Neuroscience Unit

Day 1

Procedures:o Procedure 1 (Notes): 20 minuteso Have a diagram of the brain already drawn on the board.o Cerebral cortex: ‘Cortex’ means bark. This acts like a bark to protect the lower

brain. It is the outermost layer of the brain that is made up of 4 lobes & is needed for very high level thought.

o Fissure: A depression from the front to the back of the brain that marks the division of the two hemispheres.

o Hemisphere: The two sides (left & ride of the brain). These sides work together to accomplish many tasks. They blend together what the two eyes see & what the two ears hear.

o Corpus callosum: A bundle of fibers in the middle of the brain that connects the two hemispheres & enable them to work together.

Split brain: A surgery where the corpus callosum is severed in order to cut off the communication between the two lobes, which would help to stop extreme seizure cases.

In 1961, two Los Angeles neurosurgeons, Phillip Vogel & Joseph Bogen, speculated that major epileptic seizure were caused by amplified abnormal brain activity that reverberated between the two hemispheres.

Each eye sends information to the opposite hemisphere of the brain. Without the corpus callosum enabling the hemispheres to communicate, the different hemispheres of the brain could be tested separately on tasks.

In an early experiment, Gazzaniga (1967) asked split-brain patients to stare at a dot as he flashed HE*ART on a screen. Thus, HE appeared in their left visual field (which transmits to the right brain) and ART in the right visual field (which transmits to the left brain). When he then asked what they had seen, the patients said they had seen ART. But when asked to point to the word, they were startled when their left hand (controlled by their right brain) pointed to HE. Given an opportunity to express itself, each hemisphere reported only what it had seen. The right brain (controlling the left hand) intuitively knew what It could not verbally report.

When a picture of a spoon was flashed to their right hemisphere, the patients could not say what they had viewed. But when asked to identify what they had viewed by feeling as assortment of hidden objects with their left hand, they readily selected the spoon. If the experiment said, “Right!” the patient might reply, “What? Right? How could I possibly pick out the right object when I don’t know what I saw?” It is, of course, the left hemisphere doing the talking here, bewildered by what the nonverbal right hemisphere knows.

People with split brain surgery often at first have to deal with their right & left hands working independently.

o One buttons & one unbuttons a shirt.o One put things into the grocery cart & one takes things

out. Dominance:

When dealing with small, fine movements such as writing or placing your finger in your ear, one hemisphere has dominance.

The right hemisphere controls the left side of the body, while the left hemisphere controls the right side of the body.

Tasks of the cerebral hemispheres In general, the left hemisphere deals with:

o Speech, language, logic, & writing. In general, the right hemisphere deals with:

o Spatial reasoning, art, music & emotions. Disclaimer: The hemispheres work together in virtually

everything that they do.o Lobes: The four major sections that the cerebral cortex is broken up into.

Frontal lobe: The frontmost area of the brain. Prefrontal area: The frontmost part of the frontal lobe. This is

where you reexperience personal memories. Frontal association area: Behind the prefrontal area. This is

where associations between ideas & the forming & planning of activities happens.

o Motor cortex: This is behind the frontal lobe. ‘Motor’ means movement. This control all movement in the body.

o Parietal lobe: The area behind the frontal lobe. It interprets sensory information.

o Sensory cortex: This is behind the motor strip, & it interprets the sensations that we feel.

o Association areas: These are responsible for integrating the information that the brain receives. They are found in all four lobes (parietal, occipital, frontal, & temporal).

o Occipital lobe: Located at the very back of the brain, it interprets images (makes sense out of what we see).

o Temporal lobe: Located underneath the other lobes. The major center for hearing.

o Procedure 2 (What Could Happen): 10 minutes Read the Phineas Gage story: Phineas Gage: In the 1840s, a railroad worker with the unlikely name

of Phineas P. Gage was injured in a freakish accident, which gave us clues into the nature of the frontal association area. He was pushing some dynamite into a hole with a four-foot-long iron bar in the shape of a toothpick, about an inch in diameter. The dynamite went off, firing the bar upward through his jaw, through the frontal association areas, and on out. Remarkably, he survived, because none of the vital parts that control breathing, movement, or physical control had been damaged. Still, the injury to his frontal association area resulted in some major changes. While he had been friendly and normal, suddenly he become someone who swore all the time, undressed whenever he felt like it, urinated in public, and had temper tantrums. Thus, this complex area of the brain must play a large part in what we call social control as well as in our basic personalities.

So, what could happen with an injury to the frontal lobe?o Procedure 3 (notes continued): 20 minuteso Lower brain: Located deep inside the skull, the cerebral cortex is fits over &

around this. This is the part of the brain that keeps the body running.o Thalamus: It is an oval mass of nerve cells. It acts as a relay station for

incoming & outgoing messages in the brain.o Hypothalamus: ‘Hypo’ means below, & this sits below the thalamus. About the

size of a pea, it controls rage, pleasure, hunger, thirst, & sexual desire.o Limbic system: This involves structure (the amygdala & the hippocampus)

that control emotions, & some aspects of memory. Amygdala: Also located below the thalamus, this controls emotional

responses, especially aggression. Hippocampus: Another located below the thalamus, but beside the

amygdala, this is where memories are formed (they are sent to & stored in the prefrontal area of the frontal lobe).

What could happen if the hippocampus was injured? What would happen to the memories you had already formed?

o Cerebellum: This looks like a ball of yarn attached to the base of the brain, & it is responsible for your ability to stay balance, remain coordinated, & get you where you want to go. This is where automatic actions, like muscle memory is stored (actions that were once conscious efforts).

