Wednesday, August 28, 2013

Book Review: The woman who changed her brain - Barbara Arrowsmith Young

To give you an idea of how mind-bending this book is I will start out by telling you the following... Even though I sort of knew what to expect because of the references to this story given in the book 'The brain that changed itself' I read earlier and watching a TED talk given by author Barbara Arrowsmith Young, I continuously thought to myself 'this is so important! people need to know this! this can alter and save tons of lives!' while listening to this book. So after listening to the book once, I listened to it again, summarized and basically studied it.

Just as our brain shapes us, we can shape our brain. This book is about a woman who saved her own life doing 'just' that. This is all the more amazing if you know she did it in a time neuroplasticity wasn't even an established fact among neuroscientists. Through her own compelling autobiographic view along with many case studies the author describes a dozen neurological deficits, more commonly known as learning disabilities, and how to remediate them with cognitive exercise targeting a specific cortical area. By the looks of it, this book isn't much about vision. However when in a chapter on a deficit called 'motor sequencing deficit' (more on this later) people started describing how by fixing 'the mechanical aspect of reading and writing' they gained stereopsis I was completely sold. If you are familiar with Vision Therapy the exercise she devised doesn't so much impress, but rather the fact that they  'accidentally' acquired it while trying to improve other cognitive skills. Knowing that vision is a sensory and motor processing activity in the brain this makes sense, but you have to be made of stone not to be awed by how the human brain works.

Nowadays neuroplasticity is the latest buzz word but still there is a lot of resistance to change in the realm of education and health care to methods drawing on this idea. Even though we know better now, there is still a lot of neurological fatalism around because people don't know how to practically implement this principle. Sadly a paradigm shift does not happen overnight. Many educators are still telling parents learning deficits are lifelong and suggest compensatory methods rather than nipping the problem in the bud. Compensatory methods don't come close to the functionality of a cognitively repaired brain and just aren't realistic for day to day life. Depending on how severe the deficit(s) is even compensatory methods and unlimited amounts of effort will be of no avail. This will make for a lot of broken dreams and broken lives. Dysfunctional brain patterns won't go away as a child gets older unless addressed structurally through cognitive exercise. If not, they will lead to learning difficulties, job problems, depression, substance abuse, ...

I can relate to this on a personal level. Even though my neurological deficit or functional vision problem differs from the author's neurological deficits, many of the quotes and even life events in this book were familiar. A few piercing quotes:

I was clinging to a cliff by my finger nails and I was asking myself when will I fall and who will catch me? The answers were 'soon' and 'no one'.

I couldn't go forward. I couldn't go backward. There was no place for me in the world.

Many other citations from this book went straight to my heart and hit a home run. Yet in the interest of writing an informative and complete review I will attempt to give a brief overview of the neurological deficits described in this book rather than focusing on its emotional value.

1. Symbol relations problem: Difficulties with relations, abstractions, irony, jokes, grammar, figurative speech, considering alternatives, logic and reason. This results in an overwhelming feeling of uncertainty and problems in communicating thoughts and feelings leading to social isolation. Russian neurologist Luria called it semantic aphasia or a loss of meaning. The problem resides in important association areas of the cortex.
Exercise > Clock exercise
Improvement in this area means things start to make sense and one can connect the dots.

2. Symbolic thinking deficit: Weakness in the prefrontal cortex which is crucial to executive function and judgement. Difficulties with mental initiative, problem-solving, organisation, setting goals, foreseeing consequences, strategising and an inability to learn from past mistakes. A problem located in this 'recruiter of the brain' also means one easily gets distracted. A symbolic thinking deficit can be likened to an army without a general or a company without CEO. Someone with this deficit wants to be independent but is unable to and gets constantly into trouble by making bad decisions.
Exercise > Reading fables and extract meaning and morals/ Problem solving
Improvement in this area of the brain enables one to learn from his/her mistakes and to take initiative. Vital to get anywhere in life.

3. Predicative speech deficit: This deficit makes for a lot of mumbling and an inability to pronounce or write full sentences. Language beyond simple naming is not possible meaning poor or no syntax and consequently an inability to convey complex messages. This cortical weakness not only affects outward speech and writing but also internal speech and ultimately memory.
Exercise > Listening to slowed down speech
Changes will be improved spoken language, richer vocab and understanding. This in turns ends social isolation and makes for a happier and relaxed kid/person.

4. Artefactual thinking deficit (also dubbed 'social deficit'): This deficit finds its root in a weakness located in the right prefrontal cortex. It consists of an inability to read facial expressions and body language and to adjust own behavior accordingly. Someone with this deficit is impeded to learn 'the vocabulary of social movement'. Faulty interpretation of situations and acts leads to what is perceived as asocial behavior but the sufferer is simply unable to pick up social clues. To imagine living with this deficit the author proposes a trip to Japan without previous knowledge of the culture. The difference in social rules and interpretation will soon get you in trouble.
Exercise > Examining narrative art and extract meaning and social relevance. Exercise is similar to the one for symbolic thinking deficits which is also located in the prefrontal cortex but on the left side instead of the right side.

5. Object recognition deficit (prosopagnosia or face blindness is its most well-known form): This deficit includes not being able to recognize friends or family out of context. One might not be able recognize, even in context, the face of a familiar person or be able discriminate between unfamiliar faces. Sometimes someone with this deficit is not even able to distinguish a face from an object. In severe cases that person cannot even recognize himself in a mirror. Often this disability not only limits itself to faces but also to object and places.
Exercise > Find discriminating features of similar but different pictures.

