Way to go, Rosie. Way to go.

Still Meditating on Meditation

In reference to Growing a steering wheel for one's brain, and "Mindfulness-Based Stress Reduction" - Jon Kabat-Zinn:
A recent article in the NY Times delves into the history of mindfulness meditation in therapy; check out Lotus therapy by Benedict Carey.

Thank you to Deric at Mindblog.

I just (a few days ago) obtained a copy of Kabat-Zinn's book, Full Catastrophe Living, and am reading random pages from it at bedtime. I usually do this with books ... expose my sleepy brain to them, see if something in there can grab my tired attention hard enough to make me want to read them cover to cover when I'm awake and can fairly engage. It's my own Sleepy Brain Interest Detection Screening Mechanism.

I'm grateful, actually, that at this stage of life I appear to be relatively catastrophe-free - there has been a very nice patch of smooth sailing for several years.

PS: I'm back in this post on May 29, to link to a just-released podcast from Ginger Campbell, in her books and ideas series, an interview with Delaney Dean on Mindfulness Meditation. Here are Campbell's show notes. Here is a link to the actual podcast. I am eager to listen to it.

Chris Koch : Transcript of podcast with Ginger Campbell

I've just released this transcript on Dr. Campbell's BrainScience Podcast Forum. It is of her interview with Dr. Chris Koch, in Podcast #22, last fall.

Dr. Koch, together with Francis Crick, did research to find neural correlates of consciousness. Together they wrote The Quest for Consciousness: A Neurobiological Approach in 2004. Dr. Koch has continued this work subsequent to Dr. Crick's death.

The podcast transcript can be found here:

http://docs.google.com/Doc?id=dg8sf6hf_33z9z29kfm

Growing a steering wheel for one's brain

Lately I've been crossing paths often with the idea of meditation.

My personal take on meditation is that on the one hand, I've always been somewhat reluctant to commit to anything that has any whiff of religiosity about it, while on the other, everything I ever have read about meditation suggested that at its fundamental level it is inherently secular, and biologically, neurologically friendly, which I find attractive.

I was not indoctrinated into any religion as a child, never attended church, usually headed off the other way from any setting where altars were part of the decor. I did succumb, however, to the Maharishi craze when it passed through where I was living in 1972. I took formal instruction and "sat" for awhile (a month or two at most). The meditation consisted of resting while sitting up and silently repeating a "word" given to me by the instructor in a formal private ceremony (which I stomached bravely), a word that meant nothing whatsoever in English, just a sound.

I can still remember the word ("ah-eem"), but don't recall noticing any change in myself at all. I dropped the whole process after awhile. I was/am easily bored I suppose, which is likely the whole "problem" I've had with meditation. Since then I have steered pretty clear of any committed sitting meditation on any sort of recurring quasi-permanent basis that involves being around other people.

Shortly after I became a meditation failure I learned about yoga from Ruth Richards, another physiotherapist in the hospital where I worked at the time. She was considerably older at 55 (I was a tender 22), was Danish, had been through WWII in Britain, was married to, then had become widowed by a UK man involved in the military. She seemed exotic, slightly tragic, wise, worldly, elegant and beautiful. She was a yoga practitioner and taught me the basics - how to breathe, what to feel for.

I began practicing yoga, on my own, from a book; every day for two years I spent at least an hour in my own body, focusing on every small sensation, breathing into, being with, and inhabiting every cubic centimeter of my entire body, feeling, registering, appreciating mounting improvements in my relationship with my body, my movement, my physicality.

I do not recall why I stopped. Bored again probably. But the feeling of knowing/ knowing how to feel and sense, physically, kinesthetically, has stayed ever since, right to this day.

It has helped me focus in on things that actually do matter to me, like getting the right "feel" in my work of manual treatment of pain. I can sit for several minutes without moving, breathing carefully, fully relaxed, even while exerting considerable physical force through my arms if need be, feeling with my hands, feeling for changes in someone's body tissues that tell me favorable change is happening in their nervous systems. I've done this all day long, for years. I've learned to get "me" out of the way, and let my own nervous system and that of my patient "communicate" in whatever way is required, to help that change along. Kinesthesis, whether it's auto- or applied, is so wordless it lends itself well to this deeper kind of attending. I practice this daily or nearly daily as part of my manual therapy practice, and try to teach it to the people I treat, so they can treat themselves.

After having become a manual therapist and learning to feel and control my own nervous system well enough to be able to use it to help other people with theirs, I came full circle back to learn there was meditation for dealing with pain, called Mindfulness Meditation. I wrote about this before, here.

Just a few days ago a new person joined BrainScience Podcast Forum, Delaney Dean, who is a meditation enthusiast and teacher, among other pursuits. She provided a MindHacks link (this one - thank you Vaughan), which contains a link to a great article on meditation, which was really supposed to be the point of this blog post...

Here is a link to the abstract of Attention regulation and monitoring in meditation by Lutz et al., and a link to the paper itself, a 7 page pdf.

I love the first sentence:

"Meditation can be conceptualized as a family of complex emotional and attentional regulatory training regimes developed for various ends, including the cultivation of well-being and emotional balance."

Indeed it can. Indeed it can. So much so that even "I", this rudderless construct of a self that has managed to cobble itself together over time and change, could be persuaded by my nonconscious processes to take it up, maybe for real this time... but I won't hold my breath. Which is part of the point of learning to meditate, or so I've heard..

Is certainty a dopameme?

OK, first a disclaimer: dopameme is a word I made up, just because I thought it was necessary. I'm not entirely sure yet of everything it might mean..
Here is the definition.

Dopameme: Noun; Combination of the name of a neurotransmitter in the brain involved in feeling pleasure, "dopamine", and the term "meme" as coined by Richard Dawkins meaning a thought virus.

A "Dopameme" is a feel-good idea which:

1. forms part of a belief system (e.g., "new age" notions or pseudo/antiscience)
2. keeps people from learning to see the world rationally
3. stubbornly persists through generations, because the emotional comfort or pleasure it provides the person who harbours it ensures it will be replicated frequently in that individual's brain and easily passed on to others via social and conversational contact
4. gets recycled endlessly through books sold at spiritual and self-help bookstores, thus helping support the economy, thus further ensuring its continued survival

Dopamemes can be found in any walk of life but find particularly fertile ground in the helping professions, if fact are actively cultivated by many of them which appear to base their whole existence around farming them for profit.

This morning Harriet Hall at Science-Based Medicine reviewed a new book in her blog entry On Being Certain; the book is On Being Certain: Believing You Are Right Even When You're Not, by Robert Burton. In her review Hall says,

"A “feeling of knowing” probably had an evolutionary advantage. If we are certain, we can act on that certainty rather than hesitating like Hamlet. Certainty makes us feel good: it rewards learning, and it keeps us from wasting time thinking too much; but it impairs flexibility."

This is intriguing, and makes me want to expand the definition of "Dopameme" (the extent of which I am still uncertain) to include a new point:

5. like "certainty", provides emotional comfort by removing the cognitive dissonance of "not knowing."

Coincidentally there has been a very busy thread called Chiropractic and Stroke, also by Harriet Hall, with many comments (arguments from "certainty"), running concurrently.

