Proof the Brain has a Mind of its Own
By Ellen FanningFebruary 13, 2012
Australian researchers have uncovered evidence of how a damaged brain can heal itself. Now they’re working on ways to protect the brains of social footballers, with the potential to relieve fretting parents around the globe.
Professor Graeme Jackson could almost pass as a footballer. Middle-aged now, he is still a big bloke, with red hair and a beard. He strides around the Melbourne Brain Centre like a star player enthusiastically showing off a new clubhouse.
And it is a bit like that.
Jackson returned in 1996 from London, where he had been a consultant neurologist at Great Ormond Street Hospital and a senior lecturer at the University of London. Coming back to Melbourne, he dreamed of creating a place where all the major forces in brain research in Australia could be brought together, researchers working alongside frontline doctors - all of them seeing stroke and other brain-injured patients, sometimes from the moment they are wheeled out of the ambulance.
And midway through last year, it opened.
The world's fifth-largest brain centre is located beside the Austin Hospital in Melbourne's northeastern suburbs. The architect's brief was to come up with a design allowing for chance encounters and informal conversations between the hundreds of researchers, clinicians and academics working there. Office space and laboratories are shared. The corridors are designed with an eye to channelling ideas as much as foot traffic (the centre has another building at the University of Melbournes Parkville campus).
A crane very carefully lowered Jackson's two "3 Tesla" MRI machines - worth about AUD$3 million each - into a ground-floor wing through a specially designed, retractable roof. And with that, Jackson and his research team started dreaming up what to do with them in this new setting.
A big part of that could involve football. Jackson is talking to the Australian Football League (AFL) about scanning players' brains during footy season to see what the various bumps and knocks of the weekend have produced there. These professional players will act as research guinea pigs in a project designed first to understand and then to protect social footballers from the sort of minor brain injuries which, in rare cases, can leave them with a lifetime of symptoms including chronic headaches or dizziness
Like most any Melbourne boy of his generation, Jackson himself is a football tragic. He played for the Monash Whites at university. Was he any good? He roars with laughter. "No! Although I would have liked to have been."
The part he didn't like was getting hurt. And he might just be able to find a way to ensure that in the future, those most vulnerable to brain injury have a way to avoid it.
Looking at a regular image from a magnetic resonance image (MRI) machine is like watching a re-run of the I Love Lucy show in grainy black and white compared to the Technicolor version Jackson and his team have devised.
They use a technique which produces a resolution 6,000 times greater than standard MRIs. These images are then sent off to a group of physicists for post-production work.
Using thousands of images put together in a complex mathematical model, the architecture of the brain is precisely mapped, and colours are used to trace fibres from the different, interlocking hemispheres. Developed last year and now licensed for commercial use, it is the state-of-the-art in what is called "fibre tract" imaging.
"It shows white matter, the anatomy of the brain. What exists," says Jackson. And it's a powerful tool at the hospital bedside.
Take this example.
The image on the left in Figure 1 charts the fine wiring of a normal human brain. Compare it to the image on the right, which shows the damage caused by a stroke.
The patient, 46-year-old Melbourne mother Karen Bayly, suffered a massive cerebral haemorrhage in 2009 that left her paralysed on the left side. The damage on the right side of the image is clearly visible. (Listen to Professor Jackson's detailed description of the scans by clicking the PLAY button on the brain images.)
Karen's left hand was badly affected. She had little or no ability to feel with her fingers. She couldn't figure out how hard to grip a paper cup as opposed to a china tea cup. "Things like pick-up and using a fork were laboured, and tasks where my hand was out of sight, like doing up a bra, putting on jewellery and tying up my hair, I was a non-starter," she says.
Just as bad, she couldn't assess where her hand was if she wasn't looking at it. That made sleep almost impossible because once she shut her eyes, she had no idea where her hand was, leaving her with what she describes as "bed vertigo," a feeling of disorientation so strong she was regularly forced to take sleeping pills.
