General ideas about brain rehabilitation

On this page I will discuss three general ideas about brain rehabilitation: 1. our brain is quite flexible2. practice helps shaping your brain3. brain capacity is unlimited

In what way are such ideas true or false? You will see.

There are several ideas about training your healthy or injured brain, referred here as brain rehabilitation. Here, I will focus on the most important ones. Flexibility: First of all, your brain is more flexible than previously thought, even after brain injury. The strange thing is: we (as clinicians) already knew that for a long time (in rehabilitation) but - as always - science is pretty rigid and slow to catch up. Only the last couple of ten years or so the general consensus in neuroscience is that the brain keeps changing and learning, especially after brain rehabilitation. This has led to a wealth of books and games (Nintendo!) in which the general idea is to optimize your brain training as if a fitness program will do the trick. And yes, it is certainly true that your brain can learn up to a very high age and it is also true that your brain keeps changing all the time. I mean, there really are brain cells dying everyday, some faster, some slower (see also the page about brain recovery and what kind of factors play a role). And there are indeed new brain cells forming (although not as many as we would like). But most of all, the number of connections set up between brain cells is constantly growing and changing. Some connections are terminated everyday, but most of them are newly formed. That is why we can learn so much, at any age: the brain works on connections! Strengthen them and you'll learn more, even after brain injury.

Another idea in brain rehabilitation literature is that you have to practice. A lot. Without practice you'll learn not much. And trivial as it may seem, this is largely true. As they say: without pain no gain. That is the reason why brain-training games are so addictive: to stimulate you to train even more, every day.

The third common idea in brain rehabilitation is: learning is unlimited and you can reach everything you want. Want to be a good tennis player, go ahead and train a lot. Want to be a singer, okay, take lessons and keep singing. Well, although it is true that we can accomplish many things as we practice very very much (every day at least 4 hours training!), it is certainly not true that our 'make-up' does not matter at all. Our genes do have a band width: within certain limits we can do and achieve a lot, but there are limits, even after hours of brain-training. I can never be a singer (at least not earning some income with it) or a pianist. I can become a reasonable golf player though (with a lot of practice). 

The limits of flexibility in brain rehabilitation

Three common underlying ideas in brain rehabilitation are always seen in books or games, so much so that you can almost see them as marketing ideas: the brain is very flexible, practice does it and your brain's capacity is unlimited.I do not want to spoil the party here but each one of these ideas is true up to a certain point, which unfortunately is seldom mentioned (hence my 'marketing' conspiracy ideas). Your healthy brain is indeed quite flexible in the sense that you can learn at any age. There will also be new connections formed and old ones strengthened. But your brain tends to get older each day as well and physiology tells you that brain cells are not replaced as do most skin cells every couple of months. The forming of new brain cells is only in very few places in the brain, as far as science can see nowadays. Furthermore, the rate of birth of new brain stem cells is far behind the rate of death of even more brain cells. Would the brain have a complete regeneration motor that replaced every dying brain cell, we would become much much older and wiser. I still have to see living evidence of this, especially in rehabilitation. On the contrary, we see more and more inflexibility when we get older, even with those professors who do a lot of 'brain-training'. However, as a dutch neuropsychologist Peter Houx (passed away too young) once found: up to a very old age your brain can be as fit as a 20-year old brain. The process of what we call 'aging' can be slowed by using your brain constantly, by doing brain rehabilitation. But most importantly: try keep your brain in good physical condition. So-called biological life-events can have negative effects on your brain and thát is probably the reason our brain's condition and capacity becomes less and less. Too much alcohol, too little sleep, too much stress, bad food, too much general anesthesias, and a lot of other diseases can have negative influences on your brain. Keep these things to a minimum and your brain can become fit and old at the same time.

Of course, brain injury is a very serious biological life event that hinders your brain condition considerably. In rehabilitation we experience this every day. The limit of what can be learned, how quickly it is learned, and how less flexible the brain has become after the injury, is amazing. This stands largely in contrast to the 'hallelujah-stories' we see in the media. Of course, hope and good news sell better than discouraging results. But I think we have to tell the whole story: brain injury limits all sorts of training. 