Ex: Walking a straight line, sticking your finger in your ear, getting from one class to the next during the day.

Day 2

Procedures:o Procedure 1 (notes): 50 minuteso Brainstem: This begins where the spinal cord enters the skull & swells

slightly, forming the medulla. This area of the brain is responsible for automatic survival functions.

Medulla: This is the control for your heartbeat & breathing. Reticular activating system (RAS): Also called the reticular formation,

this sits right at the base of the brain inside the spinal cord. Imagine a mesh net with one end of a hose stuck through it by a few inches, & that’s basically what it looks like. It is responsible for arousal/alertness. It interprets the impulses between the brain & the body to regulate how sleepy or alert you are.

o Neuron: This is a nerve cell, which is a part of the system that sends messages around the brain.

Action potential: This is an impulse, which is a brief electrical charge that travels down the axon. It is activated when it receives a signal from its sense receptors (dendrites).

There are excitatory singles & inhibitory signals. Threshold: This is when the excitatory minus inhibitory signals exceed

a minimum intensity (the threshold) & trigger an action potential. Dendrites: Meaning ‘tree,’ these short fibers look like branches & they

receive information from other nerve cells & send it through the cell body to the axon.

Axon: This is a very long fiber that carries a message from the cell to the other neurons. At the end of an axon there are thousands of terminals sitting opposite the receptors for another neuron.

Synapse: The space between the ends of axons & the ends of dendrites.

Vesicles: This is just before the end of the axon, & it contains chemicals for transmitting messages called neurotransmitters.

Myelin sheath: A fatty layer of tissue that insulates that axons of some neurons & helps speed their impulses.

Multiple sclerosis: This is when the myelin sheath breaks down & therefore slows the communication to muscles & the eventual loss of muscle control.

Glial cells: “Glue cells,” these guide neural connections, provide nutrients with insulating myelin, & mop up ions & neurotransmitters.

Neurons are like queen bees. They can’t take care of themselves. Glial cells are like nannies.

Neurotransmitters: Differently shaped molecules that send specific messages. They transmit information over a synapse.

Acetylcholine: This sends the message when we are getting ready to move some part of our body. It is also involved in learning & memory.

o Dysfunction: Alzheimer’s disease. Dopamine: Involved in movement, learning, attention, &

emotion.o Dysfunction: Excessive linked to schizophrenia; lack

linked to Parkinson’s. Endorphins: Involved in relieving pain & increasing our sense of

well-being. Reuptake: This is the reabsorption of a neurotransmitter after it has

already been fired off by a neuron. It allows for the recycling of neurotransmitters in order to

maintain the level of the neurotransmitters.o Nervous system: The body’s electrochemical information network.o Central nervous system: Made up of the brain & spinal cord.

Spinal cord: Handles all impulses from the brain to the body & from the body to the brain.

Reflex: An automatic behavior of the body involving movement that is activated through the spinal cord without the use of the higher brain.

o Peripheral nervous system: All the nerves outside the brain & spinal cord; it links all the body’s sense receptors, muscles, & glands to the central nervous system.

Somatic nervous system: A part of the peripheral nervous system containing sensory & motor nerves.

Sensory neurons: Send information from the body’s tissues & sensory organs to the central nervous system.

Motor neurons: The way that the central nervous system sends information back out to the body’s tissues.

Interneurons: Between the step of sensory input & motor output, these process the provided information.

Autonomic nervous system: A part of the peripheral nervous system. Regulates breathing, heart rate, digestion, etc.

Sympathetic nervous system: A part of the autonomic nervous system. It energizes us & prepares us for emergencies.

o Fight or flight. Things that alarm, enrage, or challenge you.

Parasympathetic nervous system: A part of the autonomic nervous system. Works in opposition to the sympathetic system to calm us down after an emergency or a ‘near’ emergency.

o Reflex: Our automatic responses to stimuli. This is composed of a single sensory & a single motor neuron.

When your touch something hot. Knee-jerk at the doctor.

o Neural networks: A cluster of neurons in a work group. With experience, networks can learn.

Practicing an instrument, your handwriting, through a ball, singing a song, reciting the pledge.

o Hormones: Chemical regulators that control bodily processes such as emotional responses, growth, & sexuality.

o Glands: Units of the body that contain the hormones.o Endocrine system: System that includes all the glands & their chemical

messages together.o Pituitary gland: The master gland; it activates other glands & controls the

growth hormone. Growth hormone: The hormone that regulates the growth process; it is

controlled by the pituitary gland.o Thyroid gland: The gland that controls & regulates the speed of bodily

processes, also known as metabolism. Metabolism: The speed at which the body operates or the speed at

which it uses up energy.o Adrenal gland: Glands that cause excitement in order to prepare the body for

an emergency or for some other important activity. Adrenaline: Chemical that prepares the body for emergency activity by

increasing blood pressure, breathing rate, & energy level.o Gonads: The sex glands; they make sperm or eggs for reproduction.

Androgen: The male sex hormone. Estrogen: The female sex hormone.

o EEG: Electroencephalogram. Electrical activity in the brain’s billions of neurons sweeps in a regular waves across its surface. The EEG is an amplified read-out of these waves.

Comparable to studying a car engine by listening to it hum. However, by presenting a certain stimulus repeatedly & having

a computer filter out the unrelated brain activity, you can identify the electrical wave evoked by the stimulus.

o PET: position emission tomorgraphy. This show’s brain activity by showing each brain area’s consumption of its chemical fuel (the sugar glucose).