How to sleep like a proper human primate

This morning a member of SomaSimple brought this article forward in a discussion we are having called Pain of Comfort:

Instinctive sleeping and resting postures: an anthropological and zoological approach to treatment of low back and joint pain by Michael Tetley, PT.

I'm bringing it here as a gift to all who wonder why there is so much insidious body pain in our nice, comfy, dry, temperature controlled, civilized lives. We are perhaps, as the article suggests, too far removed from our primate origin, unable to relax and sleep on a house floor, let alone a forest floor, or a wide tree branch surrounded by air and insects and potential danger.

I never had seen this article until now, and immediately fell in love with it, even though it contains a strong ortho-dominant perspective (as if there were nothing inside the body more important than joints) - otherwise it resonates with everything I think about self-efficacy. There are photos of natural sleeping positions that in my mind elongate and refresh neural tunnels everywhere. If the nerves alongside large joints are healthy, then so will the "joints" be. But this is a minor quibble overall.

The first sentence is;

If you are a medical professional and have been trained in a "civilised" country you probably know next to nothing about the primate Homo sapiens and how they survive in the wild.

Well, not quite true for me. I've been thinking about how to be a good human primate social groomer for quite a long time, Michael.

When people in pain ask me,"What should I do?" I start by teaching them how to get down on the floor and relax there. I tell them, the floor is flat and hard. When you lie down, you will immediately feel all your tightness easily. Once your brain can sense it, it can do something about it, lengthen out various tensions. When you get down on the floor, something's gotta give, and it's not gonna be the floor. The floor is the best biofeedback device there ever was, always cheap and always available. Make the floor your friend. And deep breathe with your abdomen to relax through anxiety and discomfort.

When they ask "What kind of mattress should I be on?" I say, in general, whatever gets you through the night, but the harder the better, so no waterbed.

Chris Koch lectures on neural correlates of consciousness

I found a link on BrainBlog today (thank you, Anthony Risser at Brainblog), that takes a reader to a page containing a list of eighteen(!) lectures by Christopher Koch, each one about an hour long. What a bonanza of information. I've put a permanent link into the menu on the right.

Here are a few other humanantigravitysuit posts that refer to Chris Koch and his work.


Additional reading:

1. Scholarpedia article by Chris Koch on neural correlates of consciousness

2. Ginger Campbell's brainsciencepodcast #22, an interview with Chris Koch.

More insular matters

Deric Bownds at Mindblog, always a font of interesting and useful neuro information, posted about a meeting he was at where A.D. Craig, who researches pain and the insular cortex which helps to process it into conscious awareness, presented his ideas on the functional difference between the left and right insulas with regard to deep breathing. Check it out. Thumbs up.

My own insula seems to light up irresistibly whenever the word "insula" appears, and is drawn to examining whatever new scrap of info might have turned up. I've written about the insula before, here and here.


Here are some articles about the insula:

1. Craig AD. Pain mechanisms: Labeled lines versus convergence in central processing. Ann Rev Neurosci. 2003;26:130.

2. Craig AD. How do you feel? Interoception: the sense of the physiological condition of the body. Nature Rev Neurosci. 2002;3:655-66.

3. Henderson LA, Gandevia SC, Macefield VG. Somatotopic organization of the processing of muscle and cutaneous pain in the left and right insula cortex: A single-trial fMRI study. Pain. 2007;128:20-30.

4. Olausson H, Lamarre Y, Backlund H, Morin C, Wallin BG, Starck G, Ekholm S, Strigo I, Worsley K, Vallbo AB, Bushnell MC. Unmyelinated tactile afferents signal touch and project to insular cortex. Nature Neurosci. 2002;5:900–904.

5. Blakeslee S, A Small Part of the Brain, and its Profound Effects

The strangeness of neural crest

At last I found, bought, and am busy reading a book that goes into excruciating scientific detail about neural crest, Neural Crest in Development and Evolution (1999), by Brian Hall at Dalhousie, Halifax, Nova Scotia.

Neural crest is considered by Hall as "the fourth germ layer". It makes a large amount of surprising structure in the body and head beside peripheral nerves (sensory and autonomic) and the support cells for them. There is a large amount of info here about ectodermal/mesodermal interaction, what induces what, etc. Hall is careful to point out (see the online lecture linked to below) that what is currently known about neural crest is from work done on chicks, and has only been extrapolated to humans - human neural crest may have some variations to offer up to future investigators.

Because of what we do as manual therapists, I think it's good to understand what this embryonic "layer" does and what it makes. It derives from ectoderm, after the neural tube is already well on its way to forming, and long after mesoderm has already been kicked off by ectoderm and is busily making things out of itself. Like mesoderm, it migrates inwardly, but unlike mesoderm, it makes nerves and a few structures, e.g., connective tissue inside glands, something I never knew about neural crest. I knew it made most of the face including bits of jaw and the teeth.

Apparently (according to Hall) it was neural crest cells which may well have made bony plates inside skin in our ancient finny forbearers. It was mentioned in Your Inner Fish that teeth are bony remnants from long long ago, although the neural crest connection wasn't pointed out specifically. The neural crest cell populations that make teeth have been separate from those that (can, ostensibly) make (dermal) bone for 500 million years.

Hall is now "retired" and working on a revision of Strickberger's Evolution 4th Ed., a textbook on evolution. This is Ch. 1 (18 page pdf).

Other links:
1. Unscrambling the egg
2. Online lecture by Brian Hall on cranial neural crest (as opposed to "truncal" neural crest, which behaves differently in modern mammals and birds). (The slideshow takes frequent rests; patience is advised.
3. Short summary of his achievements (about a third of the way down the page), contributor to the emergence of Evo-Devo
4. The book, Variations, which he co-authored
5. More info on Brian Hall and his work

This, along with reading the Sensory Hand, will no doubt keep me busy for quite awhile.

"Somesthesis"

I love how one thing leads effortlessly to another. In the course of preparing the transcript of Buzsáki's interview, I got interested in Vernon Mountcastle.

These days I'm busy reading Vernon Mountcastle's 2005 book, The Sensory Hand. What a great read. What a great researcher. Here's a great review by someone named Edward Jones.

I'm only on page 9, but already he has me by my neurons. He states in a section containing his general hypothesis, his thoughts on small fibre relevance:

1. The small fibres are just as important to sensorimotor "understanding" and function as large ones:

"A general hypothesis I consider at several places in this book is that the small-fibered afferent systems, long known to contain the essential neural substrates for pain and temperature sensibilities, also contribute to the higher-order aspects of the several varieties of mechanosensitive sensibility. They are activated under many conditions by the same mechanical stimuli processed in the large-fibered system, and carry signals to the forebrain that evoke the overall affective components of the sensory experiences. These small-fibered afferent systems activate many distributed areas in the frontal lobe, the limbic areas of the cerebral cortex,and the insula."

He got me with the word "insula." I've followed A.D. Craig, and Sandra Blakeslee's exposition of his work, for a long time now. I first got excited about the insular part of the brain when I found the Olausson paper (see link at end).

