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A Scientist's Pink Cast Leads To Discovery About How The Brain Responds To Disability

Jun 18, 2020
Originally published on June 19, 2020 3:43 pm

A neurologist who encased his healthy right arm in a pink fiberglass cast for two weeks has shown how quickly the brain can change after an injury or illness.

Daily scans of Dr. Nico Dosenbach's brain showed that circuits controlling his immobilized arm disconnected from the body's motor system within 48 hours.

But during the same period, his brain began to produce new signals seemingly meant to keep those circuits intact and ready to reconnect quickly with the unused limb.

Dosenbach, an assistant professor at Washington University School of Medicine in St. Louis, repeated the experiment on two colleagues (their casts were purple and blue) and got the same result. In all three people, the disconnected brain circuits quickly reconnected after the cast was removed.

The study, published online in the journal Neuron, shows that "within a few days, we can rearrange some of the most fundamental, most basic functional relationships of the brain," Dosenbach says. It suggests it is possible to reverse brain changes caused by disuse of a limb after a stroke or brain injury.

The results of the study appear to support the use of something called constraint-induced movement therapy, or CIMT, which helps people – usually children — regain the use of a disabled arm or hand by constraining the other, healthy limb with a sling, splint or cast.

Previous studies of CIMT have produced mixed results, in part because they focused on brain changes associated with increased use of a disabled arm, Dosenbach says. "We looked at the effect of actually not using an arm because we thought that was a much more powerful intervention," he says.

The study adds to the evidence that CIMT works by changing the brain, says Lynne Gauthier, an associate professor of physical therapy and kinesiology at the University of Massachusetts Lowell. "Even though it's an intensive program where they're training the arm, you're really training the brain, not the arm," she says.

The discovery of the pulses that maintain unused motor circuits should allay some fears about using CIMT on children, Gauthier says. "Therapists have expressed concern [about] what's going to happen if you restrain that stronger arm for two weeks," she says. "Is that going to affect their normal development? And what this study shows is that it probably won't."

Dosenbach says the experiment came about because he often prescribes CIMT for young patients who have an arm that is partially paralyzed as the result of a stroke, illness or traumatic brain injury.

"You put their good arm, their more functional arm, in a full-arm cast all the way down to their fingertips to force them to use the other side," he says.

One day a colleague pulled Dosenbach aside and said, "You know, Nico, you should do this to yourself and we should scan you to find out how the brain reorganizes in that situation."

Dosenbach agreed, and chose a pink cast because "my daughter at the time was 2 and I didn't want to frighten her."

Dosenbach wanted to maximize the effect on his brain, so for two weeks he kept doing all the things he'd done before, such as buckling his belt.

"The first time it took 45 minutes," he says. "I didn't want to give up and ask for help, so I was late for work."

He quickly got better at these daily tasks. "The whole goal was that I wouldn't cut myself any slack, and so, yeah, I got pretty good at changing diapers with a fiberglass cast on," he says.

Every day at 5 a.m. Dosenbach went in for a brain scan.

He says those scans revealed dramatic changes in the first few days.

"The brain is very stable unless it has to change," he says. "And then it can change at a rate, and at a scale, that I never would have thought possible until [I saw] the results from the study."

The scans also showed that as circuits involved in controlling the idle arm began to fade, a new signal appeared in the brain, Dosenbach says.

"We start seeing in the disused motor circuitry these pulses of spontaneous activity that are very large that actually seem to maintain the connection," he says, adding that this would explain how people are able to regain motor skills quickly after an injured arm or hand has healed.

And patients who receive constraint-induced movement therapy do improve quickly, Gauthier says. She and her research team have measured the change by having patients play a video game that tests the performance of their less functional arm — the one that's not constrained.

"So we're able to track the trajectory of the recovery over time, and we can see that a lot of the recovery happens in a very short period of time," she says.

Gauthier says she isn't sure whether the pulses Dosenbach discovered can help patients who've had a major stroke or severe brain injury.

"Those pulses may go through in a normal brain," she says. "But if you have a damaged brain, those pulses may not be happening; we just don't know."

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MARY LOUISE KELLY, HOST:

A scientist put his arm in a pink cast, and then stuck his head in a brain scanner. The result - a discovery about how the brain adapts and maintains connections to an unused limb. NPR's Jon Hamilton reports.

JON HAMILTON, BYLINE: Dr. Nico Dosenbach of Washington University in St. Louis says he often prescribes an odd treatment to young patients who have an arm that is partially paralyzed.

NICO DOSENBACH: You put their good arm, their more functional arm, in a full-arm cast all the way down to the fingertips to force them to use the other side.

HAMILTON: It's called constraint-induced movement therapy, and scientists think it works by strengthening the connections between brain and arm. But that's just a hypothesis. So Dosenbach says one day, a colleague made a suggestion.

DOSENBACH: You know, Nico, you should do this to yourself, and we should scan you to find out, you know, how the brain reorganizes in that situation.

HAMILTON: Dosenbach encased his arm in a full-length fiberglass cast. Why pink?

DOSENBACH: My daughter at the time was 2, and I didn't want to frighten her.

HAMILTON: Dosenbach wanted to maximize the effect on his brain, so for two weeks he kept doing all the things he'd done before, like buckling a belt and putting away dishes.

DOSENBACH: The whole goal was that I wouldn't cut myself any slack. And so, yeah, I got pretty good at changing diapers with a fiberglass cast on.

HAMILTON: And every day at 5 a.m., he went in for a brain scan. Dosenbach says those scans showed that almost immediately his brain began disconnecting the circuits that controlled his immobilized arm.

DOSENBACH: The brain can be very stable - is very stable - unless it has to change, and then it can change at a rate and a scale that I would have never thought possible until the results from the study.

HAMILTON: All that disconnecting could have meant that the brain was about to abandon the idle arm and concentrate on the one he was still using. But Dosenbach says his team noticed that as the old motor circuits faded, his brain began to generate a new signal.

DOSENBACH: We start seeing in the disused motor circuitry, but not anywhere else, we start seeing these pulses of spontaneous activity that are very large that actually seem to maintain the connections.

HAMILTON: The pulses weren't telling his arm to do anything. They were just keeping the lines of communication open. Dosenbach repeated the experiment on two colleagues. One got a purple cast. The other got blue. And the results, which appear in the journal Neuron, were the same. Lynne Gauthier of UMass, Lowell, says the rapid brain changes are consistent with what she sees in patients who get constraint-induced movement therapy. Gauthier says she and her research team have patients play a video game that tests their less-functional arm - the one that's not constrained.

LYNNE GAUTHIER: So we're able to track the trajectory of the recovery over time. And we can see that a lot of the recovery happens in a very short period of time.

HAMILTON: Gauthier says those spontaneous pulses in the brain should be reassuring to professionals who use constraint therapy on young patients.

GAUTHIER: Therapists have expressed concern that - what's going to happen if you restrain that stronger arm for two weeks? Is that going to affect their normal development? And what this study shows is that it probably won't.

HAMILTON: But Gauthier says it's unclear whether the pulses Dosenbach back found can help patients whose brain circuits have been disrupted by a major stroke or severe traumatic brain injury.

GAUTHIER: Those pulses may go through in a normal brain, but if you have a damaged brain, those pulses may not be happening. We just don't know.

HAMILTON: And finding out will take more than a scientist who puts his own arm in a cast.

Jon Hamilton, NPR News. Transcript provided by NPR, Copyright NPR.