Active neurons are glucose hogs. The person is given a temporarily radioactive form of glucose.

o MRI: magnetic resonance imaging. Our heads of full of atoms that spin like tops when they are put in contact with a strong magnetic field. After a brief pulse of radio waves disorients the atoms temporarily, the atoms return to their normal spin, & they release signals that provide images of their concentrations. This results in a detailed picture of the brain’s & the body’s soft tissues.

o fMRI: This can reveal the brain’s functioning as well as its structure. Blood goes to the parts of the brain that are especially active. By taking MRI scans that are less than a second apart, researchers can watch the brain light up as a person performs different mental functions.

o Lesion : This is tissue destruction. A brain lesion is a naturally or experimentally caused destruction of brain tissue.

This can be used to destroy tiny clusters of normal or defective brain cells, while leaving their surroundings unharmed.

o Plasticity: The ability of the brain to modify itself after some types of damange.

This does not work with the spinal cord or certain assignments of the temporal lobes.

This does work with things like losing a finger, where the adjacent fingers become more sensitive as a result.

If a blind person uses a single finger to read Braille, the brain area dedicated to that finger expands as the sense of touch invades the visual cortex that normally helps people see.

Brain plasticity is highest in young children.o Broca’s area: After an area of the left frontal lobe had been damaged, a

person would struggle to speak words while still being able to sing familiar songs & comprehend speech.

o Wrnicke’s area: After damage to an area of the left temporal lobe, people could only speak meaningless words.

o Angular gyrus: Reading aloud involves this brain area. It receives visual information from the visual area & recodes it into auditory form.

When we read aloud, the words register in the visual area, are relayed to a second brain area, the angular gyrus, which transforms the words into an auditory code that is received & understood in Wernicke’s area, & sent to Broca’s area, which controls the motor cortex as it creates the pronounced word.

Depending on which link in the chain is damaged, a different form of aphasia occurs.

Aphasia is a damage to any one of the several cortical areas, which impairs the use of language.

Day 3

o Procedure 1 (Case Study): 20 minutes Read the Case Study on pg. 78 together as a class. Have the students answer the questions on the Phantom Limbs Case

Study sheet. Go over the questions together.

o Procedure 2 (): 30 minutes

Phantom Limbs Case Study—Page 78

Name: Date: Period:

1. What is a phantom limb?

2. What causes a person to have a phantom limb?

3. What are the possible reasons that the brain would feel it needs to create a phantom limb?

4. What parts of the brain are associated with a phantom limb?

5. What are the problems associated with a phantom limb & how can they be dealt with?

Day 4

Procedures:

o Hook (Articles about Injuries): 25 minutes Split the class into 5 groups & give them an article about brain injuries

& their results on the body. Have the students use the provided worksheet to locate specific

information from the article.o Procedure 1 (Presentations): 15 minutes

Have the groups present their articles & answers.o Procedure 2 (Reflection): 10 minutes

Have each student write a half-page reflection talking where they have to choose a part of their brain to be injured. What would you pick & why?

Injuries to the Brain or Body & Their Effects

Name: Date: Period:

1. What was the injury (what parts of the brain and/or body were affected)?

2. How were these parts affected?

3. How did the person’s life change?

4. What is the job of the part of the brain that was affected?

5. How could we use the way the brain and/or body work to address the way the person’s life was changed by the injury?

http://www.nytimes.com/2010/07/04/nyregion/04soldier.html?_r=1&ref=traumaticbraininjury&pagewanted=print

July 2, 2010

Spirit Intact, Soldier Reclaims His LifeBy LIZETTE ALVAREZ

WASHINGTON

BRENDAN Marrocco and his brother, Michael, were constructing a summer bucket list, to

get them out and about, trying new things. A Washington Nationals game versus their

beloved Yankees — sure, since they were stuck here rather than home on Staten Island.

Perhaps a ride on the Metro, with its reliable elevators. Pizza: definitely.

…

Each would be a major accomplishment for Brendan Marrocco, who a year before had

come so close to death that doctors still marvel over how he dodged it. At 22, he was a

spry, charming infantryman in the United States Army with a slicing wit and a stubborn

streak. Then, on Easter Sunday 2009, a roadside bomb exploded under his vehicle, and he

became the first veteran of the wars in Iraq and Afghanistan to lose all four limbs in

combat and survive.

In the nearly 15 months since, Specialist Marrocco has pushed past pain and exhaustion to

learn to use his four prosthetics, though he can walk for only 15 minutes at a time. He has

met sports stars like Jorge Posada and Tiger Woods — and become something of a star

himself here at Walter Reed Army Medical Center, where his moxie and humor are an

inspiration to hundreds of other wounded service members. He has also met, fallen in love

with and proposed marriage to a young woman who sees what is there rather than what is

missing, though Specialist Marrocco has lately been questioning the relationship.

Now he is preparing for a rare and risky double arm transplant at the University of

Pittsburgh Medical Center that could profoundly improve his independence. One of the first

things he will ask of his new arms is to drive a stick shift (the one time he got behind the

wheel, in an empty parking lot, his rubber hand became unscrewed and was left dangling).

There have now been 988 service members who have lost limbs in combat since the first of

the wars began in 2001, but Specialist Marrocco’s many wounds raised so many questions.

Would he crumble mentally? Was his brain intact? How would he ever cope with daily

needs like eating, bathing, even simply getting out of bed and putting on clothes?

…

A contrarian by nature, Specialist Marrocco has become a bit of a homebody, preferring

the haven of Walter Reed — where he is a role model — to the awkwardness of the larger

world. And despite 14 operations, he refuses to let a dentist’s needle near his mouth to

replace the eight teeth he lost in the blast.