The limits of practice in brain rehabilitation

So keep your brain in a good physical shape. How? Well, physical fitness is good for all your internal organs, especially for your brain. So keep doing sports, adapted to your age. But how about brain training, mental practice? How about playing Braintrainer on your Nintendo a lot? How about playing Memory or Mastermind a lot? In my practice as a neuropsychologist this question is often asked. My answer is always the same: function training such as these games is nice but does not help much to become smarter or better with your memory, attention or mental speed. In this sense your brain certainly is NOT a muscle that you can train almost infinitely and it then becomes stronger or bigger. In a certain sense you DO become better in your attentional or memory functions when you practice them a lot. That is why surgeons who are playing 3D-games are indeed better at doing 3D-surgery (which it always is). However, the increase in performance quality is not much compared to what you have to do for practice. It is time spent nicely but certainly not efficiently. When you practice your brain you'd better play intelligently, practice with strategies. Strategy training is known to improve your memory, attention and problem solving skills. I will give many examples of strategies that you can use in daily life when you want to better your memory, attention or other cognitive (brain) functions, in the specific pages on brain rehabilitation focused on each domain of brain functions. The idea of strategy training is not so much that you just use your attentional or memory skills a lot (drill and practice), but that you use them intelligently (by using special strategies). With a strategy you can boost your memory performance enormously. Memory wonders like Dominic O'Brien can retain 2000 numbers after having seen them once, by using a memory strategy. Chess players can memorize hundreds of different chess board configurations, but are just as good in remembering random chess board situations as you and I. Because they use a chess memory strategy. Only rarely can someone remember almost anything, but usually that is an abnormality and often a curse (see Mind of a Mnemonist by A.Luria). So practice intelligently and you can boost your brain functions. But still up to a certain point. 

The limit of unlimitedness in brain rehabilitation

Your genes and the physical state of your brain set the limits of what you can achieve. Just as with the rest of your body. I certainly will not become the best 100m runner in the world, Usain Bolt is built for that. Let him do the trick (and let me watch him!).Your brain capacity is, of course, limited, no matter what guru's or scientists say, no matter how many hours of brain rehabilitation you do. Let's take piano playing as an example. It is well known that becoming a good piano player has a lot to do with lots of practice every day. And starting at a young age because the brain has its so-called critical periods: periods in which things can be learned optimally such as language skills. To my knowledge there is no critical period for playing a piano but we do know that learning to read musical notes and learning itself is a lot more easier done in your youth (teens) than when you are above 40 such as I am. It is an advantage when you started playing the piano at a young age (and continued doing so), because you now have more developed skills for it then when you have start now from the beginning. Furthermore, the condition of your brain and the growing rate is optimal in your youth for learning new things. Your older brain is less flexible and quick than when you were in your teens. Another factor is important in optimizing your limits in brain training: how many biological life events did you already had? I mean, I have had my share of stress periods the last 20 years (having children, a divorce, some serious operations, loosing one of my parents), and that certainly did not help my brain condition due to lack of sleep and the stress effects itself. When you are a child of say 9 years old, these events are probably much less so your brain is 'fresh' and still growing. I still am amazed of how quick my oldest daughter of 12 plays the game Set or Memory. Whatever I try to do, usually I loose when playing with her. She is so much quicker and alert than I am. I can't help myself thinking 'am I becoming thát old?' Luckily, we don't play these games every week.

Next pages on brain rehabilitation

In several other pages I will go into more detail about brain rehabilitation examples for each specific brain domain (i.e., attention, memory, problem solving, perception, language). Although function training examples will be shown, the main focus will be on known and/or studied cognitive strategies. I will concentrate on brain training after brain damage although some advice will be given for the normal brain. Please follow the links below.

Please be patient. Currently I am writing about 1 page in 2 weeks due to a very busy clinical practice. Just visit these pages regularly to see the follow-up. 

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