Changing the Brain While it is not known with any precision the exact inner workings of the brain during rehabilitation, there are some very good theories as to what the brain is capable of during rehabilitation after injury. As Dr. Ramachandran and Ms. Blakeslee have recently written in Phantoms of the Brain, "To obtain more direct proof, we took advantage of a modern neuro-imaging technique called magnetoencephalography (MEG), which relies on the principle that if you touch different body parts, the localized electrical activity evoked in the Penfield map can be measured as changes in magnetic fields on the scalp....we found that maps had changed over long distances, and ... These observations were in fact the first direct demonstration that such large-scale changes in the organization of the brain could occur in adult humans. The implications are staggering. First and foremost, they suggest that brain maps can change, sometimes with astonishing rapidity. This finding flatly contradicts one of the most widely accepted dogmas in neurology the fixed nature of connections in the adult human brain. It had always been assumed that once this circuitry, including the Penfield map, has been laid down in fetal life or in early infancy, there is very little one can do to modify it in adulthood. Indeed, this presumed absence of plasticity in the adult brain is often invoked to explain why there is so little recovery of function after brain injury and why neurological ailments are so notoriously difficult to treat. But the evidence shows contrary to what is taught in textbooks that new, highly precise and functionally effective pathways can emerge in the adult brain as early as four weeks after injury." (p. 31, 1998). Hence, we know that the brain, from infancy through adulthood, can change. This is one of the most important principles driving the changes we see as a result of neurofeedback. Another important question is asked when we seek an understanding of what is really going on in the brain at the cellular level. What is happening to make these changes? There are two possible explanations: One is that we are seeing new growth and development, or "sprouting" of new neurons. The second theory is that we have many redundant systems in the brain, and when some of the pathways are damaged, the brain begins to re-route signals along new pathways. At this point, we do not know whether it is one or the other, or possibly both types of remapping which are taking place. Knowing how much of each theory is contributing to recovery is far less important, though, than knowing that recovery and remapping is possible.

Retraining or Remapping the Brain Some remapping occurs in the brain in an involuntary manner, or without our conscious input. It is possible, however, to help the brain with its remapping or retraining. This is where neurofeedback can play an important role. The first part of remapping is knowing what parts of the cortex are likely to be responsible for certain functions. This knowledge is based upon established maps of brain function such as the Penfield map, and more recent research which has provided more clues about functional maps of the brain. When a client comes into the office, generally there is a function which is not working properly (for example, a right arm is not moving after a left hemisphere stroke). The right arm is typically controlled by the left motor cortex, so we go to the left motor cortex and place the electrodes over the area responsible for moving the arm. We know that a person who has no difficulty in moving their right arm has a certain level of certain frequencies when we measure their brainwaves, so we use those standards as our reference points. When we measure the brainwaves of the person who is having difficulties moving their arm, we are likely to find that their levels of certain frequencies differ from our reference points. If there is a substantial difference, we then begin to retrain the brain to produce levels of frequencies which are closer to our reference standards. Retraining the brain is essentially using conscious rewards and reinforcement to produce subconscious relearning. When we perform various tasks, if we are rewarded for those tasks we are more likely to perform them again. The same is true for tasks which we ask the brain to do. If, during a neurofeedback session, we place the electrodes at two points, and we begin to give the brain rewards, or feedback, about how it is firing between those two points, then the brain will attempt to repeat that behavior for which it is being rewarded. When the high-speed computer equipment gives out the visual and auditory feedback that the correct amounts of certain frequencies are being produced, a client consciously rewards their own self for producing these correct frequencies and from this conscious reward a subconscious relearning takes place. (NOTE: Some clients are unable to consciously reward themselves, and their spouses/parents/guardians sit in session and help them with this conscious reward process.) This subconscious relearning, or remapping is where new neuropathways are developed (by one of the means mentioned above) and where new function becomes possible. Hence, if we reward the brain for firing in a certain way, the brain will attempt to continue to fire in that way. After repeated sessions, the brain will have a changed pattern, and the neurofeedback will have successfully changed a previously undesired brainwave pattern and mapped out a new neural connection for improved function.

The Consequences of Retraining or Rempapping the Brain If neurofeedback is done correctly, once the brain has retrained itself and remapped new neural pathways, the work is permanent. It should not regress unless there is futher insult or injury to the brain. However, remapping is just the first step in recovery of function. Since the brain-body connection is so vital, it is important to work the body while you are working the brain. Physical therapy, occupational therapy, speech therapy and neuromuscular reeducation are all critical to the process of rewiring the brain. Our body and brain together are "use it or lose it" entities, so we must continually use both our bodies and our brains in order to prevent deterioration. The same is true of remapping and retraining the brain. While new neuropathways are being formed, we must use our bodies to reinforce the need for those pathways (like moving an arm or a leg) or the pathways will extinguish, or be "pruned" from the neurological "tree" since they will be regarded as unused, and therefore not necessary. So the consequences of retraining are twofold: First, retraining creates the possibility of new function by creating new pathways. Second, once the brain is retrained, there is a further obligation on the part of the client to use those pathways so that they have not been created only to be later discarded from disuse.