…

It is difficult, though, to train for hidden bombs, which is what makes the wars in Iraq and

Afghanistan so insidious. All he can recall of that Easter Sunday drive back to his base is

the flash of light against the black of the early morning. “I hit a pressure wire,” he said. “It

was across the road.”

The bomb, a particularly lethal one known as an explosively formed penetrator, shredded

his armored vehicle. His best Army buddy, Specialist Michael J. Anaya, was killed. Another

soldier was wounded; the fourth man in the truck walked away unharmed. Roadside bombs

do that — choose the soldier on the right but not the left, the one from Florida but not

Georgia.

…

Private Marrocco was rushed in. Within eight minutes, his clothes were off and he was

connected to a giant bag of intravenous fluid. Both arms and a leg had been sheared off.

The other leg, the left, “was hanging literally by a thread,” Major Aydelotte recalled.

Doctors quickly began pumping blood into Private Marrocco’s body, but it sprayed straight

onto the ceiling and walls. Aghast, Major Aydelotte looked more closely. One of the two

carotid arteries, which carry blood from the heart to the brain, was severed, an injury so

lethal it can kill within minutes. “When fragments fly, they make tons of holes in you,” the

doctor explained. “He had a hole in his neck. But we didn’t suspect it to be a carotid injury

because it wasn’t bleeding.”

It was not bleeding because there was so little blood left in his body — 80 percent of it had

spilled out in the field. “Any one of his injuries was life-threatening,” Major Aydelotte said.

“It’s incredible.”

The medical team cleaned out each amputation wound, took a vein from his groin to

reconstruct the carotid, and sewed him up top to bottom. The same day, he was transferred

85 miles to a larger base in Balad, and then on to Germany. He had survived the initial

trauma and surgery. But other serious threats loomed: Infection. Pneumonia. Brain injury.

…

The official-sounding voice, hoping to cushion the blow, asked when he had last spoken to

Brendan. The day before. They had talked about a motorcycle that the father was eyeing.

The son, a motor head, was urging him to buy it; one day, they could ride side by side.

…

“How did he live?” Mrs. Marrocco asked.

“We don’t know how he lived,” the doctor said.

The parents, who separated seven years ago, flew together to Germany, where their son

was in a medically induced coma. He was swollen and burnt and stitched, with a patch over

one eye. His hair was the texture of a Brillo pad. His lips were puffed out of proportion.

“Had I not been told it was my son, I would not have recognized him,” Mr. Marrocco said.

Mrs. Marrocco struggled to see beyond the wounds, the respirator and the missing arms

and legs. Her son, who was small to begin with, had all but disappeared. “I could not

accept it,” she said last month. “And I haven’t accepted it.”

…

By Wednesday night, about 90 hours after the blast, Private Marrocco was in Washington

in Walter Reed’s intensive care unit. He drifted in and out of consciousness. In time, he

began to realize something was wrong with his arms, though he could not see them well at

first, in part because one eye was swollen shut.

“He looked up at me and lifted his arms up,” his father recalled. “He kind of looked at them

and realized they were bandaged and they were different sizes. He couldn’t talk. He had a

tube down his throat. But he mouthed the words, ‘I have no hands.’ I nodded to him. And

that was it. He put his arms down. ‘O.K.’ ”

Mr. Marrocco did not have the heart to tell his son about his legs. “During that first week,

Brendan kept pleading, ‘Dad, Dad, take my boots off. My feet are burning. My feet are

burning.’ I would say, ‘Brendan, your boots are off.’ ”

…

The family wondered about Brendan’s brain. Bomb blasts are notorious for shaking up the

head so severely they leave tracks of destruction, despite the Kevlar helmets. Soldiers who

return home with even moderate brain injuries can have trouble holding jobs or

remembering to pick up a child at day care.

“You can’t rehab a brain-dead individual,” Mrs. Marrocco said. “How would you show him

to do a situp if he doesn’t understand that?”

After Private Marrocco’s brain passed a battery of tests, his family then fretted about his

mental health. Could he avoid the powerful punch of depression and post-traumatic stress,

a one-two so harrowing it can cripple a soldier as easily as a bullet? Not long after Private

Marrocco regained consciousness, Sgt. Justin Minisall, who had been wounded in the

bombing, ducked in for a visit. Private Marrocco asked how Specialist Anaya, the gunner in

the truck that day, was doing.

…

Then his brother did something nobody expected: he volunteered to leave his friends, his

social life and his job in information technology at Citigroup, and move to Washington.

…

Since May 2009, the brothers have lived on the Walter Reed campus in connecting

dormitory-style rooms, with a kitchen and maid service. The Army does not charge Michael

rent and it gives him $64 a day for living expenses. The military also underwrites all of

Brendan’s expenses, including the hand transplants, and pays him a $2,400 monthly salary.

…

He mastered standing in his prostheses within two months, and walking a few steps shortly

after that. But walking long stretches is infinitely more difficult, a bit like balancing on

stilts, only without the benefit of knees or real arms for balance. He spends a lot of time

doing situps and side body lifts to build up core strength, then transfers to the parallel bars

to walk with support if he needs it. Unlike other soldiers, he does not listen to an iPod while

exercising, so he can fully concentrate on the instructions of his therapist, Luis Garcia, a

former medic in the Army Reserve.

Of all the leg amputees Mr. Garcia has worked with over five years at Walter Reed,

Specialist Marrocco has been the quickest to adjust to his legs. “He has incredible balance,

incredible drive,” Mr. Garcia said.

