Can some skills be improved after a neural lesion?

Understanding brain changes after neural lesions

FELIPE FREGNIDOMINGO, 9 DE OCTUBRE DE 2016

In the recent movie me before you (http://mebeforeyoumovie.com/#/), the main

protagonist is a man who suffered a spinal cord injury and became tetraplegic. One of
the main story lines of the movie is his goal of killing himself because of his spinal
cord injury as he lost most of his motor control and has difficulties to live with that.
Not even going further in this discussion that does not even resonate with real life as
subjects with spinal cord injury after the initial few months of adaptation usually
return back to their mood state as before the lesion, this movie makes us think on an
interesting question: does someone only loose after a brain, spinal cord or nerve
lesion? Can there be any gains?

One interesting example to discuss given this question is the extraordinary skills in
savants. In savant syndrome, subjects with developmental delays or brain lesions have
unusual cognitive abilities, such as mathematical or memory skills. One striking
example is Stephen Wiltshire, a savant with outstanding visual memory and drawing
skills. Stephen only started to speak at age of 5 and had other neural development
delays. But on the other hand, he has done phenomenal things such as draw the skyline
of Rome and New York City after a single 15-minute helicopter ride and with a level
of detail that has, for instance, the exact number of windows in the hundreds of
buildings he reproduced from his memory only (worthwhile to see:
https://www.youtube.com/watch?v=jVq...). Is this extraordinary visual capability a
result of other neural delays? Neuroscience has not definitely explained the
mechanisms but there is a good possibility that indeed this is the fact.

The main theory behind such artistic improvement comes from the idea of paradoxical
inhibition. For instance, all the common neural activities such as speaking and
walking are associated with inhibition of other brain areas. If we are involved in a
speaking task, our creative visual skills are likely inhibited. The main reason is that
the brain works in a serial mode. In other words, to be able to engage in an activity,
we need to simultaneously inhibit other neural areas associated with other behaviors.
Thus, having a lesion in an area of the brain can lead to a release of other brain areas
for instance involved in artistic creation.

Is this always true (i.e. all subjects with stroke will have better artistic skills)? No. It
depends on a series of factors, such as the level of brain organization that will take
place after stroke and how they will change neural networks and also baseline level
of activity in other neural areas. Likely only a minority of subjects will indeed develop
these artistic skills after a brain lesion such as Stephen did; but on the other hand it
also underscores a very important point in rehabilitation that is: the nervous system is
extremely dynamic and can be shaped and become highly adapted to a number of
lesions. Also the idea that less neural tissue is associated with worse adaptation may
not be true.

There are also several examples of great artists with a variety of peripheral and central
neural lesions such as Degas, Beethoven and Michelangelo who made great artistic
contributions despite and/or because of their neural lesions.

Now there is a field in neuroscience trying to decrease brain activation transiently (for
instance with brain stimulation) and test whether this results in enhanced cognitive
skills. We have shown in a recent study that this is indeed possible
(https://www.ncbi.nlm.nih.gov/pubmed...). In this study, we showed that false
memories can be reduced by 73% when brain stimulation is used with the goal of
changing the balance between inhibition/stimulation between different brain areas.

The role of the rehabilitator and the educator is to understand and help to drive these
changes positively and indeed remove the idea that someone after a neural lesion
becomes worse. On the opposite, after a brain lesion someone becomes different
and this different has undoubtedly significant great potential skills.