Taking Advantage of the Stupid Brain–an Exercise Hack

A lot of recovery focuses on how amazing the brain is, how it is astoundingly good at picking up the slack left by damage, and how resilient it is. To be this way, the brain itself has to be stupid and lazy, at least when it comes to self-aware animals like us. If we're cunning, though we can use some of that stupidity and laziness to our advantage.

The brain is evolutionarily geared to prefer activity that takes least effort for greatest reward. Throughout our lives, it tries to make our actions, in particular, as efficient as possible. Not only do we use less energy that way, but we end up using fewer neurons for things that we do repeatedly, and have more brain left over for complex, abstract thought. If you have ever got to work but don't remember the coffee you drank on the way, you've felt this.

This process can be seen in children when they go through adolescence and prune an amazing number of neural pathways to leave optimal paths, and the clumsy duckling becomes an elegant swan. It's what is really going on when we talk about "muscle memory"—when a complex sequence of physical actions is neurally optimized as an atomic unit that, once initiated, completes without conscious intervention.

It's impossible to decide consciously which path is going to be optimized, and which is going to be discarded; repetition tends to be the key, at least for physical activity. How do we determine, though, what habits of mind we can form?

Although the impetus to exercise was clear to me, a year ago, it's not so clear now, not so immediate. Put another way, the small incremental gains I get in function are proportionately less significant, so I appear to be getting less reward for more effort. Put yet another way, it's gotten harder to go to the gym and pool.

So I tried a hack on my brain, to see if I could make going to the gym (and pool) easier. I've already made the going as efficient (and energetically cheap) as possible, so the idea was to front-load the reward. Typically the benefits of exercise that we can sense, and the brain can operate on, come too late for us to associate the action of going to exercise with the reward of having exercised. The hack was simple: any time I thought about the action of going to exercise, I would then say to myself, with a mental tone of glee, "ooh, goodie! I'm going swimming tomorrow!"

That was it. I didn't have to mean it, and I frequently didn't, I just had to think (or say) it, no matter how artificial. That was the totality of my experiment.

It worked.

I was far more likely to actually go to the pool or gym, after I had thought "yippee! gym tomorrow! and legs, I love legs!" (I don't), the night before. I'm hoping that in two or three years' time, I won't have to say my silly fake mantra, because my brain will have associated the benefits of the exercise with the (short and painless) drudgery of getting to the exercise. Until then, "Yay! Skeevy pool tomorrow!"

Brain Experiment

As part of my effort to transform my life so it's not defined by brain damage, I'm trying a brain experiment.

People often waffle on about the 'power of positive thinking' and it seems to me to me to be so much superstitious magical thinking rubbish. By contrast, however, I am convinced of the brain's plasticity, and our ability to change the patterns of the brain--our habits--by the action of our conscious mind.

So here's the experiment: every time I think "Ugh. Gotta go to the gym (or pool)." I am going to stop myself at "Ugh" and change that into "Yay! Time to go to the gym (or pool)."

It's going to be easier with the gym than the pool, because although the gym tends to be more physically strenuous, the pool I go to is kind of sketchy: it is a stupid length (22m, I ask you), is cloudy with chemicals, and the changing room is frankly nasty. The pool is on my block though, which easily outweighs any flaws.

The brain doesn't change without repetition, attention and intention, though, so it won't be enough just to think the words. I'll have to focus on the after-effects of exercise before they've happened, to strengthen that association; the pleasant glow of used and tired muscles, and how good that can feel.

If it works at all, it will take a long time for the artificial to become automatic, especially in an adult brain, but if it does, I'll let you know.

Balance

Balance has been on my mind a lot recently.

On an immediate and obvious level, my balance is very poor these days. Walking now is quite like walking while drunk off my ass; I stagger and weave and bump into things, especially if I'm not concentrating or I'm doing something extraordinary like talking. As an added bonus, I bruise easily, too (thanks, Aspirin!), so my upper arms are particularly beautiful. 

I can't tell why my balance is so poor (apart from the blindingly obvious because you have brain damage resulting from a stroke, dumbass). I maintain that my sense of balance is still good, that I know when I'm going over, but that it is muscular weakness on my right side and my brain still expecting dead bits to control my right side that fails to prevent the fall from happening. This is an optimistic view: it suggests that as I strengthen my right side and keep doing coordinated movement with it, my brain will gradually learn to use not-dead bits to control muscles that keep me upright, and maintaining balance will become less of a conscious activity.

