The Flip Side of the Brain
Ever since President WH Bush declared the 1990s the “Decade of the Brain,” there has been an immense amount of research into the workings of the brain, development of the brain, and how easily these processes can go wrong at any stage of life. On the flip side, new findings provide optimism about the brain’s plasticity, or ability to change and improve.
Sections of the brain
The brain is unlike other organs of the body. It is immensely complex, with quadrillions of connections. To understand the brain, one must understand that each section performs a different function. The Temporal Lobes handle the processing of sound, language, and speech. The Occipital Lobes manage visual messages, Parietal Lobes proprioception and sensations, and Motor Lobes motor function. The Frontal Lobe is what makes us particularly human, with its multiple subsystems that encompass our social skills, executive skills, judgment, insight, and self-management. The Prefrontal Cortex is the Chief Executive Officer (conductor) of the brain.
Pathways of the brain
To connect all of these lobes and functions, the brain has Neural Pathways, called neurons, that run together like a fiber optic cable—ensuring all areas of the brain work in a coordinated manner. An example would be riding a bike. The first time you ride a bike it is awkward. You look and feel uncoordinated, trying to find your balance. However, after many trials and practice, the tracts of neurons grow branches to different parts of the brain required to ride a bike smoothly. The neurons also make better connections, increasing the connections at the synapses; thus, increasing the speed of transmission of the signals. As a result, the person becomes more coordinated, more fluid, and eventually can ride the bike without even being conscious of the actions. A person can even ride their bike and talk on the phone or listen to music at the same time. The more these pathways are used, the more stable they become. That’s why you can do something your whole life without practicing for many years and never forget. The brain is always changing and developing depending on our experiences. If we do not use a function, those pathways will wither and eventually be removed. “Use it or lose it!” This pruning process occurs to allow the brain to create new pathways or get better at the ones we use often.
Timing of the brain
Yet another dimension of the brain is the timing of electrical stimulation, or pulsation of the brain. Highly functioning brains not only have good coordination, they also have good timing of their Neural Pathways. There are some things that we have discovered that are particularly helpful for improving this function. The research I have done shows Interactive Metronome (IM) to be a useful tool to enhance timing. It has been used successfully by professional athletes, such as golfers and basketball players, to improve the timing and coordination of their athletic ability.
Emerging brain technologies
Since the 1990s, more sophisticated methods have allowed us observe the brain in action due to fMRI (functional MRI) and PET scans. We can finally watch the brain do the intricate functions it does. While these methods are still research tools in Psychiatry, we have used them to correlate with how medications work, why certain disorders cause the brain to malfunction, as well as other measures like QEEGs, which show us the brain functioning from an electrical point of view. With QEEGs having been around since the 1970s, a huge amount of data has been amassed. In addition, large databases have been developed over the past 40 years to collect information about how medications affect the brain.
New computer programs are now available to stimulate areas of the brain to start the change process, to stimulate the neurons to grow and make new connections. Practicing these functions in a specific way over time enables the brain to function normally, or even better than normal.
These changes have taken some of the guess work out of Psychiatry, which has traditionally relied more on clinical judgment than data and evidenced based practice. The best clinicians have used their experience and intuition to select medication based on the clinical information given to them by patients and their families. Then, the Psychiatrist selects a medication and tries it on the patient and waits and watches the reaction that is subjectively reported by the patient and family. Are all patients and families objective and clear about the changes? No! But, this, in combination with our observations, was all we had. Now, we have more objective data and scientific measures that have made the old ways of assessing brain function more conclusive and improved.
Personalized Medical Care- The Genome
I am proud to announce one more scientific breakthrough that will further personalize medical care. This is Genome study. We now have the ability to do a cheek swab and grow a person’s genome—their genetic makeup. To do the entire sequence is thousands of dollars and we are not aware of the meaning of all the data. But, we can grow one genome of their metabolism and reaction to medications now in our office. It takes only one week to obtain the data we need to make informed decisions about which medication has the best chance of working, with the least chance of side effects.
Tarnow Center brain developments
At the Tarnow Center, we have developed further testing methods to assess a patient’s functioning in the world. Not only to look at their strengths and weaknesses, but also to examine the blocks to functioning, how they process information, or where the process is blocked. As a result, new methods of treatment have been developed that can be measured to assure success. Brains do not change easily. It takes work. But they do change!
The Tarnow Center model is to use all these new innovations in diagnosis and treatment to improve outcomes, take the trial and error out of the process, and develop a long-term road map for treatment.