The Brain's Way of Healing – Stages of Neural rehabilitation.

1. General Cellular correction

2. Neurostimulation
3. Neuromodulation
4. Neurorelaxation
5. Neurodifferentiation

Correction of general cellular functions of the neurons and glia. This is the only
stage that does not directly address “wiring issues”—that very specialized ability
of neurons to connect to and communicate with each other—but instead focuses on
the general health of the neurons, and the cell functions they have in common with
other cells. In many brain problems, the brain becomes “miswired” because the
neurons and the glia have been disturbed by an external source (such as an
infection, a heavy metal toxin, a pesticide, a drug, or food sensitivity), or they have
been undersupplied with resources, such as certain minerals. These general
problems are best corrected before beginning the stages that follow for the patient
to get the most benefit. This general cellular repair stage is especially relevant in
treating autism and learning disorders, and in lowering dementia risk, for example.
It also applies to common psychiatric disorders. I have seen elsewhere in the body.
Instead, small “microglial” cells protect the brain from invading organisms, and
they are one of the unique ways that the brain protects and heals itself. The glia
also support the neurons by getting rid of waste products produced by the brain.
The following four stages all make specific use of the neuroplastic capacities of the
brain to alter the connections between the neurons and to change its “wiring.” 
 
Neurostimulation. In almost all the interventions in this book, some kind of
energy-based neurostimulation of the brain cells is required. Light, sound,
electricity, vibration, movement, and thought (which turns on certain networks) all
provide neurostimulation. Neurostimulation helps to revive dormant circuits in the
hurt brain and leads to a second phase in the healing process, an improved ability
of the noisy brain to regulate and modulate itself once again and achieve
homeostasis. Some forms of neurostimulation begin from an external source, but
other forms are internal. Everyday thought, especially when used systematically, is
a potent way to stimulate neurons.
When we think particular thoughts, certain networks in the
brain are “turned on,” while others are switched off. This process was the basis of
Moskowitz’s visualization cures of chronic pain (see Chapter 1). Once a relevant
circuit is turned on by thought, it fires, and then the blood flows to that circuit (a
process that can be seen on brain scans that monitor blood flow in the brain) to
replenish its energy supply. I believe that Taub’s Constraint-Induced Therapy,
though a movement-based behavioural therapy, involves great intentional effort
and motor planning, so it too likely triggers some thought-based neurostimulation.
(It also involves the final phase, neurodifferentiation and learning.) Pepper’s
conscious walking, to build up new circuits in his brain, is an example of internal
neurostimulation using thought. Neurostimulation is effective in preparing the
brain to build new circuits and in overcoming learned nonuse in existing circuits.
Brain exercises, and many of the forms of mental practice described in The Brain
That Changes Itself, are forms of internal neuroplastic neurostimulation.

Neuromodulation restores the balance. As we shall see in Chapter 7,

neurostimulation can trigger neuromodulation, improving brain self-regulation,
generally. One way neuromodulation works is by resetting the brain’s overall level
of arousal by acting on two subcortical brain systems. The first such system is the
reticular activating system (RAS), which is involved in regulating a person’s level
of consciousness and the overall level of arousal. The RAS is housed in the brain
stem (an area of the brain between the spinal cord and the bottom of the brain) and
extends up toward the highest parts of the cortex. It can “power up” the rest of the
brain and regulate the sleep-wake cycle. I shall show in the following chapters how
stimulation with light, electricity, sound, and vibration often causes patients with a
brain problem (who are usually exhausted and jittery from 
in a state of sympathetic fight-or-flight, feeling desperate, endangered, and hyper-
anxious because they can’t keep up with unfolding events. The problem is that a
person in fight-or-flight can’t heal or learn well in this state, which makes brain
change harder. The second branch is the parasympathetic system, which turns off
the sympathetic system and puts a person into a calm state in which he or she can
think and reflect. While the sympathetic system is often called the fight-or-flight
system, the parasympathetic is sometimes called the rest-digest-repair system.
When this system is turned on, it triggers a number of chemical reactions that
promote growth, conserve energy, and increase sleep, all of which are necessary
for healing. It also recharges the mitochondria, the power sources inside the cells
(which I will discuss at length in Chapter 4), reenergizing them. Finally, and of
special importance, recent studies by Michael Hasselmo and his colleagues from
Harvard show that turning off the sympathetic system appears to improve the
signal-to-noise ratio in brain circuits. Thus turning on the parasympathetic system
is probably another way to quiet the noisy brain. Many of the techniques in this
book turn on the parasympathetic system, and turn off the sympathetic system,
rapidly relaxing people and preparing them for growth. In Chapter 8, we shall learn
that the parasympathetic system also turns on a “social engagement system,” which
allows us to connect to other human beings, and use them to soothe and support us,
and help us to regulate our own nervous system.

Neurorelaxation. Once fight-or-flight is turned off, the brain can accumulate and
store the energy that will be needed for the efforts of recovery. Subjectively the
person relaxes, and often catches up on sleep. Many people with brain problems
are exhausted, and poor sleepers. A recent discovery by Maiken Nedergaard from
the University of Rochester showed that in sleep the glia open up special channels
that allow waste products and toxic buildups (including the proteins that build up
in dementia) to be discharged from the brain through the cerebral spinal fluid,
which bathes much of the brain. This unique channel system is ten times more
active in the sleeping brain than in the waking state. This helps explain why loss of
sleep leads to a deterioration in brain function: too much sleep deprivation leads to
a toxic brain. The neurorelaxation phase appears to correct this, and can last
several weeks, in some cases

Neurodifferentiation and learning. In this final phase, the brain is rested, and the
noisy brain has been modulated and is much “quieter,” because the circuits can
regulate themselves. The patient is able to pay attention again and is ready for
learning, which involves the brain doing what it does best: making fine
distinctions, or “differentiating.” Many brain exercises for learning disorders and
those that are based on listening therapy, for instance, involve training a person to
make increasingly subtle distinctions in sounds.*
All these phases combined foster the optimal amount of
neuroplastic change, but as we shall see, each of the following chapters will
emphasize different states. Chapter 4 will focus on restoring general brain cell
health, as will parts of Chapter 8 and Appendix 2, on Matrix Repatterning. Chapter
6 will emphasize neurorelaxation. Chapter 7 will emphasize neurostimulation and
neuromodulation to reset the brain. Chapter 5 will emphasize the final stage,
differentiation. And Chapter 8, on sound, will show all the phases working.
While most people with a brain injury will have to go through
each of these stages in their treatment, many of the problems in this book do not
derive from brain injury; rather, they require that the patient build up circuitry that
had never developed. Some, for instance, require only neurostimulation and
neurodifferentiation to do this. And others will benefit from several different
interventions.
An individual’s progress is never, in this neuroplastic
approach, dependent solely on the technique, or the disease or the problem alone.
We don’t treat diseases, we treat people. Because of genetics, and neuroplasticity
itself, no two brains are alike, and no two brain problems—or injuries—are
identical. A person with a generally healthy brain who has an injury can’t be
compared with a person with a similar injury who has had exposure to drugs,
neurotoxins, a previous stroke, or serious heart problems. Location of harm
matters: a bullet to the breathing center will kill instantly, before a person has time
to “rewire”; damage to the attention centres might make it difficult to do brain
exercises. Yet even attention can be neuroplastically trained, sometimes, as
neuroscientist Ian Robertson has shown.

The next chapter describes an approach that triggered the first three stages for a
patient who, because she was exceptionally resourceful, put together her own
program to trigger the neurodifferentiation and learning stage.