When asked to touch a rough surface inside the scanner, she couldn't feel it with her left hand. The functional MRI - in Figure 2 - shows areas of her brain "lighting up" to think. The white areas towards the middle on the outer right side of each image show damaged brain.
In the image on the left in Figure 2, the wrong side of Karen's brain is attempting to operate her impaired hand, with little success. Years ago, she would have been counselled to accept her disability and make the best of it.
Instead, Karen underwent special training at the Melbourne Brain Centre to help her rediscover her sense of touch. In the scan on the right of Figure 2, there is an explosion of colour showing neural activity on the damaged side of her brain. See the difference it made to Karen's ability to hold a fork in Figure 3.
"Happily I have now moved on from the basics of eating and grooming," she reports. "I am readily using both hands in preparing family meals and dressing my young children. I am currently trying to master shuffling cards!"
In response to Karen's effort to use her impaired hand, her brain had worked out how to bring still-healthy parts of the damaged hemisphere of her brain back "on line" so she could achieve that task.
"If the left hand is not working, most people won't use the left hand," says Jackson. "And the brain quickly works out, 'The best way to feed myself is to use my right hand.' So that's what the task becomes. Whereas if you take the right hand away and said, 'Okay, brain, now work out how to solve the problem now that you've only got that damaged hand,' the brain remarkably works it out.
"That," says Jackson, "is brain plasticity. "The brain works out, with what it's got, how it can solve the problem."
In the past, it had been thought that the brain could only adapt in this way in a younger person.
"Nope," says Jackson firmly, "they're plastic all the way. So if you know that an older brain can reorganise, you can get very keen about keeping on pushing [the patient in rehab] to make it reorganise rather than giving up."
The Melbourne Brain Centre had similar results when it invited a group of children with a type of cerebral palsy, hemiplegia, which produces a weakness on one side of the body, to participate in a circus camp.
"The way we did that, which was quite cute, was we got Circus Oz out and the kids had a circus camp," says Jackson. "But the [children] had to have their 'good' side tied [constrained in a glove] and they had to learn to do the tricks with their impaired side. So we gave them intense motivation to want to do it."
In the image on the left in Figure 4, one budding circus performer was asked to use his impaired arm and hand in normal circumstances.
The image on the right in Figure 4 shows how much harder he could get his brain to work - with a corresponding improvement in movement in his impaired arm and hand - once he really, really wanted to complete a trick during circus camp.
"It shows that the brain has an absolutely remarkable ability to [find a way to do] what you want it to do. If you injure too much, the whole network can be trashed. But if the brain can do it," he says, "the brain will do it.
"Now, again, there are factors in there. Some people have more ability for plasticity than others. So there are individual variations. And if you're going to understand brain function, you're going to have to understand all these things."
Jackson has specialised for many years in epilepsy and was called in to assist with the case of a woman who developed a lesion on her brain. A school teacher from New Zealand, the young mother was having virtually constant seizures and the decision was made to operate to remove the lesion, which sat under the speech centres of her brain.
Jackson mapped her language areas so the neurosurgeons could avoid affecting her speech when they removed the lesion.
The patient was conscious and able to speak throughout the operation, which led Jackson and the neurosurgeons to believe they had, in fact, managed to avoid damaging her speech. They congratulated themselves on a job well done - until they put her back in the scanner and were shocked by what they saw: The scalpel had cut through the speech centres, the very part of the brain they had been trying to avoid. So how had the young woman been able to keep speaking?
During the operation, her brain had instantaneously reorganised itself to preserve speech function, transferring the language centres to the opposite side of the brain.
In Figure 5, the image on the left shows the woman's brain before the operation, with the language centres marked by an arrow. The image on the right is the woman's brain after the operation. The dark area on the right is where the lesion was removed. The two arrows indicate the new language areas.
"We had absolute proof that it had been in the left side [on the right of the image] before the operation. And we did the operation, all the time testing her language. So she switched it while we were operating and we didn't know about it," says Professor Jackson.