This view might be wrong, and the neuroscience facts I learned 20-30 years ago would say that it is wrong. It's possible that I will always require conscious mental intervention to stay physically upright. Video game controls tend to give the lie to that thesis, though, if you've ever played a game obsessively enough.

Somewhere between the two is the possibility that it will take too long for an adult brain to sustain the level of intent attention that making balance automatic requires. In this view, I will reach a point where my walking is good enough for my brain to be satisfied, and it won't improve further. The trick to avoiding this seems to be to keep my mind dissatisfied and hope that it influences the brain to continue adapting. Same deal with my eyes: if ever I get too used to the double vision, the neurologists end up being right, and my vision stops improving.

All of which plays into another issue of balance: how much time do I spend on recover versus how much time do I spend just accomplishing the task at hand. I can stagger quickly, or walk more correctly slowly. This affects almost everything: when I use my right hand (for example typing this), am I doing so correctly or quickly? Correct doesn't become quick without time and effort, especially at 41. 

The intention tremor in my right arm and hand makes this choice even more pronounced: clearly, it's worth taking time to lift a glass or write with a fountain pen, concentrating on not having the tremor. Sometimes, though I'm just thirsty, or I just need to get a phone number down quickly and don't have a computer right there. That's when I have to compensate for the tremor, and hope that I'm not reinforcing it.

Furthermore, I think about work-life balance quite a lot. I am lucky to have the opportunity to focus on recovery, but soon I'll be looking for work (or student loans and work), and I wonder how I will ever have time to keep up the exercise I'm doing and sustain a paying job. Long before I had the stroke, I thought that American (and British) working practices were insane, and I think so even more now. Whatever work I do in the future must allow me enough time to return to full function.

Finally, I wonder about the balance to be struck between being disabled, and looking disabled. The facial palsy is a strange help here, as is the occlusion in one lens: I look as if I am disabled in the head somehow. That seems to be picked up on more than my walking stick, where although I look increasingly muscular and buff (huzzah!) I am actually more impaired by the physical than visual (probably; it's hard to quantify). The net result is that sometimes I do need help, but not necessarily where and when an observer might think. I'm new to the term and concept of invisible disability, and honestly never thought I'd be looking at it from this side. But then I never thought I was going to be disabled at all, more fool me!

I'm sick at the moment with a chest bug. This is a pain, because it means I can do less, which hampers my recovery, and I feel crappy. It also illuminates for me something I have grown to suspect about stroke in general, or maybe just my stroke in particular.

A lot of people, from sufferers of stroke, to stroke doctors, nurses and physios have warned of the great tiredness that can come with stroke. Now, there's no doubt that in the first months of my recovery I tired very easily; anyone who came to Mt. Sinai and found me asleep in the middle of the day can attest to that. But I don't think that tiredness itself is symptomatic of the post-stroke experience.

Instead, I think that we sufferers of stroke are told that we'll get tired, we experience that overwhelming tiredness in the early days of recovery, and we then practice being tired. Our brains learn that being tired is an acceptable way to be, and it's pretty cool, because other people take care of stuff while we're snoozing. Being tired as a symptom of stroke is, in this case, pretty awesome, because most of the time "he had a stroke" is an adequate STFU to any question.

I'm left wondering, though, what's the biological cause of the tiredness? I mean, sure, when we're first recovering our brains take frequent times out to create new pathways, but six months later? Why would I be extra tired? The short answer is, "I'm not," but maybe that's peculiar to me, and there really is some reason why everyone else gets tired and sleeps more.

What I have found is that stroke is a sort of magnifier, but again that's not quite right. My response to emotional stimuli, for example, seems magnified, even in as trivial a case as really enjoying The Avengers movie. But that's more to do with the fact that my physical response is less muted, so my emotional response feels disproportionate for an adult. I'm actually pretty content with saying "adult with brain damage here" and enjoying a lot more bang for my exorbitant movie buck. Or at least, I shan't be working overly hard to recover from that particular change; I'm content adapting to it.