Before and after lunch in the cafeteria he has occupational therapy: writing, picking up

small items like popcorn, positioning a pin on a beret, baking a cake, opening a can. In his

wheelchair, a BlackBerry balanced on his thigh, Specialist Marrocco pecks furiously at the

keys with his rubber hand or with his “fluffy finger,” an upside-down pencil contraption

created just for this task.

Unlike using the prosthetic legs, using mechanical arms does not hurt physically. But the

tasks are mentally taxing, and Specialist Marrocco occasionally nods off at the table.

…

THE donor has to be a man. The blood and tissue types have to match, of course. But so do

the skin tone and size. The call could come at any time, and the Marrocco brothers will

jump into Michael’s black Monte Carlo and high-tail it 237 miles to the University of

Pittsburgh to prepare for surgery. They have 10 hours to get there to give the doctors

enough time to do their work.

Dr. W. P. Andrew Lee, the hospital’s chief of plastic surgery, will lead four teams of more

than 20 surgeons to give Specialist Marrocco, as he put it, the chance to live “a normal life”

(a fifth team will handle the donor). His legs would still be missing. But new, human arms

would mean he could put on the prosthetics himself. And: hug tightly, drive, twist open pill

containers, catch himself when he falls, fix an engine, play Modern Warfare 2 and greatly

increase his chances of getting a job.

“It’s going to give me so much more independence to do more stuff on my own,” Specialist

Marrocco noted.

Nine people in the United States and about 34 others around the world have received hand

or arm transplants since the first successful one in France in 1998. Dr. Lee has performed

three in the past 14 months; in May 2009, his team did the first double hand transplant in

the United States, and in February, the nation’s first double transplant that extended above

the elbow, like Specialist Marrocco’s.

The transplant is mind-boggling in its complexity. The doctors must attach nerves, blood

vessels, muscles, tendons and elbow joints, all within about 11 hours. A new antirejection

protocol that Dr. Lee formulated should reduce the risk of infection, organ damage and

diabetes.

…

Unlike a heart or liver transplant, “a hand transplant does not save lives,” Dr. Lee noted.

“It improves the quality of life.” He added, “We have to be very careful to balance benefits

versus the risk.”

…

He expects to spend six months rehabilitating in Pittsburgh (his brother will move there

with him). The time there may set back his leg progress, so he will likely return to Walter

Reed for further therapy.

Back home in Staten Island, several charities — the Stephen Siller Children’s

Foundation, Building Homes for Heroes and a fund dedicated to Specialist Marrocco —

have been raising money to build him a wheelchair-accessible house. In August, the

actor Gary Sinise, who played a combative double amputee Vietnam veteran in “Forrest

Gump,” is scheduled, with his Lt. Dan Band, to support the effort.

Ms. Barto is still hoping to move to New York with him, after a wedding at the National

World War II Memorial on the Mall here in Washington. She said they had talked about

having children, and that Specialist Marrocco wanted a girl, if only so he could answer the

door when a date arrived and say the words, “You should see what happened to the other

guy.”

http://www.nytimes.com/2011/02/14/us/14giffords.html?sq=brain%20injuries&st=cse&scp=13&pagewanted=print

February 13, 2011

Word and Lyric, Giffords Labors to Speak AgainBy MARC LACEY and JAMES C. McKINLEY Jr.

PHOENIX — Representative Gabrielle Giffords, an eloquent speaker before she was shot in

the head last month, is relearning the skill — progressing from mouthing words and lip-

syncing songs to talking briefly by telephone to her brother-in-law in space.

With a group of friends and family members acting as a backup chorus, Ms. Giffords has

been mouthing the lyrics to “Twinkle, Twinkle, Little Star” and “I Can’t Give You Anything

but Love, Baby.” And as a surprise for her husband, who is celebrating his birthday this

month, a longtime friend who has been helping her through her rehabilitation videotaped

her mouthing the words to “Happy Birthday to You.”

“It’s not like she’s speaking the way she spoke, but she is vocalizing and making progress

every day,” Pia Carusone, Ms. Giffords’s chief of staff, said in a telephone interview on

Sunday. “She’s working very hard. She’s determined. It’s a tight schedule. A copy of it is

hanging on her door.”

Outside specialists say it remains unclear, despite the hopeful early signs, what functions in

Ms. Giffords’s mind were affected by the traumatic injuries she suffered when she was shot

at point-blank range on Jan. 8 at a constituent event in Tucson.

It is not uncommon for patients with a similar injury to have trouble communicating or

undergo personality changes, brain specialists say. Everything from ambition and

concentration to short-term memory and social inhibitions can be affected, doctors say.

But relatives and friends who have been at Ms. Giffords’s side as she undergoes

rehabilitation at a hospital in Houston said in interviews and e-mail exchanges that though

her recovery was slow and exhausting, it was marked by significant progress.

Ms. Carusone said that on Sunday afternoon, Ms. Giffords’s husband, Capt. Mark E. Kelly,

put the congresswoman on the phone to talk to his twin brother and fellow astronaut,

Scott, who is aboard the International Space Station.

“She said, ‘Hi, I’m good,’ ” Ms. Carusone said.

With the help of therapists at TIRR Memorial Hermann in Houston, the congresswoman

known for her active, outdoorsy ways now labors through the halls clutching a shopping

cart and does squats and repetitive motions to build her muscles, her mother, Gloria, said

in an enthusiastic e-mail she sent about a week ago to friends that recounted her

daughter’s progress. Others who have visited Ms. Giffords recently have left similarly

upbeat.

