The Plastic Brain - Fake It Until You Make It

About a decade ago, Philip Martinez was involved in a motorcycle accident in which the nerves in his left hand were destroyed, leading to an amputation. However, after the amputation he was haunted by his amputated hand, as if it still existed, but was immovable and in excruciating pain. He eventually found Dr. V.S. Ramachandran, a neuroscientist at University of California at San Diego, who had been researching the phenomenon Martinez was experiencing - "phantom limbs".

To help amputees deal with their phantom pain, Ramachandran created an ingenious solution called a mirror box, designed to trick the brain into thinking that it is working with the phantom limb. It is an uncapped box with two compartments separated by a vertical mirror. As Martinez placed his good arm into one of the two compartments and imagined that his amputated hand was in the other compartment, from a certain angle the mirror box allowed him to see the reflected image of his good hand, as if his amputated limb was there. As he moved his good hand while looking at the reflected image, he was not only able to "see" the amputated limb, but to feel it as well. This seems almost as magical as a fantasy. In Harry Potter and the Sorcerer's Stone, Harry first saw the sorcerer's stone in his pocket through the Mirror of Erised, before he actually found it in his pocket. Similarly, Ramachandran's mirror box allows someone to see what they want to happen before their brain actually makes it happen.

At first, Martinez felt that the phantom limb was unfrozen and moving again only when looking at the reflection; when he closed his eyes, the painful sensation returned. After four weeks of working with the box for ten minutes a day, the seemingly permanent pain was cured. The mirror box had caused the brain to believe that the nonexistent limb had begun working again, relieving the pain and uncomfortable sensation. The brain had rewired itself - the body faked it until the brain made it.

Neuroplasticity is the characteristic of the brain that allows it to adapt, rewire, and change its structure, similar to the ability of plastic to mold and change shape. The plastic brain defies the long standing theory that brains, especially adult brains, are rigid structures.

In the past, neurologists did many studies to identify which part of the brain controls which body function or action, also known as brain mapping. The previously accepted belief was that these brain maps, once established during childhood, could never be changed; a particular area of the adult brain can control only a certain part of the body so that all regions of brain maps were immutable. It would be as if the boundaries of countries had been permanently established since the beginning of time. However, the discoveries of neuroplasticity in the early 1970's led to an entirely new view- brain maps can expand, diminish, and become more specific to certain sensory inputs and motor functions. Ramachandran witnessed changes in brain maps when he scratched the cheek of a patient experiencing phantom pain. The patient not only felt the scratch in his cheek, but in the phantom limb as well. Confirmed through brain imaging, Ramachandran concluded that the limb's brain map had meshed with the cheek's brain map. Like an emperor with an avid desire to gain territory, the cheek's map was encroaching on the limb's map.

Before designing the*illusory mirror box, Ramachandran uncovered the brain map of phantom limbs. He observed that many amputated patients had the limb in a sling before amputation, which caused the brain map to adapt to the "frozen" state of the limb. From a healthy limb, the brain receives motor and sensory outputs signaling the completion of an action, however, after a limb is amputated, the brain no longer receives those messages. The brain therefore continues to think that the limb is frozen because it was not signaled otherwise. If a tree fell in a forest but no one was there to hear the sound, did the tree really make a sound? Was the limb really amputated if the brain was not told so? According to the brain map, the limb was still there, but because it was not responding, the brain pushed harder and harder to try and receive an output signal, leading to excruciating "phantom" pain. The knowledge of changing brain maps combined with the identification of the phantom map, led to the cure for phantom pain.

Aside from the mirror box, another "trick" to change the brain is visualization. Visualization has gained popularity as an alternative way to improve any skill when unable to practice, and has now been proven scientifically through neuroplasticity. Scientist Pascual - Leone of Harvard Medical School studied two groups of people, those who physically practiced the piano, and those who simply imagined practicing the piano. The brains of both groups of people were constantly mapped over the same intervals and showed similar changes. The group who simply imagined playing the piano was able to play almost nearly as well as the group with physical practice, and only needed one physical practice session to catch up. The repetitive imagination of an action strengthens the neuronal connections of that action similar to the way in which physical practice does, resulting in physical improvement.

When I used to train for competitive tennis and was learning a new shot, my coach would say "Imagine this shot in perfect detail several times and it will come more easily to you." I did not appreciate the advice he gave me until now. "Fake it until you make it" seems to have the potential to help anyone with anything, whether it is through the mirror box or visualization. Neuroplasticity is introducing magic into the world of science, like a sprinkle of Tinkerbell's pixie dust.