Reading is a very complex process and many areas of the brain are involved in reading. Being able to read comfortably is not a luxury but without structural cognitive training, poor readers will remain poor readers. Based on her many years of experience and the neuroscientific material available the author has tried to determine which areas are critically involved in reading and what deficits they might produce. This quest has produced three main reading deficits which lead to poor reading performance.

6. A Broca area deficit: Impaired auditory speech discrimination and trouble connecting a symbol to a sound. Improvement will not only result in better reading but also better speech.
Exercise > Discriminate between phonemes and listen to sounds.

7. Symbol recognition deficit (word blindness): Difficulty with visually remembering sight words and a limited visual vocab library.
Exercise > Study Arab or Urdu. It's not about learning how to speak those languages but about remembering the shape of the symbols. This strengthens visual memory and makes reading English or the Latin alphabet comparatively easy.

8. Motor symbol sequencing:  An inability to smoothly track words and sentences with the eyes. This leads to a lot of misreading, being easily tired and quick loss of concentration. Weakness so powerful it can impair speech, spelling and signature. With this deficit speech often does not completely reflect ones thoughts. Those kids write slowly, sloppy and with poor spelling. Needless to say that for those people grades fail to reflect their intelligence.

"Of all learning disabilities treated by Arrowsmith, difficulties with the mechanical aspect of reading are most common and take longest to deal with."

Exercise > With intent to stimulate the left prefrontal motor region they always patch the left eye and focus on writing smoothly (motor skills). Doing this some people with a weaker right eye have acquired stereopsis which is magnificently described in the book. I do have some questions however about what she would suggest in cases of a weaker amblyopic left eye such as myself. But this exercise isn't so much about vision as it is about writing. Seemingly reading and speech just improved along with it. So it influences the visual 'only indirectly' unless you really have a lazy right eye. Regardless of my visual problems my own writing is pretty okay at that so it does make sense.  In the end I wasn't so much impressed with the exercise as with how clearly all those functions and vision are intertwined in the brain.

Personal note: I do have some reading difficulties of my own and clearly no two reading problems are the same. I liked this analytically view of how the brain reads and it confirmed a couple of things for me. It is pretty clear my reading problems are entirely originating from the mechanical aspect of reading. A Broca deficit makes it hard if not impossible to learn a second language so I can erase that from the list. Furthermore I think that symbol recognition is one of the ways I compensate for poor eye muscle control. I need relatively little visual information to recognize a written word, even upside down. So in a sense this is good news. If I keep improving my eye movements, I should be able to overcome this as so many others have. It was also affirming to see that of all deficits described in this book this one takes longest to deal with. The testimonials of this deficit were particularly familiar and poignant from my point of view. I would like give examples but this review will be way too long if I do.

9. Kinestetic deficit: Problems with the mental body map or proprioception meaning that you have trouble knowing where your body parts are in space without visually seeing them. This deficit may for instance also lead to a situation in which one feels pain at the left side of the body but has to visually search for its source. This deficit often causes uncoordinated body movements. In short, it puts you at odds with your own body.
Exercise > Stop visual compensation methods and execute precise movements with eyes closed relying on other sensory input.

10. Primary motor deficit: Interferes with the speed, strength and control of muscle movements. This deficit is more commonly known as low muscle tone.
Exercise > Fast and controlled transitions from one muscle position to another

11.Spatial awareness deficit: Excessively getting lost and an inability to creating mental maps or visualize three dimensional items or situations. This weakness may for instance make it hard to estimate when an approaching car will reach you. A strength in this area enables some Hockey players to mentally visualize the field of players from above and predict their  potential movements.
Exercise > Tracking exercise in a spatial configuration

12. Memory for information deficit: Memory is intricately linked to our identity and allows us to write our own autobiography so a deficit in this area is therefore especially painful. The sieve that is their memory has unusually 'big holes' leading to poor long term retention. In severe cases major life events cannot be remembered, oral instructions can barely be followed and making lists becomes essential to survival.
Exercise > Listen to songs until one can repeat the lyrics. Start out with very easy songs and gradually move on to more difficult lyrics.

13. Quantification deficit: Difficulty with time and numbers. Some people are for instance incapable of differentiating between 8, 80 and 800. Mental math and the relativity of numbers eludes people with a quantification deficit. This causes them to get in financial trouble, be chronically late and be bad at scheduling.
Exercise > Repeated and progressively more difficult mental calculation: addition and subtraction.

14. Auditory speech discrimination deficit: One isn't able to distinguish between similar words and has a hard time discriminating speech form other sounds. With this deficit listening to your own language becomes like listening to a foreign language. You can hear the sounds but it's hard and fatiguing to make sense of them.
Exercise > Listening to speech sounds in unfamiliar languages (Swahili, Kurdish, and Bengali, to name a few). This way listening to the sounds of your own language becomes relatively easy.

Keep in mind that the exercises are brought back to a customized level empowering the student to stimulate the impaired brain area without being overwhelmed. This makes it possible to gradually pursue normal functioning in that area or number of areas. The Arrowsmith program currently assesses and treats 19 deficits so not all of them were explained in the book. Even if they were, this list is not an exhaustive and can be further refined over the years. Nevertheless I am already sure this is the future of education. Aside from just providing content, education should be about making a brain susceptible to that content. Vision therapy is a great example of such cognitive interventions and so is the Arrowsmith program. Once you enable a student's brain to learn, that student will soar on his own.

The Arrowsmith program is increasingly implemented accross Canada and the United States and recently expanded to New Zealand. More information on and

No comments:

Post a Comment