"We didn't know this was possible. We all thought that language, once it's in a spot, had to stay there. What we've [come to understand] is that the brain doesn't work in pieces. It's not like this spot does that and that spot does this. Here's where speech is and so on. The whole brain works as an integrated whole in almost every task it does.
"We have all these networks that all work together to do special things," he says. "It's a hell of a lot more complex than I'm going to be able to understand in my lifetime."
What happened to the New Zealand mother when she returned home is, if anything, more startling that the neural gymnastics her brain performed during surgery in Melbourne. While the fits stopped almost entirely and she could speak normally, she was distressed to find that she couldn't read a book.
"Most of us read and store the information so we can keep track of the story. That's why reading a novel is probably interesting," says Jackson. "Our brain likes this whole active process. And she couldn't do that. She couldn't read and recall. She'd get to three pages in and she couldn't remember the story any more."
After 18 months of trying to read books, she was counselled that this condition would be permanent and she would have to learn to accept it. But then a final functional scan in Melbourne revealed that once again, her brain had responded to her determined efforts and had switched the language functions back close to their original position, on the now-damaged side of the brain, where the lesion had been.
"So I said [to her], 'You are going to start being able to read again because your brain is reorganising.' And, lo and behold, she found that six months later she had acquired the ability to read normally again," he says.
Over two years she'd transferred this function back and forth across the hemispheres of her brain, twice. "This is the sort of thing we would never have known the brain was capable of, without this sort of technology," says Jackson.
Just at that moment of the interview, Professor Jackson has a thought that offers a glimpse of how his brain works.
"I'll just take an aside that pops into my mind here. You know if you get up some days and you can just work better than other days? Wouldn't it be interesting if some days you put your language systems together as in the right picture, and other days you woke up and it was in the left picture. This could be what athletes call being 'in the zone.' They get the right ingredients in the right network at the right time," he laughs.
So this could account for why some days the crossword is harder than others? He chuckles "It's just a speculation. But, ah, it's an interesting idea of how our brains might work."
This year, Jackson hopes to be watching a great deal more Aussie Rules football during working hours. Team doctors in the various AFL clubs are keen to help with his project to measure the impact of the minor head injuries.
The idea is, Jackson's research team would review TV footage to assess the force of impact on head blows to players during a weekend game. The researchers would then get those same players into the scanner by Monday morning to assess the impact of those hits on their brains. The players also would take computer-based cognitive tests.
"AFL is a model of minor head injuries for us in science," he says. "We have this high-speed video from every angle and it's almost like a perfect model of what the forces were. You can calibrate exactly what the accelerations and decelerations and G-forces must have been, so you can control and calculate the nature of the injury."
In the past, Jackson says, "if one person comes off and is crook for a week and can't play the next week and someone else comes off and they are fine for a beer and that, you'd say 'One got hit harder than the other,' right? We don't know that!" he chuckles.
"We don't know if they are different individuals or different hits."
This is important because, as many a punch-drunk boxer has discovered, once the brain has endured one minor injury, the consequences of a second hit to the head can be much worse.
"It's a priming injury, and you can have a further injury from a similar, fairly benign thing in someone who has been primed," says Jackson.
By combining the results of the TV footage analysis, the brain scans and the player's cognitive tests, Jackson says, "we can measure exactly what type of injury caused what sort of consequence in what percentage of cases."
Jackson wants to use the data to validate a set of computer-based tests - which could then be delivered via a simple iPad application - to predict which social players, having had one concussion or knock to the head, should not play again.
"This is probably not for the professional footballers who can consent to the risks. It's probably in community football where you'll have 16-year-old kids with some injury. We may be able to show that if you have this pattern [of results on the cognitive test] you will have that injury," he says. "It would work out who's vulnerable - who has been injured already and should not take a second hit."
The result might be that a middle-ranking weekend player or a teenager would be advised to quit. Or, as Jackson says, "They might want to take up basketball."
Ellen Fanning was MC for the opening of the Melbourne Brain Centre in 2011.