2. The small-fiber and the large-fiber afferent systems work together:

"At the same time signals in large-fibered afferents are processed in an elegant and quantitative manner and present to higher-order cortical systems signals that can be detected, discriminated and rated with precision, in quantitative correspondence with the parameters of the stimuli that evoke them."

Indeed, how could they not?

3. Research on the two systems became separated:

"Until now we have learned very little about the final "integration" of these varied inputs in producing overall somesthetic experiences. This integration and its varieties are obvious in everyday life - the touch of a loved one's hand carries overtones not found in more ordinary tactile experiences. The hitherto perceived dichotomy of these two classes of systems has resulted in a parallel separation of investigators. Those talented individuals who have made such spectacular discoveries about the functions of the small-fibered systems in pain and temperature sensibilities now sense that the deepening knowledge of these systems, particularly the molecular aspects of the peripheral transducer mechanisms, will lead to chemical methods of blocking pain at its level of inception,with no effects on the function of the central nervous system. Yet, only a few have taken full account of the broader - or perhaps I should say, other - meanings for behavior of activity in the small-fibered systems. Of course, the same is true inversely for those investigators involved in quantitative studies of the brain mechanisms in mechanoreceptive sensibility. They have because of the constraints of experimental design and execution not been able to take into account the accompanying activity in the small-fibered systems and the powerful contributions they make to the overall somesthetic experience."

Maybe we can lay the blame on Cartesian dichotomy.

4. Mountcastle is trying to bring the two fields of investigation together again: this book is his effort to provide a "sublation":

"This division now ends, and concerted efforts are directed to study of the somatic system, complete. That such a dichotomy has not occurred, or at least not to the same extent, in studies of the visual and auditory systems is attributable to the relative simplicity of those systems. Compare, for example, the 12 different sets of first-order fibers innervating the primate hand with the much smaller number of afferent sets leaving the eye or the ear. The visual and auditory systems are by no means simple, but only appear so when compared with the somatic afferent system, in which a number of afferent sets with congruent peripheral distributions feed many ascending systems. Moreover, at several transition stations of these systems there is a complex interaction with motor mechanisms. I make here an effort to begin the process of unifying these two major fields of research. The reader will find in several chapters descriptions of the small fiber systems, with some effort to show how they condition the overall mechanoreceptive sensory experiences."

Let's repeat something in there for emphasis:

That such a dichotomy has not occurred, or at least not to the same extent, in studies of the visual and auditory systems is attributable to the relative simplicity of those systems.

What? Relative simplicity of vision and hearing?
This explains why touch has been ignored for so long. Production and perception of sensory physical contact is more complicated to study/make sense out of than either vision or hearing.

I looked for some good links to bring here on "somesthesis", but all I could find (so far) are simple definitions like this one.

I have high hopes for this book. I'm hoping to uncover material that will make sense out of human primate social grooming, make meaningful connections. I hope it will clarify a path that can be taken by people (like me) who want to see this form of human interaction not just lifted up out of the muck of institutionalized human greed and exploitation, but restored clean and shiny and science-based to those who want to bring hands-on care back into good use, good service, ethical service.

Additional Reading:
1. The Brain Voyager; includes a picture of Mountcastle in his retirement
2. See Sandra Blakeslee's article, A Small Part of the Brain and its Profound Effects (6th one down the list)
3. Unmyelinated tactile afferents signal touch and project to insular cortex; nature neuroscience 2002; Olausson et al.

Transcript For BrainScience Podcast #31

I have prepared a transcript of Dr. Ginger Campbell's Episode #31, Brain Rhythms with Györgi Buzsáki, with her permission.

You can read it here: Synchrony and Oscillation in the Brain.

The transcript was written to assist my own learning of the material in both the book and podcast. Here is a link to Brain Oscillations: Ten Part Series, on the same topic.

The ideas in the podcast are much easier to follow if one can read along as one listens; the intention of publishing this transcript is for it to be a listening/learning aid for anyone who wishes to dig deeper into understanding the presentation, and the book upon which it is based.

More on Lorimer Moseley, and mirror therapy

I stumbled upon a blog called Psychology of Pain (in which I found a link to humanantigravitysuit, about which I'm pleased), authored by Gary Rollman, Professor of Psychology at UWO in London Ontario.

In it I found a post, The Mirror Cure for Phantom Pain, which is linked to an article by Lorimer Moseley, PT and currently pain researcher at Oxford.

The article by Moseley, also called The Mirror Cure for Phantom Pain, has just been published in SciAm.

Excerpt:

"To consider how mirror movements might reduce pain, it might be helpful to first consider what pain is. I argue that pain emerges from the brain in accordance with the brain's unconscious perception of danger to the body part in question. Sensory input of danger (called nociception) is important, but not sufficient (nor necessary actually), for pain. Perhaps mirror movements simply convince the brain that all is exactly as it should be, which removes the brain's need to evoke pain. Alternatively, perhaps mirror therapy is a great distracter: distraction remains our most effective analgesic. Such explanations are very reasonable, but not particularly exciting.

Here is a more exciting theory, one the authors' introduction suggests they had in mind. It is based on the idea that phantom limb pain results from an internal conflict in the brain. Although sensory feedback, from the nerves that used to supply the missing limb, tells the brain that the limb is still present, visual feedback tells the brain it is not. According to that theory, seeing the phantom would remove the conflict and attempting to move the phantom (i.e. the other two conditions) might exacerbate it (although removing visual feedback didn't help, which doesn't fit neatly into the theory). That anaesthetizing the stump can eliminate phantom limb pain seems consistent with this theory. Perhaps anaesthetizing the stump brings sensory feedback into line with visual feedback, whereas mirror movements bring visual feedback into line with sensory feedback."

He goes on to discuss implicit versus explicit movement, citing one study showing no difference, and another that does.


References, additional reading:

1. The Neurotopian: Mirror Box Therapy

2. The Neurotopian: Pain for Dummies

3. Neurotonics: blogpost search for Virtual Body

4. List of publications by Lorimer Moseley (up to 2005)

How I really feel about chiro

In reference to What the ....?:

What is irritating about the chiro blogathon site mentioned previously (to which my own (PT!!!!) blog has been attached without my permission), is that there is no contact address provided so that I can protest directly about my blog being lumped in with chiro blogs.

There is, however, a little paypal thingy so that people may "donate" to help "maintain" the site... how chiropractic. Really.

I haven't been very outspoken on this blog about how I really feel about chiropractic. When I say anything much about manipulative therapy, I usually lump orthopaedic manual therapy in with chiro as being nearly indistinguishable on the surface, i.e., in that both groups love to manipulate, want to keep SMT (spinal manipulative therapy) alive as a treatment. I think this is still true; however, I may have been a bit myopic because of how I've been a PT for nearly 40 years and have never needed to use SMT on anyone. Upon digging deeper, and as a clarification, and to reassure ortho PTs that when I have to pick, I will always pick them over chiro any day, I offer this blog post.



