20230806 : dead ends & U-turns

Disclaimer:- these are my thoughts based on my observations. They are not backed by research or medical proof. Take it with a pinch of salt...

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This is not a recent observation but observed over the past 4+ years. I have not been able to make sense of it for a very long time and after I processed it in my head, I didn't know how to express it and write about it... Giving it a shot now...

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When I drove the car/ rode  the bike, I have always been very bad with directions and orientation. And I am a "man" - so I wouldn't stop to ask for directions either. And I was not slow either...

Net result was, i usually over shot an exit, hit a dead end, etc and invariably I would have to take a U turn and go back to get further.

When in Australia, my wife would be struggling to let me know the directions with a big and bulky map book only to witness the U turns anyway (these were the days when Google maps were not yet in). 

After I had my stroke and a few months afterwards, I slowly got some movements in my left hand fingers and forearm (nothing else).

After the movement started, I kept moving it to build strength. I had assumed it is then only a matter of regularly continuing those movements and build muscle strength.

Every few days, the movements slowed and reduced - some days, I couldn't even move it.

I used to get very panicky and used to make everyone (especially my wife) anxious as well I guess. 

The reason I used to get so panicked was because I was told (by doctors, therapists, family, friends everyone) - that a movement/ ability once regained won't be lost again. 

But what I was experiencing was very different. Abilities were constantly initiating and after a few days would go away overnight. I have observed if there were health changes, medicine changes, sleep pattern changes, feed changes , changes to routine, etc. 

But no - there was no pattern at all from anything to cause/ influence the changes .

It's not like I stopped movements and exercises to lead to muscle wasting and loss of strength. It would just abruptly stop overnight. 

The main reason everyone told me when I used to get anxious was "spasticity". I would be told "it's just spasticity, it will become ok in a few days. Sure enough - it was true, it used to get back in a few days. So in my mind, spasticity it was.

Those were the days (~2 years) when I was not able to use my phone and get online and watch what I wanted on TV. So I went with what I am told - I didn't know what spasticity was really. 

After I read and understood what spasticity is which is a muscle action (muscle action is very fascinating by itself), i realised what I was going through was not spasticity. The malfunction of muscle action is also caused by malfunction of the brain, but I have realised the feeling in very different between the 2 experiences .

I do get spasticity also a lot. But I know now what spasticity feels like and the other experience I was feeling. The closest I can describe spasticity is a muscle cramp somewhere - where the muscle contracts/ tightens and cannot release/ relax. In a cramp it is caused by local chemical/ electrolyte imbalance in the muscle whereas is spasticity it cannot release because the brain is not able to instruct it to release.

It is not a "was", I regularly go through this experience a lot even now:

- some days I can slightly move my shoulder and it suddenly stops for many days.

- some days I am able to support myself when standing. After a few days the hip just doesn't support.

- even in my left hand (which is seemingly fine), the forearm between the elbow and wrist has not become fully alright and keeps going through this cycle . 

- etc. etc.

My thinking/ assessment of the experiences is this:

When I had a stroke in my brain stem (I crudely think of the shape of the brain stem as a cone - inverted cone , like a funnel) connecting the upper part of the brain to the spinal chord.

The cone has a certain volume, full of neurons highly interconnected to achieve the functioning of the body

 (i) as a conduit for signals from rest of the brain

 (ii) many many of basic functions - which is not just a conduit but the source/ controller of function itself.

When I had my stroke, parts of the cone got destroyed (the neurons died). So effectively, the volume of neurones available for it reduced. (I don't know how much, but I assume quite a bit given the damage). Now the brain has to rewire itself in the best way it can, with the remaining neurons to support as many of the original functions it is able to (both as a conduit and as a controller)

So, imagine this in an animated way  (like walking in a maze game). 

The brain reorganizes its neurons in a different path to start some function. It continues to progress in that path to build that capability and strength. After a while (a few weeks maybe , it realises that this path is not helping it complete the function fully as desired because it is not able to find the connecting path or because that part of the brain has no more available neurons etc.

It has hit a dead end! It needs to take a U turn and go exploring a different path. In that process, it has to let go of some of the functions/ abilities it had picked leading to the dead end. Hopefully it will learn them back on the different path it is exploring/ forming.

My thinking is that this is the experience I have been having regularly. Losing an ability (because the brain realised it can't progress further in that path) and picks the ability back up in the next try .

Lucky I have been an expert in hitting dead ends and taking U Turns earlier! 😀

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Extension of the above thinking:

My understanding is that the human being has evolved with an absolutely perfect replication method - by imprinting the blueprint of the entire human body in every cell through the DNA . Every cell does its role in being the building block of the body depending on the instructions in the DNA. The brain matter too develops in the same way. Certain cells become neurons as a consequence.

But, my understanding is that there is nothing in the DNA to instruct the nurons further on how to interconnect and form networks or abilities.

Absolutely every ability/ function we do in life is "learnt" after being born because of the interconnections are formed later, due to the influence of external environment.

Which is why I guess they say very young children should play and do physical things and not try logical things because the nurons are not yet fully and strongly interconnected to stabilize their physical body movements and abilities. That's probably the first job of the brain. It probably uses all the senses like seeing others, hearing everything, etc and uses this as a feedback loop to correct itself and learn - it also supports the theory that young children should be surrounded by imitable people because everything they are learning to do/ to behave is learnt by imitating others. (This is not my gyan but a well known theory for over a century - by a very well known philosopher and educationist)

The logical thinking part of the brain is still forming and only after the body is stabilized will it focus on the interconnections in the upper/ logical brain. 

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Extension of the above:

This phenomenon doesn't just happen to visible limbs like hands or legs. I can feel the different functions which are not visible undergoing this experience as well - right from sleeping pattern to digestion to excretion. 

Ex, the swallowing bit. Goes through cycles of getting a little better and reverting back to nothing. I would assume it is the same phenomenon it is also experiencing.

Only challenge which I see with these abilities is - where is the feedback loop for improvement? It's not like we can watch somebody's throat and learn the swallowing rhythm. I guess it is completely left to trial and error for the brain...