Aides conduct bedside briefings for her, telling her about the events unfolding in Egypt, for

instance, and the decision by Senator Jon Kyl, Republican of Arizona, not to run for re-

election next year.

“We tell her everything that’s going on,” Ms. Carusone said. “Don’t get the idea she’s

speaking in paragraphs, but she definitely understands what we’re saying and she’s

verbalizing.”

In long days that begin with breakfast at 7, Ms. Giffords, 40, has beaten one of her nurses

at tic-tac-toe and transformed herself, her mother wrote, from “kind of a limp noodle” to

someone who is “alert, sits up straight with good posture (in fact anyone in the room

observing unconsciously sucks it up and throws back their shoulders) and is working very

hard.”

Ms. Giffords’s mother says doctors are regularly surprised by her latest achievement. They

say, “She did WHAT?” she wrote in her e-mail, adding that “Little Miss Overachiever is

healing very fast.”

Reached by telephone on Sunday, the congresswoman’s mother offered a one-word

assessment of her daughter’s road to recovery. “As far as Gabby’s progress, you can quote

me as saying, ‘Yippee!’ ” she said.

The rehabilitation center referred requests for comment to Ms. Giffords’s staff.

Dr. David Langer, an associate professor of neurosurgery at the Cushing Neuroscience

Institutes at North Shore University Hospital in Manhasset, N.Y., who is not treating Ms.

Giffords, pointed to encouraging signs.

“She’s obviously communicating, obviously verbal,” he said. The gunshot wound, he said,

“probably didn’t irreversibly damage her speech center.”

“Until she’s really talking, giving a speech,” Dr. Langer said, “you won’t know if there’s a

subtle speech problem. But it sounds like with rehabilitation, with time, she ought to be

very functional.”

The use of singing, he said, is a standard technique to help restore speech in people with

brain injuries. (It is sometimes used to help treat stuttering, Dr. Langer said, citing the

movie “The King’s Speech” in which King George VI sang to overcome his speech

impediment.) The part of the brain that controls singing is not the same as the one that

controls speech, though it is close.

Dr. Langer also said it was good news that Ms. Giffords was walking. “People’s ultimate

endpoints are often based on how rapidly they improve,” he said. “If there’s rapid progress,

the recovery potential is much higher. It sounds like she hasn’t plateaued yet and is

improving really quickly.”

The specialized clinic that is helping Ms. Giffords recover has several gymnasiums

equipped for people with spinal and brain injuries, as well as a swimming pool for therapy.

The main hallway is lined with large photographs of former patients who have made

spectacular recoveries, among them Kevin Everett, a former National Football

League player who suffered a spinal injury.

There are plaques with the inspiring tales of the survivors next to the photos. One shows a

man hunting ducks in a wheelchair, his shotgun up and a dog by his side. Another is a bride

on her wedding day, who had suffered a traumatic brain injury two years before.

Therapists push patients in wheelchairs along the hallways. Some brain-injury patients who

have had parts of their skulls removed, like Ms. Giffords, wear helmets to protect their

brains. (In Ms. Giffords’s case, her mother said, doctors are planning to reinstall a section

of her cranium at the end of the month, well ahead of schedule.)

Mockups of stairs, a kitchen and a washing machine help patients relearn basic skills. A

therapist encouraged one patient to try moving his leg and was caught by an unexpected

kick. She winced as she said, “Good, Jim!”

Ms. Giffords is receiving similar encouragement, by doting therapists and a network of

friends, some of them from the political world.

Brad Holland, a Tucson lawyer and old friend, has been a regular presence at her bedside.

Senator Kirsten Gillibrand, Democrat of New York, has spent the night in the

congresswoman’s room in what Gloria Giffords called a “sleepover.”

A visit by Representative Nancy Pelosi, the Democratic minority leader, is planned soon,

and the first President George Bush, who lives in Houston and visited with Captain Kelly

recently, may stop by for a visit as well, those close to the congresswoman say.

Despite some obvious signs of progress for Ms. Giffords, experts offer some caution.

The human brain has what amounts to redundant circuits for some simple tasks, like

walking, and it is possible for patients to make rapid progress on those skills and still have

trouble with mental work and speaking, doctors said.

“There are backup systems in the brain for the more basic functions that have been around

longer in human beings,” said Dr. Jonathan Fellus, the director of the Brain Injury Program

at the Kessler Institute for Rehabilitation in New Jersey. “Conversely, for things such as

language, which are uniquely human, it’s a highly specialized and delicate network that

doesn’t get reconstructed so easily.”

But those close to Ms. Giffords remain optimistic that her recovery will be dramatic.

Representative Debbie Wasserman Schultz, Democrat of Florida, was at Ms. Giffords’s

bedside in Tucson on Jan. 12 when she first opened her eyes. She was visiting Ms. Giffords

again, in Houston, last Monday when she asked for toast with her oatmeal.

“It is an excellent development and a great indicator of the progress of her recovery,” she

said.

Ms. Wasserman Schultz predicted that her friend would one day walk back into the House

chamber.

Marc Lacey reported from Phoenix, and James C. McKinley Jr. from Houston. Denise Grady contributed

reporting from New York.

http://www.nytimes.com/2007/01/26/science/26brain.html?sq=body%20injuries%20affect%20on%20brain&st=cse&scp=1&pagewanted=print

January 26, 2007

In Clue to Addiction, Brain Injury Halts SmokingBy BENEDICT CAREY

Scientists studying stroke patients are reporting today that an injury to a specific part of the brain, near the ear, can instantly and permanently break a smoking habit. People with the injury who stopped smoking found that their bodies, as one man put it, “forgot the urge to smoke.”