Evidence in Motion

At Evidence in Motion, there is a nice thread about chiro in general and about cervical (neck) manipulation (which I have always, always been opposed to) in particular. The thread points out the video, Kinsinger Report on Chiropractic (about a half hour). It's worth talking about this very informative video for awhile, which I will do in a minute. But first, I want to say that I think this thread represents a good example of what "evidence" can be used for - i.e., it can be used to highlight chiro hubris, blow holes through chiro hegemony. A chiro came on the thread to attempt to dissuade readers away from the Kinsinger video, and a PT came on to say, au contraire, here is evidence to support the contentions made in the video about cervical manipulation risk. If you would like to examine this more closely, read the thread itself.


The Kinsinger video

So, I want to discuss the actual video now: In it, Bill Kinsinger, an MD, points out the public perception of chiropractic: i.e., an

"advanced form of physical therapy with a focus on treatment of low back pain."

He points out the perception chiropractic has of itself: i.e., an

"alternative comprehensive health care profession whose practitioners see patients on a primary care level treating everything from ear infections to PMS."

Then he points out the medical and physiotherapy view of chiro: i.e.,

"a philosophical belief system based on ideas that are not only unscientific, they are actually anti-scientific."

I agree. In fact, I couldn't agree more.
He says chiropractic has remained virtually unchanged since 1895. The ideas it is based on have not evolved, that the field more closely resembles a religion or a cult than a health care profession.

Kinsinger covers the main details on how chiropractic originated (a Canadian immigrant to the U.S., D.D. Palmer, founded it. As a Canadian, I apologize deeply for this..). By way of example for how non-evolved chiropractic is, he points out its superglue-like adherence to a concept called "vertebral subluxation complex" that has never been shown to exist, was something dreamed up by Palmer, and still rules chiro thinking. He goes on to outline what he terms "milestones to legitimacy", or how chiro has managed to crowbar its way into legitimacy through political ways and means. He discusses the fight (won by reason) in Florida a few years ago to keep a chiropractic program out of Florida State University. He talks about how PT has done most of the existing research on manipulative therapy. He points out:

1. the questionable benefits for musculoskeletal concerns and flat-out non-benefit for non-musculoskeletal concerns

2. the anti-vaccination statements emblazoned over doorways in chiro schools

3. risk of stroke associated statistically with over utilization of neck manipulation

He invites people to check out the grass-roots advocacy groups such as Neck 911. He ends his presentation by saying that PT provides the best hope for the future of manipulative therapy.

Other than my own personal dislike for manipulative therapy (i.e., the high-velocity kind) I agree entirely with this entire video.


Further links and resources

1. Neck 911

2. Petition: Legislate to Warn Public that Neck Manipulation can cause a Stroke (an Australian initiative)

3. The Kinsinger video, The Kinsinger Report on Chiropractic

4. The Evidence in Motion thread, Extra! Extra! The Kinsinger Report on Chiropractic

5. Chirowatch.com (read about the foiled plans to insert a chiropractic school at FSU, Jan/2005.)

6. Science-Based Medicine blogs in their chiro category

7. Chirotalk: The Skeptical Chiropractic Discussion Forum

8. Confessions of a Quackbuster (many many many more counter-chiro links at this blog)

9. Screwed4life ex-chiro blog

10. Chiropractic is Quackery squidoo page

11. Duplicitous Primates ex-chiro blog

12. (Added June 13/08) Alberta woman sues chiropractic after being made quadriplegic by a chiropractor, also this.


NOW, PLEASE TAKE THIS BLOG OFF YOUR CHIRO BLOG LIST. THANK YOU.

What the ....?

Somehow humanantigravitysuit has ended up on a list of chiro blogs.

I would like to state for the record, that I an NOT a chiro, and this is NOT a chiro blog.

I am now, always have been, and always will be, a physiotherapist, and this is a physiotherapy blog. Remove me from the chiro blog list. Whoever you are. Thank you.

Believe?

I don't usually talk much here about belief, because I'm usually too busy trying to sort out what to think. I've "believed" (mentally entertained for limited lengths of time) various things over the course of a life, most of which turned out to have been a complete waste of mental and emotional energy as more information came to light. So long ago I decided the simplest option was to scrap beliefs altogether, including religion (because it is so fraught with intrinsic contradiction it'll drive you crazy if you let it) and just pare away any lingering dopamemes. Not that I still don't know how to have a good time in the private rooms of my own brain..

Just yesterday I spotted this blogpost from an atheist vet, Dr. G, who calls his blog, Wandering Primate. (Sounds like he's embraced his inner primate social groomer as I have.)

I liked this post, A Nice Statement. It seems he saw this posted originally, at Pharyngula, by PZ Myers and did this currently trendy thing called 'hat tipping', which means he acknowledged the post and reproduced it, sort of like what I'm about to do.

I run in a slightly different human primate troop and don't wear a hat, so don't have one to tip, but perhaps tilting my head briefly in the direction of both these bloggers, smiling and raising a thumb in the air would suffice...? So, thumbs up to Dr. G and to PZ Myers, who may have authored it:

"An atheist's creed

I believe in time,
matter, and energy,
which make up the whole of the world.

I believe in reason, evidence and the human mind,
the only tools we have;
they are the product of natural forces
in a majestic but impersonal universe,
grander and richer than we can imagine,
a source of endless opportunities for discovery.

I believe in the power of doubt;
I do not seek out reassurances,
but embrace the question,
and strive to challenge my own beliefs.

I accept human mortality.

We have but one life,
brief and full of struggle,
leavened with love and community,
learning and exploration,
beauty and the creation of
new life, new art, and new ideas.

I rejoice in this life that I have,
and in the grandeur of a world that preceded me,
and an earth that will abide without me."

I really like this. It's simple and clear. I don't "believe" it, I agree with it. I'd like to place my favorite Dawkins quote here:

"We are all atheists about most of the gods that humanity has ever believed in. Some of us just go one god further."

And thus ends my one and only blog post on "belief."

Here is an interesting 2-part video, featuring Daniel Dennett, Richard Dawkins, Christopher Hitchens, Sam Harris, called The Four Horsemen:
1. Four Horsemen - Hour 1 (58 minutes)
2. Four Horsemen - Hour 2 (59 minutes)

"Noise" in the brain

Here is an interesting comment from Carl Zimmer about noise in the brain, Your Brain Is a Mess, but It Knows How to Make Fixes. It suggests that the noise is a problem for the brain to overcome, "damages" its "signals", whereas Buzsáki wonders instead if the brain uses noise, if it serves a fundamental purpose for moving processes along more easily.

The comment on size is interesting - my understanding was speed of transmission was limited by size (as well as by myelination or lack of myelination) but didn't know noise was another issue that related to size:

"our neurons could be much smaller than they actually are. If you packed all material necessary for sending signals as tightly as possible, the branches of a neuron (called axons) would measure just .06 microns [about 2.3 millionths of an inch] across. In fact, the thinnest axons are about .1 microns [about 4 millionths of an inch]. Recent studies have shown that it's noise that prevents them from getting thinner. The thinner an axon gets, the noisier it becomes. Below .1 microns, the noise abruptly rises so much that it drowns out any signal. We might be far smarter if noise didn't keep us from growing more neurons."

Zimmer makes it sound like noise is a problem the brain must overcome. Buzsáki figures it's there for a reason, calls it "deep brain activity", even suggests it is necessary for cognition.

