Brain and Body Rehabilitation

Latitude please. I am going to attempt to cover this in about 1/10th of the number of words that one could take. Here goes:

When people have symptoms of fear, pain, dizziness, Functional Movement or Functional Gait Disorders – their brain can come to expect “more of the same”, and become very skilled in watching for these symptoms to arise again. These conditions can be pervasive. I have experienced a Functional Movement Disorder myself (the Yips), I know about these things from a personal and professional basis. Saving that story for another time. (Thanks for stopping by, George).

These conditions share some commonalities in that they can feel mysterious, challenging-to or impossible to image (MRI, CT), may come with shame or guilt that is self-imposed or externally imposed, and may become chronic (I prefer persistent, but writing to be clear for all). 

As the brain is bombarded with the unknown and the shame, it attempts to both make sense of the problem and prevent recurrence. The brain becomes exceptional at correlational predictions,

“When you ride in the backseat of a car, you will become nauseated.”

“When you are around people, your walking will become disorganized.”

“When you need to make that throw (pressure in sport), your hand will become uncontrollable/inaccurate.”

“When you cross that intersection again (site of a prior accident that was not your fault), you might get hit again.”

“When you bend over, your back will be painful.”

“When you don’t have full visual resources (dark restaurant, objects in motion, head in motion, glare or eyes obstructed), you will feel disoriented.”

…I could to on. I hope that this resonates with you personally or professionally with the examples provided thus far. Let’s proceed. 

These situations or experiences are so frequently associated with your symptoms (fear, pain, dizziness, uncontrolled movement), that the brain begins to physically connect the environment to the symptom. Soon, just thinking about the environment can begin to trigger the sensation. Herein lies the maxim attributed to Donald Hebb, known as “Hebb’s Theory”. Neurons that fire together, wire together. Soon the pathway/wiring becomes strong enough that we may begin to avoid the situations and…then…we may become less-tolerant of the environment. 

The solution? Call it what you will. Habituation (primarily vestibular rehabilitation), graded exposure (persistent pain), exposure based therapy (psychological symptoms). All three are essentially un-wiring the pathways by introducing the trigger yet not experiencing any (or the full expression) of the symptoms. As we predict nausea, fear, pain, dizziness, movement error…and then the worst-case does not develop, we may receive reward from this prediction error. Reward Prediction Error (oversimplified) can be a dopamine reward that helps to facilitate the neuroplastic rewiring of the nervous system toward a more normal state of function. 

I could write about another 20 pages on this…and (maybe) someday I will in a book simplifying our understanding of the brain. For now, I hope that this helps you!