The working title of my new book is The Boy Who Could Run But Not Walk: How Neuroplasticity Rewires the Young Brain due out in September 2016. My final manuscript has finally gone off to the Copy Editor and the Production team of my publisher, Barlow Books. It has been a long time in getting to this point, but it has been worth the effort. In this Blog, I will start to write about some of my key observations and conclusions about how neuroplasticity is expressed in babies with an early brain or nerve injury like cerebral palsy or brachial plexus injury. More importantly, I will also write about how we can maximize this neuroplasticity in children, teens and adults.
Brain growth does not stop at birth. It is just getting started. New studies on brain maturation show that girls’ brains continue to mature until age 20 to 25 years; Boys’ brains take up to 10 years longer, until 30 to 35 years. Over this very long time period, all our children’s brains have the ability to grow and regrow new brain cells to compensate for brain damage. This ability is not lost in old brains,1 but the rate and amount of new brain cell development is more evident in the young brain.
All our body parts, including the brain, start the innate processes of repair as soon as there is an injury. All brains have this potential, but baby brains have more. It is a well-recognized fact that baby animals from rat to monkey can come back from a brain injury better than an adult animal.2 Especially with early injuries, it is often surprising just how many baby brains can recover from documented brain scan damage. No one knows how long the repair process goes on for in little babies. However, we can extrapolate from what we know about adult brain recovery from stroke. It takes 3 to 4 years. Baby brains should do better than adult brains as the continued growth and maturation of the young brain into young adulthood is a positive benefit.
Waiting for brain repair and maturation is tough on parents of a child with an early brain injury because it takes time and truthfully, you cannot always tell how much recovery has taken place until the child is old enough to assess. On the basis of my long career and review of the literature, I have come to two important conclusions about the time of diagnosis. First, waiting for a cerebral palsy diagnosis until age 3 to 4 years is wrong. It limits the available interventions to help the baby maximize neuroplasticity and minimize maladaptive habits.3 Second, waiting for nerve reinnervation before starting therapy in a baby with a brachial plexus injury will compound the nerve injury with developmental non-use.
Rewiring the baby brain includes both reorganizing undamaged brain components around the area of damage and reallocating brain real estate to perform a new function. This can occur throughout life; young brains do it better in both animals and humans.4 Hemispherectomy in a young child, where half of the brain is removed, is the most impressive example. What about a big bleed in a baby brain? In one recent study, almost half of the babies with a big Grade IV bleed in the NICU were cognitively normal with no sign of CP at age 2 years.5
Our current rehabilitation systems need a paradigm shift. Neuroplasticity is a true scientific revolution and I hope my book will be a call for change, starting with the parents and families of children with an early developmental injury.
- Kunlin Jin, et al. “Evidence for stroke-induced neurogenesis in the human brain”, PNAS, 103 no. 35, (2006): 13198-13202.
- Bryan Kolb and Robin Gibb, “Brain Plasticity and Behaviour in the Developing Brain”, Journal of the Canadian Academy of Child and Adolescent Psychiatry, 20 (2011): 265-276.
- Sarah McIntyre et al, “Cerebral palsy-don’t delay”, Developmental Disabilities Research Reviews, 17 (2011): 114–129.
- Mark Burke, et al., “Adaptive Neuroplastic Responses in Early and Late Hemispherectomized Monkeys” Neural Plasticity (2012).
- Annemieke Brouwer et al, “Neurodevelopmental Outcome of Preterm Infants with Severe Intraventricular Hemorrhage and Therapy for Post-Hemorrhagic Ventricular Dilatation”, The Journal of Pediatrics, 153 (2008): 648-654