I provide individually tailored rehabilitation programs for head injury survivors, which tap into neuroplastic processes using mindful movement as the primary vehicle for healing.
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A common experience among brain injury survivors is “loss of self” — manifested by detachment from one’s physical body, emotions, and the outside world, including persistent difficulty relating to other people, with devastating consequences for one’s daily functioning and overall quality of life.
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Somatic therapy offers a strategy to overcome this most debilitating aspect of brain injury, which uses whole-body movement explorations (guided by gentle touch and verbally) to help people recognize that they have a range of choices in everything they do. Increased bodily resourcefulness enables the person to make the activities of his or her daily life more pleasurable and pain-free and fosters overall mind-body harmony, leading to more skilful performance in every endeavour and a more secure, “grounded” sense of personal well-being.
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In my work with brain injury survivors, the general goal of enhancing functional awareness of the self is tackled by focusing on the movement sequences involved in performing everyday activities — such as walking, standing, sitting, or lying down, and relational movements. These sequences are intentionally broken down into small components in order to “awaken” the person to his or her habitual movement patterns and limitations, and to stimulate exploration of new, more efficient ways of moving. Exploring, discovering, and adopting new movement patterns stimulates the growth of new connections in the brain and thereby increases the overall efficiency of the nervous system, which translates into improved cognitive abilities and emotional intelligence as well as enhanced physical functioning.
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This approach is very different from exercise therapy with its emphasis on exertion. Instead, I focus on movement quality and body awareness. One of the pioneers in the field of somatic therapy, Dr. Moshe Feldenkrais, captured its essence in one eloquent sentence: “The aim is a person that is organized to move with minimum effort and maximum efficiency, not through muscular strength, but through increased consciousness of how movement works.”​​
A Neurobiological Perspective on Head Trauma,
and the Modalities I Use to Address It
From a neurobiological perspective, a sudden, violent blow or jolt to the head causes mechanical perturbation of neurons, which triggers a massive release of excitotoxins — neurologically active compounds that, due to their high concentration, initiate cellular injury cascades extending far beyond focal damage. These biochemical events ultimately disrupt neuronal communication across the brain. As a consequence, its large-scale functional networks — the coalitions of widespread brain regions that are jointly activated through synchronized neuronal signals to perform specific sets of cognitive or motor tasks — are disrupted as well, and so is coordination between them. This leads to wide-ranging functional impairments including persistent pain and spasticity in different areas of the body, impulsivity, poor attentional control, memory problems, and difficulties in problem solving, task switching, and planning — all of which are commonly observed after a head trauma.
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The initial stage of my rehabilitation strategy for brain injury survivors is aimed primarily at alleviating the most debilitating functional impairments including, in particular, persistent pain. In terms of neurological processes, this stage predominantly involves neurostimulation, which helps revive dormant circuits in a damaged brain, and neuromodulation, which helps restore the balance between excitation and inhibition in the nervous system, necessary to enable it to relearn after a brain trauma.
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Two components of neuromodulatory work deserve special mention: integrating primitive reflexes and balancing the autonomic nervous system.
Primitive reflexes are automatic stereotypic movements directed from the brainstem, which require no cortical involvement. They are needed for survival and development in the womb and in the early months of life. In typical development, these reflexes are naturally inhibited during the first year of life, and merge into more sophisticated, voluntary patterns of response, called postural reflexes, which control balance, coordination, and sensory-motor development. Once these more purposeful motor patterns have been established, primitive reflexes recede to the background, as it were. But they never disappear, and often re-emerge after a brain injury, causing disintegration between the sensory and motor systems, which entails poor balance and coordination alongside difficulties with concentration, attention, and impulse control. Reactivated primitive reflexes must be integrated to enable sensory-motor coupling, which is crucial for restoring high-level motor and cognitive functions. To that end, I use a program of gentle rocking movements imitating those that infants spontaneously make. In doing them, the client “revisits” the developmental stages when particular primitive reflexes get inhibited naturally. I also use low-level laser therapy, which has been shown to promote reflex integration.
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Modulating the autonomic nervous system to achieve a proper interplay between its sympathetic and parasympathetic divisions is also critical for genuine recovery from a head trauma. When the autonomic nervous system is working properly, it exhibits a moment-by-moment responsiveness to shifting demands, which allows a person to move easily between sympathetic dominance when the body is mobilized to “fight or flight” threatening situations, and the parasympathetic dominant state of “rest and repose.” However, many brain injury survivors find themselves stuck in the sympathetic mode — they are constantly tense, anxious, and on guard for potential harms in their environment and relationships. This “stuckness” can continue for years after the traumatic event has occurred. As long as they are locked in this state, their capacity to regain functional abilities remains severely limited. In such cases, I may use LENS neurofeedback, which helps the brain to “reset” itself; and also hemoencephalography neurofeedback, which strengthens the parasympathetic wing of the nervous system, which restores the organism to a state of calm conducive to learning new skills and self-repair.
Genuine rehabilitation after brain injury — in the sense that the functional gains achieved through therapy can be maintained or improved independently by the survivor over the long term — involves not only reviving dormant, and building new, neural pathways to compensate for the ones that were damaged or destroyed. It also requires attaining a stage when these newly formed circuits begin to regulate themselves by making fine distinctions. This stage, known as neurodifferentiation, is when organic learning — a continual self-correcting reorganization driven by the person’s own inner capacities — can occur. Without this process, neuroplastic healing may not complete. To stimulate neurodifferentiation, I rely primarily on manually guided body awareness techniques, especially those based on the Feldenkrais Method. I also draw on other somatic modalities such as Focusing (a process for attending to body sensations, which brings greater clarity and freedom from unhelpful emotional habits, developed by psychotherapist Eugene Gendlin) and Emotional Anatomy (exploration of how a person’s psychoemotional history influences the shape and structural peculiarities of his/her body).
