Neuroplasticity for Dummies

Here's the update re: my latest D.I.Y. cognitive therapy experiment at Harvard on 24 September.
The challenge? To distill images and anecdotes of my Stroke rehabilitation for a 5minute TED-styled session at Harvard class of 1981's 30th reunion. In terms of degree of difficulty, this forum presented a great cognitive/speech therapy opportunity!
After circulating multiple drafts to the moderator and classmate Lance Miller, I had narrowed an original deck of 20 slides down to 7.

Over the first two weeks of September, I worked daily- not only on slide content but also on refining and rehearsing comments within the speaker's notes section of each slide. To lend focus to a topic as esoteric as Neuroplasticity and to evoke themes appropriate to the occasion of a 30th College reunion, I selected anecdotes that not only explained my gradual awareness of Neuroplastcity but anecdotes that roughly paralleled phases of my collegiate experience E.G. a sophomore slump, some dysfunctional focus on running at the expense of pursuits of the cognitive realm. I also sprinkled references to Heroic Epics that would be familiar to many classmates (two course quite popular in the early '80's at Harvard were Al Lord's Humanities 9 course re Early and Oral Epics, and a course affectionately known as "Heroes for Zeroes." )

Rehearsal of the near final version of a presentation to sister Sheila clocked @ 8minutes. When the session moderator reviewed my near-final effort and my promise to shave more content, he advised me to stick with the version- even if it would take 8 minutes to deliver (as he had budgeted some of the extra time into the schedule.)

Given the occasion of a 30th reunion, and some latitude with time, I opted to retain concluding with a reference to a metaphor in Tennyson's Ulysses to explain how I continue to find both parallel and more critically - motivation - for these late stages of my rehabilitation in Tennyson's metaphor of an Arch with fading margins:
"Yet all experience is an arch wherethro'
Gleams that untraveled world, whose margin fades
For ever and for ever when I move.
How dull it is to pause, to make an end,
To rust unburnish'd, not to shine in use."

Confiding that a primary motivation to participate in this very forum was in essence an opportunity of forced use (an integral lever of neuroplasticity), I gathered for what really did feel like a sprint to a finish line by explaining that not unlike 30 years ago when as a Senior at Harvard I was injured yet chasing the elusive 4 minute mile; this day, to keep my brain's fire burning "not to rust unburnished but to shine in use." I was sprinting to chase an (equally elusive?) 5 minute cognitive mile!

The experience of executing this presentation in a crowded amphitheater and the feedback were simply overwhelming- quite frankly had it not been for a timely congratulatory hug from classmate and event facilitator Kate I might not have held together. Ironically, one of several congratulatory notes captured this very aspect of the experience:

"Kate worries that her having impulsively hugged you afterward might have obscured your view of your standing ovation. You're the only speaker who got one of those, and it was a credit to the power of your presentation. We both hope that you got a glimpse of THAT."

Oh, I got THAT alright!
Here's a link to a PDF file of slides and my speaker's notes as well.

Form III Advisory Follow up

As requested by Mr. Zelden, I'm posting two resources for you:
[make sure you take time to review BOTH formats to determine which is most suited to your assignment]
1. An online slide show of yesterday's PowerPoint presentation:


2. A PDF file (includes slides,Speakers Notes, and option to print selected pages) Click here for PDF file.

Sunday morning

Options?

1. Nice to have friends and family in multiple climates;-)
2. Placed updated version of slide show originally posted on Friday's post (below) but...
3. I'm still soliciting feedback on "speakers notes - awkward to access from slide show;-(
4. So, now have new option to view PDF formatted with slides+Speaker's Notes -an option to view speaker notes or print.
   
   PDF FILE HERE
   

Friday Oct. 15 Update

• chat with Kale achieved exactly what i needed to get on right track:
• Liz found word doc w/new 2010 Form III advisee curriculum
• Kale came up with the perfect "visual" that advisees would associate with the meetings: Dunkin Donuts boxes.....
• I'll coordinate time through Kale to test my laptop connection to AV and wireless web access, etc.
• made progress on Latest: v2.1 - "fancy" EH? has animated effects cleaner content EVEN embedded YouTube w/ soundbite warning me NOT to go to fast or to try being fancy:

Tips on viewing: to access speaker notes,click on square icon for "full screen", then, select "Action" ->"Speaker notes"

First weekend in Bristol
Arrived just in time for a spectacular stretch of New England autumn (in addition to great company of Jay, Sheila, Jimmy and Sean Buckley) See a few representative slides of the highlights- captions icon by pacing cursor over slide show.

I should mention that October 9-10 marks five years from a traumatic night for me (worse perhaps? for my family). So celebration was even sweeter than thumbnail pictures(or captions)might convey.