"Monkey College"

In this video, a little primate cousin is being trained to help human cousins with disabilities. The monkey will go to live with a disabled individual, will do all of the handling of objects, even scratch itches and push eyeglasses back up noses, fill watter bottles, lift paralyzed arms up onto wheelchair arms, change CDs, magazines, switch lights on and off. It has agile hands (with a very big S1M1 same as we have, I imagine) and it has a trainable brain reinforced sufficiently through affection and positive reinforcement.

Apart from the admiration one feels for those who have designed and executed such a useful "primate social grooming" facility, and the endearing qualities these monkeys demonstrate, this whole idea puts a really interesting twist on the matter discussed in the previous post - kind of blurs the edge between species.

Where did the term "human primate social grooming" come from?

I coined this term, have used it for a few years now. I suppose I should explain what I mean by it.

It arose out of thinking about the whole problem we have with PT having evolved as a culturally specific form of health care, along with most of the others, without good biological foundation (i.e., embryology and evolution), therefore rudderless. Although I've tried to grow myself a rudder, the profession lacks such a thing collectively.

Anywhere humans have a culture, there exists "healthcare." Culturally specific forms of health care we are familiar with in the western world include:

1. manual/physical therapies: PT, chiro, osteopathy, massage (many kinds), and the multitude of techniques named after individual originators who came out of the woodwork, Rolfing, Bowen, all these..
2. medical, surgical and nursing care for life-threatening trauma and disease
3. care for emotional, mental and psychological difficulties, e.g. psychotherapy, psychiatry

Other cultures combine these three main forms in other ways. All are categories of interventions sought, instinctively, by people who are undergoing life-disrupting or life-derailing problems with their bodies or their ability to think or relate appropriately.

Humans are primates, and primate survival is enhanced by being a member of a "troop". All three of these categories represent "help" extended to an individual who seeks it from the social human "troop" in times of either overt or perceived need. One can quibble over what constitutes "true" need; however, usually the most prioritized need is the one that bothers a given individual most within a given time frame. This would include such things as the "need" to breathe, to drink if thirsty, etc. Of the array of "need" states that can be defined, many of which the individual can instinctively take care of, a few seem to be recalcitrant to self-help for some people; e.g., pain is one (defined as a need state by Patrick Wall) that looms quite large for many people who have an active and functional nervous system. Pain is a frustrating phenomenon to endure; it can cause stress, and stress can in turn worsen pain. Pain can reduce one's ability to cope in a mature manner, thus interfering with relationship. Relationships interfered with may threaten one's place in a troop, and threat like that can lead straight to anxiety - for a primate - and more stress.

When stressed, primates (including human) seek social grooming. There will always be those among us who feel best when able to access "social grooming" of some sort for pain or distress or illness, and there will always be a supply of groomers ready to help, because humans are primates. Other primates groom each other instinctively, and so would we, if we were not constrained by "culture" and laws in place to regulate boundaried contact (for good reason). Social needs blurred into biological needs have a way of making culture adapt to them. Enter quintessentially "human" primate social grooming.

Also, enter the collision between who and what humans (collectively) think ourselves to be, and who or what humans (individually) default to in times of stress or physical need - biology takes over. Enter the "professional" splintering of a nurture behavior once fueled by nature into a bunch of modern (correction - let's make that postmodern, counter-enlightened) fragmented, rigorously (or not) regulated, politically defensive turf-raiding, territory-defending groups that are operationally primate troops in and of themselves to a great extent. Some are science-based while others are thoroughly a- or even anti-scientific. They exist in relation to each other, like rail cars on a train track, their position in the train having emerged by their relation to science; they all move along (some eagerly and some reluctantly), clashing, colliding, all ultimately pulled along through time by the chugging engine of Science and Society, the caboose of anti-science bringing up the rear, linked by that primate biological troop mandate "to help" and "to serve" and restore quantity and quality of living to fellow human primates, doomed to never escape the train - unless sidelined permanently, decommissioned due to dwindled popularity or de-legalized by future social contracts. This train is not bound for glory. It is slow and lurches uncomfortably. Cars routinely collide into each other. Any individual can climb aboard anytime onto any car of choice. Individuals that belong to one car can move about the train and visit other cars, check them out.

The whole point of the interaction of human primate social grooming (the non-medical kind, the more strictly manual therapy kind), or the establishment of any therapeutic relationship, is to get the right placebo response (in the Patrick Wall sense) started. All forms of health care are therefore veiled forms of human primate social grooming, and manual therapies are more direct forms, attempts to physically elicit said placebo response.

Social grooming started out as the simple 'nurture of nature', you might say - an animal activity, i.e., mammal mothers attentively licking their pups/kittens/calves etc. Primates took it further into wider social arenas, intra-troop behavior, maintenance of relationship.

Primatologists think one of the factors that may have driven development of our big brain in the first place was that it may have come in handy for keeping track of who was who, and to keep the peace (see Dunbar's number). The initial bonding that goes on between humans (e.g. parent/child) may well need to be reaffirmed artificially once in awhile, such as when there is a period of personal drama or trauma,, chaos or growth, which may or may not include physical injury. What we know for sure is that physical injury is certain to knock one off one's tracks for awhile; how it is handled socially, therapeutically, can be/often is pivotal to good resolution. See here, and here, for old blog posts about the insula.

If that's all true, then good old, non-nociceptive/unresolved 'pain', physical and/or psychological, is a need state all right, one that may require consummatory movement on a spectrum that ranges from just practicing some creative motor output at one end of the scale, further along to active physical relating e.g., hugging/sex with a partner, way over to the far end of the social spectrum to boundaried input of a physical sort from a therapeutic 'stranger', all depending on the individual. In the latter case perhaps the bond inside the patient, their intra-psychic balance, the bond they have, perhaps with their perceived relationship to their own biological life itself, can only be restored through physical human contact, from way outside the immediate family.

I think this is probably so fundamental that everyone just ignores it completely.

There are likely to be social groomers out there who because of human belief systems, won't entertain the possibility that we evolved instinctively doing this merely because of how healthy it feels, both for the groomer and the groomee. (Manipulation is likely more of a latecomer on the social grooming scene. It has its own unique sensory charm for some, I suppose.) There are still more who insist on trying to turn (manual) human primate social grooming into something quantifiable, standardized, objectified, reproducible... something more "human" (by mechanized western cultural standards), but possibly something at the same time less "humane" (by human primate social grooming standards). Still others get the kinesthetic part, love the kinesthetic part, but refuse to try to understand such a phenomenon scientifically - they even reject it, preferring to adopt mystical explanations instead, presumably because these "feel" better. We probably all get held back by all these proclivities.

This was once a huge problem/obstacle/quandary for me.. I could barely see the outline of it and it felt awfully big, like a chasm in the fog. When I came up against it in my own thinking I just didn't quite know where to go with it, how to dissect it, deconstruct it, deal with it, digest it. I understood it but not well enough to dispel it. I felt capable of nothing but blatting it out halfbaked. It made me feel cognitively dissonant, weak in the knees. Maybe the whole faintly nauseated feeling cognitive dissonance confers is what drives PTs and other "groomers" off to once again cling to religious anti-evolutionary belief systems. The truth (and I think this is truth) kinda sucks, doesn't it? - adds no glamour at all to our profession, makes us humble, puts us in our place at the bottom of the health care hierarchy, confronts us with the probability that we mostly deal with the non-human underpinnings of physical human existence, the deeper ways that bodies and nervous systems are connected. To go there boldly means confronting the fact we are primates, I think. And that like monkeys, our various manual therapy professions, by virtue of being "hands-on", and more primally primate than others, perhaps.