Ultimately, my experience is that I have little to no reserves. When I get tired, that's it, I'm done. This makes sense when you accept that I lost a few c.c.s of highly optimized motor control brain matter, and now the rest of my brain is having to pick up the slack. Unfamiliar parts of my brain are working to learn how to interpret signals and send meaningful responses to the bits of me that have been walking, seeing with binocular vision and being a face for forty odd years. My brain is still at it, it hasn't even finished just figuring that stuff out yet, let alone started to optimize it so that there's some left over capacity for me to draw on.

If this seems incomprehensible or far-fetched, let me put it to you that I now have a visceral understanding of why a child who's just become a toddler will rocket around, then keel over and fall asleep. Just the act of walking right as well as getting where I want to go can be exhausting. Or it was, it's getting easier with every passing day, because I'm working hard at the exercise I do.

Which brings me back to being sick, which is annoying because, although it's exactly the same as when you get sick, it seems to affect me more, because unlike you, I don't have anything to draw on in reserve. Of course you could just as easily have depleted your reserves burning the candle at both ends, but for me it means that I shan't get up tomorrow morning to go see the Queen toddle around Sherborne and I'll be asleep in about 20 minutes' time.

The Brain That Changes Itself

At +Ralph Mazza's suggestion I recently read The Brain That Changes Itself, which sings a paean to the wonders of modern neuroscience, and in particular neural plasticity, which would seem to offer, say, someone who had a stroke, cause for optimism.

To get the bad out of the way, I didn't like at all the chapters that were thin on science, or relied to much on the author's experience as a psychoanalyst. The conclusions may be accurate, but the chapter on Internet porn came across to me like the author banging a well-worn sensationalist drum of titillation and puritanical propriety. Also, I haven't waded through the annotations, which seem to take up half the eBook, since reading is a bit slower at the moment, and I couldn't be bothered at the time. I still have them to read at my leisure, though.

Other than that, I thought it was an excellent book whose implications matched my personal experience very well. For example, the first chapter described a woman who--due to a poorly prescribed antibiotic and an almost total loss of vestibular function--had had the sensation of falling for five years, even suffering the same sensation when she had already fallen over. Miserable. The chapter describes how she was successfully treated using principles of neural plasticity.

Using the ideas in the first chapter (but lacking expensive equipment) I derived a way to experiment upon myself, potentially improving my own poor balance; it could do little harm. It worked. My balance improved noticeably. Score one for the principles the author was describing.

As I read more, it became clearer that everything I knew about neurology from high school (my A-level Biology 20-odd years ago) was wrong, or at best an inaccurate approximation. The implication for me is evident: recovery is not only possible, but attainable; it takes time and hard work, it will often be boring. My relative youth and the quite small amount of lost brain matter are an advantage. I suspect that never learning to drive will also help.

Yesterday, I was asked to speak as the "expert patient" or graduate of the ASPIRE program I mentioned in an earlier post and I found that I was unable to be as coddling as some medics seem to be. Sure it's horrible having a stroke, and sure it's tough, and for sure sometimes there's so much damage that recovery is going to take decades at best, if it's possible at all, but given all that we have a conscious choice to make, and we should be damn sure we make that choice consciously: Do I want to sit in an armchair and fester for the rest of my life, or do I want to get better? If the answer is "get better" then we do the hard work. 

The book lays out some of the principles and, I think, gives a pretty coherent and sensible view of how our neural matter really works, why localization made sense at the time, and most importantly for me, some ideas about how best to use those principles to effect a faster recovery. As an example, I now go to the gym quite a bit, and I was already concentrating on form over apparent brute strength, but understanding more about plasticity has meant that I pay more attention to my right leg while cycling, for example.

Another example that cuts to the heart of the recovery vs rehab dilemma, is that it matters when my left hand compensates for my right hand. Early on, I was compensating enormously and didn't know it, which partly accounts for my wildly over-optimistic expectations of how long it would take to recover. Now, I work hard to notice when my left hand has quietly assumed an automatic task that my right hand should be doing, and force myself to use my right. Even though it's often much slower. When I pay attention to forcing my right hand to do the things it used to, it improves. Any other improvement is as good as accidental.

If you've read the book and have thoughts or questions or whatever about chapters in it, let's talk about it! (Except the internet one. Can't be bothered. Not relevant to me.)

(Originally posted on Google+ with some commentary.)