The finding, which appears in the journal Science, is based on a small study. But experts say it is likely to alter the course of addiction research, pointing researchers toward new ideas for treatment.

While no one is suggesting brain injury as a solution for addiction, the finding suggests that therapies might focus on the insula, a prune-size region under the frontal lobes that is thought to register gut feelings and is apparently a critical part of the network that sustains addictive behavior.

Previous research on addicts focused on regions of the cortex involved in thinking and decision making. But while those regions are involved in maintaining habits, the new study suggests that they are not as central as the insula is.

The study did not examine dependence on alcohol, cocaine or other substances. Yet smoking is at least as hard to quit as any other habit, and it probably involves the same brain circuits, experts said. Most smokers who manage to quit do so only after repeated attempts, and the craving for cigarettes usually lasts for years, if not a lifetime.

“This is the first time we’ve shown anything like this, that damage to a specific brain area could remove the problem of addiction entirely,” said Dr. Nora Volkow, director of the National Institute on Drug Abuse, which financed the study, along with the National Institute of Neurological Disorders and Stroke. “It’s absolutely mind-boggling.”

Others cautioned that scientists still knew little about the widely distributed neural networks involved in sustaining habits.

“One has to be careful not to extrapolate too much based on brain injuries to what’s going on in all addictive behavior, in healthy brains,” said Dr. Martin Paulus, a psychiatric researcher at the University of California, San Diego, and the San Diego V.A. Medical Center. Still, Dr. Paulus said, the study “opens up a whole new way to think about addiction.”

The researchers, from the University of Iowa and the University of Southern California, examined 32 former smokers, all of whom had suffered a brain injury. The men and women were lucid enough to answer a battery of questions about their habits, and to rate how

hard it was to quit and the strength of their subsequent urges to smoke.

They all had smoked at least five cigarettes a day for two years or more, and 16 of them said they had quit with ease, losing their cravings entirely.

The researchers performed M.R.I. scans on all of the patients’ brains to specify the location and extent of each injury.

They found that the 16 who had quit easily were far more likely to have an injury to their insula than to any other area. The researchers found no association between a diminished urge to smoke and injuries to other regions of the brain, including tissue surrounding the insula.

“There’s a whole neural circuit critical to maintaining addiction, but if you knock out this one area, it appears to wipe out the behavior,” said Dr. Antoine Bechara, a senior author of the new paper, who is a neuroscientist at the Brain and Creativity Institute at U.S.C. His co-authors were Dr. Hanna Damasio, also of U.S.C., and Nasir Naqvi and David Rudrauf of the University of Iowa.

The patients’ desire to eat, by contrast, was intact. This suggests, the authors wrote, that the insula is critical for behaviors whose bodily effects become pleasurable because they are learned, like cigarette smoking.

The insula, for years a wallflower of brain anatomy, has emerged as a region of interest based in part on recent work by Dr. Antonio Damasio, a neurologist and director of the Brain and Creativity Institute. The insula has widely distributed connections, both in the thinking cortex above, and down below in subcortical areas, like

the brain stem, that maintain heart rate, blood pressure and body temperature, the body’s primal survival systems.

Based on his studies and others’, Dr. Damasio argues that the insula, in effect, maps these signals from the body’s physical plant, and integrates them so the conscious brain can interpret them as a coherent emotion.

The system works from the bottom up. First, the body senses cues in the outside world, and responds. The heart rate might elevate at the sight of a stranger’s angry face, for example; other muscles might relax in response to a pleasant whiff of smoke.

All of this happens instantaneously and unconsciously, Dr. Damasio said — until the insula integrates the information and makes it readable to the conscious regions of the brain.

“In a sense it’s not surprising that the insula is an important part of this circuit maintaining addiction, because we realized some years ago that it was going to be a critical platform for emotions,” Dr. Damasio said in a telephone interview. “It is on this platform that we first anticipate pain and pleasure, not just smoking but eating chocolate, drinking a glass of wine, all of it.”

This explains why cravings are so physical, and so hard to shake, he said: they have taken hold in the visceral reaches of the body well before they are even conscious.

Other researchers have found that the insula is activated in unpleasant circumstances, like a bad smell or the anticipation of a painful shock, or even in shoppers when they see a price that seems too high. Damage to the insula is associated with slight impairment of some social function.

While antismoking treatments based on the new findings are still a long way off, the authors suggest that therapies that replicate some of the physical sensations of the habit, like inhalers, could be useful.

And at least two previous studies suggest that people can reduce the sensation of pain by learning to modulate the activity in an area of their brain.

In experiments, healthy volunteers watched real-time M.R.I. images of a cortical region linked strongly to pain sensation and learned to moderate that neural activity, reducing the pain they felt from a heated instrument pressed to their palms. The same kind of technique could be tried with addicts watching images of their insulas.

“The question is, Can you learn to deactivate the insula?” Dr. Volkow said. “Now, everybody’s going to be looking at the insula.”

 

http://www.nytimes.com/2007/01/23/health/psychology/23amne.html?sq=injuries%20to%20hippocampus&st=cse&scp=1&pagewanted=print

January 23, 2007

Amnesiacs May Be Cut Off From Past and Future AlikeBy BENEDICT CAREY

In the movies amnesia is bizarre, and thrilling. The star is usually a former assassin or government agent whose future depends on retrieving the bloody, jigsaw fragments that restore identity and explain the past.

Yet in the real world, people with amnesia live in a mental universe at least as strange as fiction: new research suggests that they are marooned in the present, as helpless at imagining future experiences as they are at retrieving old ones.