Yet, when I pondered the matter from another side, as one who instinctively moved toward this type of work when I was still a child, driven perhaps by overactive mirror neurons, it feels real and honest and natural and honorable by comparison with lots of other human activity going on that is greed-based and disgusting and destructive. What I find more disgusting is when human primate social grooming is dragged down further by greed and scam and dopamemes.

Fast forward a few years and I'm still not quite sure how all this fits together, but I think this sociological/evolutionary/psychological overview deserves at least a mention in the overall consideration of manual therapy. Acupuncturist/medical physician, Anthony Campbell, wrote:

"Among primates, we are the only species that does not routinely perform physical grooming. The manual therapies provide one of the few occasions when it is socially acceptable for comparative strangers to touch another's body in a manner that approximates to primate grooming. It seems likely to me that part of the success of the manual therapies depends on this, and differences in success rates among therapists are probably related to differences in how they apply touch.

The mechanism of touch as therapy is no doubt complex but is likely to involve the limbic system (cingulate gyrus) and release of oxytocin."

(See his whole comment in "Rapid Responses" after this article, Characteristic and incidental (placebo) effects in complex interventions such as acupuncture.)

"Mindfulness Based Stress Reduction" - Jon Kabat-Zinn

I finally checked out Jon Kabat-Zinn more closely, after having heard about him and his work several years ago. He has written several books, some or all of which entered the world of persistent pain via pain clinics, probably because of the obvious overlap of stress reduction. I heard him interviewed on a radio program a few years back, and very much liked his blend of common sense coupled with description of the kinds of ordinary stressors meditation can help with. His book, Full Catastrophe Living (one of many) has been around since 1990, and I'm embarrassed to admit I've never read it.

Here are some links:

1. Mindfulness Meditation, 72-minute you-tube presentation to google employees (recommended)

2. "Coming to Our Senses" a short (9.15 minute) you-tube video

3. Coming to Our Senses, a 57 minute google video (long intro by someone at UCSD Medical Center)

4. A simple bio. Excerpt:

Dr. Kabat-Zinn received his Ph.D. in molecular biology from MIT in 1971 with the Nobel Laureate in Medicine, Salvador Luria. Dr. Kabat-Zinn’s research between 1979 and 2002 focused on mind/body interactions for healing, on various clinical applications of mindfulness meditation training for people with chronic pain and/or stress-related disorders, on the effects of mindfulness-based stress reduction (MBSR) on the brain and how it processes emotions, particularly under stress, and on the immune system; on the use and effects of MBSR with women with breast cancer and men with prostate cancer; on patients undergoing bone marrow transplant; with prison inmates and staff; in multicultural settings; and on stress in various corporate settings and work environments.

5. Wikipedia entry on JKZ.

6. An interview, "Mindful Medicine". Excerpt I:

Jon Kabat-Zinn was one of the earliest students of Zen Master Seung Sahn and was a founding member of Cambridge Zen Center. Over the years he has studied with a number of Buddhist teachers and incorporated their teachings, especially the practice of mindfulness, into his practice of medicine. His book Full Catastrophe Living (New York: Delacorte Press, 1990) was on the New York Times bestseller list.

Excerpt II:

"The two fundamental things that most people get out of the program, independent of symptom reduction, are these. First, the breath is an ally and can be used to calm down and see more clearly. The other, related discovery, is that you are not the content of your thoughts. You don't have to believe them or react to them. That's incredibly liberating."- JKZ

After seeing him, especially in the 72 minute video linked higher up, I might actually acquire and read that book. What he says is simple and it makes total sense.

Brain Oscillations: Ten part series

This series of blogposts is based on Ginger Campbell's interview with Dr. György Buzsáki in Feb. 08, and released as a podcast, #31 of her series of BrainScience Podcasts. It was written mostly as a study effort, to help me better understand how the brain works, to help me get more from reading the book itself - Rhythms of the Brain.

INTRO: Oscillatory Matters

Part I: Where do brain oscillations come from?

Part II: Input/Output

Part III: Why write a book?

Part IV: Complex Systems

Part V: Strength and efficiency in numbers

Part VI: Origins and interactions

Part VII:Inhibition, excitation and balance

Part VIII: Deep brain function or "noise"

Part IX: References and suggested reading

Link to transcript of episode #31

Oscillations Part IX: References and Suggested Reading

(This is a final post in the series "Oscillations" based on notes taken from Ginger Campbell's podcast #31 with György Buzsáki, and a continuation from Part VIII):


REFERENCES AND FURTHER READING:

1. Stephen Strogatz: (homepage ) known for his discovery of “small world” architecture
His 2003 bestseller Sync: The emerging science of spontaneous order is aimed at a general audience

2. Nancy Kopell: mathematician
Buzsáki recommends her review of the analytical approaches to neuronal oscillators: We got Rhythm: Dynamical Systems of the Nervous System. (pdf 11 pages) N Am Math Soc 47: 6-16 (2000).

3. Zoltán Néda (Bebes-Bolyai University Romania): the spontaneous synchronization of hand clapping
Self-organizing processes: The sound of many hands clapping Nature 403, 849-850 (24 February 2000)

4. Hermann Haken (his homepage ): German laser physicist who studies bidirectional causation
The Science of Structure: Synergetics (1984)
* His Scholarpedia articles on self-organization and on synergetics

5. John O’Keefe (University College, London): along with Lynn Nadel he discovered how the hippocampus forms a cognitive map of the world.
He has shown how the timing of oscillations in the hippocampus are important
* “Independent rate and temporal coding in hippocampal pyramidal cells ” by John Huxter, Neil Burgess, and John O’Keefe. Nature 425, 828-832 (23 October 2003)

6. David McCormick (Yale University): showed that neurons from the thalamus can oscillate spontaneously
Neocortical Network Activity In Vivo Is Generated through a Dynamic Balance of Excitation and Inhibition (11-page pdf)
He has also studied the oscillations of place cells in the hippocampus
List of publications

7. David Hubel and Torston Wiesel recieved a 1981 Nobel Prize for their discoveries concerning information processing in the visual system, based on work done by Vernon Montcastle on the use of single neuron recordings.
Montcastle, VB (1997) “The Columnar Organization of the Neocortex.” Brain 102:01-722.
*Montcastle's biography

8. Claude E. Shannon : Founder of Information Theory

9. Jan Born (University of Lübeck, Germany): experiments with how sleep improves both memory and problem solving
*list of publications

10. The Handbook of Brain Theory and Neural Networks, Michael Arbib 2003

11. Scholarpedia Encyclopedia of Dynamical Systems

August 6/08
Added: When Neurons Fire Up: Study Sheds Light on Rhythms of the Brain

Oscillations Part VIII: Deep Brain Function or "Noise"

(This is a continuation of notes taken from Ginger Campbell's podcast #31 with György Buzsáki, and a continuation from Part VII):


Independence of "deep" brain function

* the brain maintains its own excitability, activity, in the absence of external information, or external perturbations
* what is it good for?
* physicists and computational neuroscientists like noise, because many of the systems they study wouldn't be able to operate without some energy which is usually supplied with the mechanism of noise
* this noise is generated by the internal activity of the brain at a time when the brain cannot rely on outside sources
* this is the time when brain activity moves forward independently
* sometimes it coincides with sleep - it's very difficult to understand what kind of processes go on in sleep but one of them seems to be consolidation: e.g., remember a conversation with someone - you will:

"recall that information with just one single question and you go through a whole long process of thinking, and that implies that there are cell assemblies that produce self-organized and perpetuating sequences without any further input. And you can think and talk about these events for a long time. And this is all maintained by internally generated activity."