Week One in Bristol, RI

Arrived Bristol on Sunday 2 October and set sights to work preparing for talk on 26th, brain training, and tues, thurs contact with Convio projects still part of plan BUT
Goal for week of October 8:
Circulate draft of presentation to faculty at Portsmouth

intermediate tasks required to meet goal:

• get sign-off on work plan from dean of students
• get distribution email list and intro to faculty
• find and insert all graphics for use in presentation
• Start rough cut of narrative on Notes Pages
  
• send by end of business Friday
  
• [OPTIONAL] POST PLACEHOLDER ON BRAIN BLOTTER

Note on "speaker NOTES" clicking on square screen icon expands show to full screen; once in full screen mode lmenu item "action"->"show speaker notes displays notes for current slide

Botox,Ballet, and Pedicure Protocol

I  have been in no mood or state of mind for blogging for some time;-(


BUT here's a turn of events since last summer. Progress, ANY progress always pulls me out of tail-spins. THIS time took couple of rounds of Botox, pedicures to relieve inflamed, curled toes, and a serendipitous Feldenkrais discovery on my daily limp past Austin Ballet. Yup ALL true!


The Botox, Ballet and pedicure protocol?


Ideally, I think I should plot these treatments with a view to cycles of Botox efficacy with:

• mobility issues note: last two rounds have ended with ugly toe curling, nail loss and infection...... I now have a personal pedicure specialist Vicki for big toe maintenance conveniently located within barefoot walk down the hall from my place;-) but goal is to keep those visits to a neighborly walk-through to say hi.;-)
• pain management and/or spasticity medications such as Lyrica vs additional S1 or other nerve blocks? Do i really need to revisit Baclofen??Again timing and sequence is key issue From what I understand, I have pain from "secondary" effects of spasticity- impingement on sciatic nerve from contraction creates pain and that stimulus provokes additional waves of spasticity. At what stage of this cycle might expect some or any non-medicated relief??!!
• "corrective" post -botox physical therapies? have yet to find the " ideal" to optimize whatever opportunities I might leverage during window of opportunity when excess tone is "blocked" by the chemo-denervation.
  
  One theory has been to focus on increasing flexibility and range of motion of the offending IT band and Gluteus have tried several approaches but with little progress.
  
  Another theory has been to re-train the brain to move these muscle groups {or opposing sets} with new and more fluid control to override the cyclical patterns induced by excess tone.
• I discovered a Feldenkrais instructor and classes at nearby Ballet Austin- Instructor Lisa del Rosario just happens to have recovered from left hemisphere paralysis from car accident. Soooo, she has a relevant “body of knowledge.” Feldenkrais sessions are a bit like TAI CHI, but conducted on a horizontal plane. These classes have tremendous potential for re-training cramping leg and hip muscle groups but at certain stages my sciatic nerve and surrounding is so hypersensitive I can't partake of some Feldenkrais positions – Mark Miller noticed this during PT sessions and raised question re: some injection for this type of pain. So again, choice of available therapies and coordination is critical, but has been "off-track" or uncharted to date.

My private March madness

After 5 months of an aggressive campaign to combine cognitive therapy with Stroke awareness, I've hit yet another rough patch [a.k.a. plateau] with my Spasticity<-> Sciatica. This painful chicken and egg enigma has befuddled both neurological and orthopedic therapies. Latest course is being plotted by a pain management specialist who sees indications of both spasticity and disc related sciatica. This most recent neurological exam,however provided a few insights and phrases that are almost too comic not to share: a "mild flattening of the nasolabial fold on the left" explains the facial expression I'm sporting that has been inviting strangers to ask me if I need help -and has me either drooling or feeling like I am. Then the
"increased tone in upper left and mild pronator dift."Picture -if you'd be so imaginatively kind - an upright, but heavily sedated Dr. Strangelove[video sample below]. The mild pronator drift explains the unsightly pose in which I'm often stuck -see stance I'm holding in pic above as illustration of why my left arm and flank are exhausted and in spasms at days end.


Given lack of progress over the past two years with multiple approaches he's proposed a modest adjustment to medications as an experiment before considering more aggressive i.e. surgical option for disc problem. So, here's the drill over the next 14-21 days:

Add new medication called Lyrica - prescribed in low doses for neuropathic pain or at high dosage levels for intermittent seizures [i.e. seizures like mine not attributed to epilepsy]

I'm gradually introducing this additional, new drug @150/day-> 300 Mg on top of my existing pharmaceutical panoply that includes a morning and evening 500MG dose of the anti-seizure drug Keppra.

If I can tolerate steps 1 &2 [150->300MG doses ] of this experiment w/Lryica, I might then have option of a gradual removal of wet-blanket-on-the brain Keppra from the mix.


Challenge with this experiment?

The cognitive trauma invoked by inserting a new gladiator into the battle waged on my brain blood frontier each morning....The good news? I've survived a few failed experiments of this sort before, so I have both perspective and adaptive strategies.

I CAN and WILL deal with this; just a few white-knuckled and lay-low days comprised of solar naps and short walks around my familiar routes of Austin's 2nd street district for a little latte and brief chats with friends {more accurately-stoically patient acquaintances} I've cultivated along this appointed route. So there you have it: a few Patches of fog, but my Vita Est Dolce.

Chance are that my cagey point guard Ritalin will eventually negotiate a "head-fake" and spin past the heavy footed twin towers Keppra & Lyrica- agents of my private March Madness.


As a reward for anyone who scrolls this far [no good deed goes unpunished does it?] here's a link to a video excerpt from Kubrick's masterpiece parody of the US <-> Soviet MAD doctrine - explains MY association between the "left pronator drift" and Herr Dr. Stangelove