The new study, reported last week in The Proceedings of the National Academy of Sciences, is the first rigorous test of how brain-injured people with amnesia mentally inhabit imaginary scenes. The results suggest that to the brain, remembered experience and imagined experience are reflections from the same mirror, rich inner worlds animated by almost identical neural networks.

The findings provide a glimpse into what it might mean to truly live in the moment. And they feed a continuing debate about memory. Some researchers say that the brain region central to forming new memories — the hippocampus, a sliver of tissue deep in the brain where the day’s memories are registered — is not necessary for retrieving those experiences, once they have been consolidated elsewhere in the brain.

Others, including the authors of the new study, contend that the hippocampus in fact provides the stage on which inner mental

dramas are set. Without its help only the props remain — loose facts, people’s names, snippets from favorite songs: the players without the play.

“The study suggests that these patients have fragments, the brick and mortar to create new scenarios, but their descriptions lack coherence because they don’t have the scaffolding the hippocampus provides,” said Morris Moscovitch, a neuroscientist at the University of Toronto, who was not involved in the study. “The other interpretation is they don’t have enough brick and mortar to put it all together.”

The researchers, led by Eleanor Maguire and Demis Hassabis of University College London, instructed five men with severe hippocampus injuries to imagine themselves in familiar scenes, like a museum, a pub and a beach. People with this type of injury, often from oxygen deprivation due to a heart attack, can seem in conversation to be as mentally adept as the next person — until it becomes clear they have forgotten comments made only moments before.

The men, urged to fill out the scenes with imagined detail, described what they could. The researchers analyzed transcripts of their answers, carefully scoring each one for personal touches: projected emotions, sensations and actions. They found that compared with similar descriptions produced by adults without brain injuries, the five men’s imagined scenes were flat, barren of personal dimension.

“We think that what the hippocampus provides is a scaffold for experience and imagination, and that scaffold is spatial,” Dr. Maguire said. The brain’s record of physical space, she said,

appears to be necessary to infuse a scene with rich personal dimension.

Other researchers said the dulling of imagination could reflect a more fundamental dynamic. The brain may naturally draw on previous experiences to inform imaginary scenes, said Peter J. Bayley, a neuroscientist at the University of California, San Diego. If so, the only such memories accessible to the men might have been childhood scenes, consolidated over the years outside the hippocampus, which would not likely provide rich detail to outfit, say, an imaginary pub.

“The differences between the two groups may reflect the difficulty the patients are having retrieving information from the recent past,” Dr. Bayley said. He and other researchers have previously reported on patients with hippocampus damage who can recall childhood memories in the same kind of detail almost everyone else does.

The distinctions the brain makes between loose facts and the richer, wraparound ambience of an experience are important to understanding memory, because people with healthy brain function tend to recall the gist of experience, whereas those with hippocampus damage can often recollect discrete facts with more accuracy. The difference is partly reflected in the study participants’ words.

When asked to envision an open-air market, one brain-injured man said: “I see people, very many people. Most of all ... um ... not many men, all I see are young ladies. And basically they are all in a hurry.”

A participant without brain injury responded: “Right, so on either side of me I’ve got stalls and it’s noisy. We have a person on my right who is selling fruit and veg, and they’re telling us that bananas are on special offer this week, and they’re shouting about that.”

In an essay published this month in the journal Nature, two Harvard researchers, Daniel L. Schacter and Donna Rose Addis, contend that this ability to richly imagine scenes, whether entirely dependent on the hippocampus or not, is perhaps the most promising frontier for memory research.

“For almost 100 years, memory has been the object of experimental studies that have focused almost exclusively on its role in preserving and recovering the past,” they wrote. “We think it’s time to try to understand some of memory’s errors by looking to the future.”

Day 5

Procedures:o Hook (Assigning of brain parts): 5 minutes

Split the class up so that each group has a part of the brain. Cerebral cortex Left & Right Hemispheres Corpus callosum Frontal lobe Prefrontal area Frontal association area Motor strip Sensory strip Parietal lobe Occipital lobe Temporal lobe

Lower brain Thalamus Hypothalamus Limbic system

Amygdala Hippocampus

Cerebellum Reticular activating system (RAS) Spinal cord

o Procedure 1 (Make a big brain): 10 minutes

Have each team draw their part of the brain on the board. One lobe version & one lower brain version.

o Procedure 2 (Tasks & Examples): 20 minutes Have the students describe the job of the particular part of the brain

that they have been assigned. They must give at least 3 examples of when this part of the brain has

been used. The students must cut out pictures from magazines to make a collage

that helps to demonstrate these examples.o Procedure 3 (Half-page Story): 10 minutes

Have the students write a half-page story of what their life would be like if their assigned brain part were damaged.

o Procedure 4 (Homework Assignment): 5 minutes Tell them that their teacher will bring in her flute. Tell the students that for the next day they need to bring in something

to demonstrate a dual task. Like playing the flute (two-hands working together), dribbling a basketball while moving, rubbing their tummy & patting their head at the same time, sign your name & rotate your leg in a circle at the same time, etc.

Day 6

Procedures:o Hook (Show & Tell): 10 minutes

Demonstrate with the flute first. Have the student show & tell their dual tasks to demonstrate how the

hemispheres work together.o Procedure 1 (Music & the Temporal Lobe): 10 minutes

Have everyone hum a song that everyone knows (Row, Row, Row Your Boat). Start by conducting, then stop conducting & have everyone stop humming aloud, but keep humming in their head. Start conducting again, & everyone should enter into the same part of the song.

Beethoven continued to compose even after he went deaf!o Procedure 2 (): 30 minutes