Why is brain "noise" necessary?

"(Deep brain activity) is the internally-generated activity that is independent from the outside world and that is the one that interferes with the incoming inputs. This is the source of noise that is annoying when you are trying to understand the impact of a stimulus on the brain. So this noise, which is considered noise for many, is my most important signal. That's in fact the only source of cognitions - the self-generated or inside-generated activity or internally generated activity of the brain is an absolute requirement for cognition. And there has been very little thought about this, and they are very difficult experiments."

* self-generated, inside-generated activity, or internally generated activity of the brain is an absolute requirement for cognition
* it is very difficult to approach this experimentally, especially in animals
* but if you are seriously interested about how cognitive information is transferred around from one place to the other in the brain, then we have to consider seriously how self-generated activity is serving important functions

* various things must be energy efficient, volume-efficient, wiring-efficient etc., but certain problems must be solved - a balance becomes struck between needs and goals and energy efficiency
* it seems a waste of energy to maintain spontaneous activity - why do we have a lot of neurons firing when we are drowsy?
* this activity/noise makes:

"perception less effective, the inputs are not the same so in fact when you are driving on the highway and getting tired, then your brain takes control and your input is becoming less efficient. So from this point of view it's a disaster. But we have to understand and give some good rationale why is it good in the long run for the brain that it has its own fluctuations."

Some benefits of sleep:

* activity during sleep is not a random useless activity
* in many structures where this has been looked at, it turns out that the activity of sequences and patterns in the neurons that are being active in our sleep processes are pretty much the same as the ones that have been used in our waking experience
* a recent book about creativity discusses what could be the mechanism of creativity in the brain; many creative people reported to the author that they try to create in an environment which is peaceful, calm, and they try to fall asleep, but not quite sleep, and whenever the associations occur in an interesting and random manner they can bring it back to wakefulness.

"I have fantastic associations every single night in my dreams, but I don't have the ability to bring them back to the waking states. These are the states when the activity of the previous day dominate, but at the same time, other things that happened in our previous life will also emerge, and mix with the recently acquired information. Sleep is the best mixing phase because it's noisier so to speak, but perhaps this noisiness is creating, is using something or serving something very important."

Does sleep make you 'smarter'?

* sleep seems to be very important for consolidating memories
* Jan Born, in Lübeck, Germany has done work on this:
* students are given a puzzle to solve
* the puzzles are of sufficient difficulty that it takes more than two or three times to solve them
* they go and sleep on it:

"...when they wake up, a fairly high percentage of students can solve the task right away, compared with those students who have been engaged doing something else, implying that during sleep, those representations about the unsolved problem went through various synapses and various parts of the brain, and in the morning, they were, so to speak, consolidated, and the answer was available."

* many examples show that sleep provides an advantage - there may be a savings of 10, maybe 15% (more information retained)
* interestingly this can be enhanced beautifully by oscillations
* the same lab followed up the idea that there is a slow oscillation in the neo-cortex capable of entraining these fast ripples that seems critical for storing and consolidating episodic memories
* the rationale was, if this is the case, then we should be able to enhance the magnitude of these slow oscillations during sleep
* EEG electrodes were placed on the scalp, electrical currents were applied while the students were in stage 4 sleep

"..as a result of the electrical sinusoid stimulation, the power of the slow oscillation increased, and perhaps this enhanced activity increased the probability and timing of hippocampal ripples (although this hasn't been shown...). But this entrainment of oscillations enhanced the ability of sleep for an additional 10% or so (more information retained).

* students whose brains were stimulated during stage 4 sleep remembered the memorized items even better than those who had just had a regular sleep

* a counter-argument might be: oscillations not only produce oscillations but they made neurons fire more synchronously, contact with the balancing partners were discharged more effectively
* if perturbations did not occur in an oscillatory manner but in a random manner, perhaps the outcome would be the same

* it's a very difficult issue to answer -

"... it's a bi-directional causation, and the system that oscillates uses every ingredient, and every ingredient when it works perfectly together produces an oscillation. So whether it's an epiphenomenon or not, it doesn't have a trivial solution. However, it does not matter. If you are looking at the practical aspects of this, because they are there, they can be used, they can be useful for a researcher who is interested in how internal activity of the brain or internal generated activity of the brain is generated, and whether oscillations are epiphenomena or not doesn't really matter as long as he understands the processes that underlie behavior and commission."

......................................................

So ends the interview. I will bring a list of references and further suggested reading here in a separate blogpost, then I will hook all these posts together and post a single link in the menu.

This has been a great few weeks of soaking in this information. I want to thank Ginger Campbell and György Buzsáki for having such a good informative conversation about oscillations.

Oscillations Part VII: Inhibition, Excitation and Balance

(This is a continuation of notes taken from Ginger Campbell's podcast #31 with György Buzsáki, and a continuation from Part VI):


In the brain, inhibition and excitation operate as opposing forces

* inhibitory neurons on a single pyramidal cell from the neocortex are in the minority ... about 15 - 20%.
* however, they are located strategically - most of these inhibitory terminals are near the soma and the axon initial segment, parts of the neurons that are critical for generating action potential output
* inhibitory terminals make sure that the timing of the neuron is optimal - that's what happens in many cases of oscillations


Balance between excitation and inhibition

* even though the number of inhibitory terminals are smaller, the inhibitory terminals are very active, about 5 times more active than the principal cells: i.e., way fewer inhibitory terminals and inhibitory neurons, but activity is higher; the result is that the total number of EPSPs and IPSPs, i.e., the excitatory inputs and inhibitory inputs per unit time, are exactly the same or almost exactly the same, resulting in a balanced system


How fluctuation creates balance

"However, this balance is brought about by fluctuation... if you zoom in in small time windows then we always see that either inhibition or excitation dominates. And the easiest thing to balance the two opposing forces is through oscillations. So that is the reason why inhibition is so important. Without inhibition there would be no computation in the brain. Why? Well, the second law of thermodynamics clearly states that in physical system if you have only collisions then collisions will produce more collisions and the entropy of the system will increase and there will be no order. This applies also to the brain, of course, and any other physical systems, and the brain is a physical system, is that if we had only excitation, and then excitation would produce only further excitation. In fact, in principle, the action potential of one neuron would lead to the discharge of every single neuron in the brain."

Variability

* Shannon's information theory approach works perfectly - at the periphery - at the first senses
* it works good at the retina, at the cochlea, perhaps even at the first relay station in the thalamus

* as one goes deeper and deeper into the brain the variability increases; not because the reliability of the brain isn't good, but because other sources of "noise" come into the picture; this "noise" is generated by the brain itself

* the deeper we go into the brain, the more we find independence from the environment

"The deepest structure in the brain, if there is such a thing as deep, is the hippocampus, or the prefrontal cortex, because they are multiple synaptic connections, far from either the motor output or the sensory inputs, and, they maintain their activity. But this maintained activity is observed almost everywhere. Visual cortical neurons are active, a little bit less perhaps, but they are still active when we close our eyes or when we fall asleep. Many parts of the brain, for example, again, the hippocampus, they are as active during sleep as in the waking state. The number of action potentials of all neurons, that is, the energy they use, is pretty much constant, independent of what happens out in the environment."

Oscillations Part VI: Origins and Interactions

(This is a continuation of notes taken from Ginger Campbell's podcast #31 with György Buzsáki, and a continuation from Part V):


How do oscillators get themselves synchronized?

It's simple to link oscillators together:
- every neuron is an oscillator - the issue is how they get synchronized into an oscillation activity
- one can make an oscillator where none of the elements individually serve as an oscillator - e.g., a mechanical clock is a perfect example - a mechanism that ties all the elements together to make the clock tick is all that is needed

"...if you record from single neurons, you can record from them for long long long times, and you will never see that there is an underlying oscillation. And this is the main reason perhaps, this explains the skepticism of many investigators in neuroscience that deal usually with one neuron at a time. For example, the ripple oscillations that I just mentioned is a perfect illustration of that. If we would be looking at single neurons for five years, there would be no moment in time, perhaps, when we would say, aha - there is a population output here. But if we begin to look at 50 or 100 together, then it becomes absolutely obvious, and we won't miss any of these events. So, in this case, none of the neurons oscillate, but their cooperative activity produces a perfect sinusoid oscillator."

Is there a pacemaker, something in the brain that controls these oscillations?

- there are pacemakers: e.g., our respiration rhythm is determined by a group of neurons in the brainstem responsible for maintaining or pacing respiration
- in hippocampal theta activity it has been thought that there is a pacemaker in the medial septum
- many neurons in the medial septum, cholinergic and gabenergic neurons can be recorded when in slice preparation, in in vitro conditions, when they are disconnected from the hippocampus and every part of the brain, they maintain oscillating activity
- David McCormick has shown that isolated neurons can oscillate perfectly

"Now, calling many of these or some of these 'true' pacemakers comes with some burden, because in many cases, like in the thalamus, even in the medial septum, it turns out that yes, individual neurons have the propensity to oscillate, and under certain circumstances they do, but when they are embedded into a physiological substrate or physiological activity their timing is coordinated by various feedbacks. And even if we have an independent set of neurons, let's say in the medial septum, that can fire at 5 Hz, somehow their activity must be coordinated. And in many cases that kind of coordination comes from their target structures, in our case the hippocampus."

- in terms of energy, it may be cheaper to have neurons that can transform information, affect the firing patterns of neurons, and simultaneously in cooperation with others, produce an oscillation, than it would be to have a set of neurons which did nothing but keep time


How does an isolated neuron (without excitation or inhibition) oscillate independently?

- inhibition and excitation are very important in the brain, but not required for an oscillation
- ocean waves don't have inhibition and excitation in this exposit sense - oscillation always emerges
- it's inevitable when you have opposing forces - a push and a pull, like in the swing, is perfect enough to maintain oscillations
- in the brain opposing forces include potassium and sodium going in opposite directions in the membrane - this is perfectly sufficient to maintain oscillation in a single neuron
- no inhibitory neurotransmitter is needed for this but there is inhibition in the sense that one force tends to counteract the other force
...........................................................

This last part is important because it suggests that no outside agency is required to make a brain or to keep it oscillating, other than energy from ordinary, thermodynamically congruent energy sources, utilized through ordinary metabolic pathways; this is supported by other observations as noted in the post Oscillatory Matters where different concepts regarding "movement" are listed. There is a bit more on this in the next post.

Oscillations Part V: Strength and efficiency in numbers

(This is a continuation of notes taken from Ginger Campbell's podcast #31 with György Buzsáki, and a continuation from Part IV):


So what is it that changes during synchronization?

* individual neurons don't change their firing rate at all
* when synchrony emerges through oscillations, it's the timing of the neurons relative to each other that changes
* the result is that now the impact of the same neurons when they are firing in synchrony is much more effective
* in fact these ripple patterns have been associated later on in several laboratories with the transferring of information from the hippocampus to the neocortex
* this was just one single oscillator


What happens when you have two oscillators?

* when two oscillators come together with slightly different frequencies, we get an interference pattern
* the best example for this interference pattern has been provided by John O'Keefe from the University College London
* he observed that individual place cells in the hippocampus oscillate at a frequency slightly faster than the ongoing so-called theta frequency oscillation
* the result of this is very precise timing - the importance of this that was translated into behaviour is that the phase position of the action potential relative to the ongoing clock cycle, reliably predicted the position of the animal

"..here's a convincing case where we go from the basic features of oscillators through physiology all the way to behavioural significance. And then you can pose other questions - how would this be possible without an oscillator? And I can come up with some scenarios that could be done without oscillators, but it would be very expensive energetically and it would involve a lot more computation and would be a lot more complex."

What about when many oscillators come together?

Simple rule that applies to oscillations of various frequencies:
* the brain is a physical system
* information from one place to another goes through
1. axonal conduction delays
2. refractory delays:

"...when one neuron discharges, its target neuron will discharge later, not only because it takes time for the action potential to go through the axon, but it also, when the neuronal transmitter is released, on the post-synaptic neuron, the neural transmitter has to charge the membrane to threshold - so there is a time delay - a finite time delay of how fast the information can go from one place to another."

Efficiency

Brains are very slow mechanisms compared to computers:
* if it generates a fast oscillation that has a short time period, the number of neurons, or the proportion of neurons that can be involved in these fast oscillations, are relatively small
* the oscillation is typically local
* when the time period is long, there is time for activity to propagate from one area, from one set of neurons to many other sets of neurons
* a large volume is involved, the result of which is that the synchrony of the population or the proportion of the neurons that are engaged in this rhythmic activity is much larger:

"This explains the common observation that slow oscillations are always high in amplitude, or almost always high in amplitude, whereas fast oscillators are small in amplitude. But the important consequence for the purpose of our conversation is that slow oscillators can affect fast ones, in such a way that the phase of the slow oscillator, because it involves very large areas, can organize the activity of the faster ones that emerge locally."

* though other possibilities also exist to coordinate activity, oscillations provide the cheapest possible solution:

"If you talk to anybody who works in this field he'll remind you that our brain uses 20% of our energy; with a newborn it's actually 50% and if you look at the smallest mammal, the tree shrew, the tree shrew uses continuously even during sleep, 50% of all the energy to sustain brain activity. It's very expensive. Evolution must be very careful how it allocates resources."