Could “learned” non-use after spinal cord injury be unlearned?

Warning: technical jargon ahead

Edward Taub, PhD, coined the term “learned non-use” to describe an inability to use a limb affected by a stroke or spinal cord injury. He later developed methods called “constraint-induced” movement therapy (CIMT) that might help people regain use of a limb that was no longer being used.

The CIMT therapy involves hours of intense training to “unlearn” the non-use behavior. The person must actively intend to move the limb as coached by the trainer. The aim is to perform a “re-mapping” of the limb in the brain’s movement maps. Today, the CIMT therapy remains largely unused. The required time and effort limit who might have access to the therapy. Other limitations must be met before trying the therapy.

https://www.physio-pedia.com/Constraint_Induced_Movement_Therapy

The principles of CIMT suggest that the brain and limb may be able to reconnect through highly intentional movements.

 

Unlearning “learned” non-use

PhotoMed’s team took a machine-learning (ML) approach to solving the non-use problem. Their studies included people for whom everyone expected exactly nothing. Many improved, but the cases were separated by years.

Real-time recordings from the visits sat on the shelf until enough cases could be compared. Margaret, below, demonstrates responses to the latest testing methods. Watch as Margaret’s fingers come back on line for grip and extension movements.

Note that this is NOT a variation of CIMT because there is no constraint of the “good” limb. The CIMT outcomes inspired the attempts at using PhotoMed’s therapy by showing that improvements might be possible.

In PhotoMed’s development studies, several volunteers with limited movements improved beyond any reasonable expectation. The renewed abilities remained a mystery until our team learned about Taub’s findings. In two cases, teenagers with C5-C6 spinal cord injuries (SCI) responded to the therapy (in 2007) with a sequence of improvements. They followed a similar trajectory of improving bowel, bladder, and activities of daily life routines. Within 6 months, both were back in rehab training. In one year and 30 visits, both were beginning to use manual wheel chairs. PhotoMed’s team focused on pain. Their functional improvements were interesting but were not the focus of development of a pain-relieving therapy. Under-appreciated at the time was that the therapy relieved neuropathic pain in one person that returned after therapy ended. PhotoMed’s direct costs for each was about $10k.

Figure 1  - “Barbara” responded to PhotoMed’s then experimental therapy during her first visit. Her improvements overcame her “plateau” to enable her to return to physical therapy. She hand-wrote a thank you note as she gained more independence. At one year, Barbara transitioned to using a manual wheelchair.

Figure 1 - “Barbara” responded to PhotoMed’s then experimental therapy during her first visit. Her improvements overcame her “plateau” to enable her to return to physical therapy. She hand-wrote a thank you note as she gained more independence. At one year, Barbara transitioned to using a manual wheelchair.

Figure 2  - “Steven” responded to PhotoMed’s then experimental therapy during his first visit. Within a month, he was able to feed himself. His progress was like Barbara’s improvements. It was a coincidence that two young people with C5-C6 spinal cord injuries joined PhotoMed’s development study. Both needed oxygen while beginning their physical therapy after each visit. Techniques developed for one person could quickly be tested on the other. Thank you, Mr. Physical Therapist.

Figure 2 - “Steven” responded to PhotoMed’s then experimental therapy during his first visit. Within a month, he was able to feed himself. His progress was like Barbara’s improvements. It was a coincidence that two young people with C5-C6 spinal cord injuries joined PhotoMed’s development study. Both needed oxygen while beginning their physical therapy after each visit. Techniques developed for one person could quickly be tested on the other. Thank you, Mr. Physical Therapist.


What is going on here?

The concept of quantum biology was not yet on our event horizon. The outcomes were not supported by conventional explanations. The experts reported their unease with the findings because they were not explainable within their medical specialty. The responses were too fast and frequently too complete to compute using the it’s forever notions about chronic pain. They then directed us to other specialists…

A chance conversation with a quantum physicist got us to look in a totally unexpected direction. He shrugged his shoulders and said, that’s so easy, that’s quantum physics in action.

Years of accumulated weird responses and outcomes snapped into focus for re-examination. We can’t find a better explanation than quantum biology. Hopefully, future researchers will figure out how that works.



Could intention and attention be the accelerating ingredients?

Margaret is spry at 83 except for recovering from quadriplegia. She was in a horrific auto accident about 2 years before trying PhotoMed’s therapy. She didn’t expect anything to happen based upon her doctor’s prognosis. Her Medicare physical therapy had been exhausted. She was stuck with a brace on her left foot. Her right hand was mostly working except that her middle finger always moved together. Her left hand was a clenched claw. Her left thumb painfully pressed and twisted her index finger over her middle finger.

Figure 3  - Margaret, June 2018, shows her claw. She isn’t too happy that her hand won’t respond to her strongest intentional thoughts. Here left thumb pressed so hard on her index finger the finger is painfully twisted and bent.

Figure 3 - Margaret, June 2018, shows her claw. She isn’t too happy that her hand won’t respond to her strongest intentional thoughts. Here left thumb pressed so hard on her index finger the finger is painfully twisted and bent.

Figure 4  - Margaret, August 2018, Base knuckle joints are rigid. Some movement of fingers was possible by force or by bending of the wrist. Her fingers had no significant intentional movement.

Figure 4 - Margaret, August 2018, Base knuckle joints are rigid. Some movement of fingers was possible by force or by bending of the wrist. Her fingers had no significant intentional movement.


By 1 year, her left hand effectively remained a claw with her base knuckle joints being “frozen” irrespective of her wrist position. Notably, her fingers moved some with flexing her wrist, but without significant independent movement. Progress had stalled. She had learned to hold a few items by flexing her wrist.

In August 2019, PhotoMed’s software team added synchronized multiple cameras to the list of Instant Verification System™ capabilities. Testing in the office was rather boring. Fortunately, Margaret came to the rescue. Over the past year, she had recovered much of her right hand utility. But could her left hand make progress while testing the new camera system?

Margaret was eager to add a step of intense intention that might accelerate a return back-to-normal function, or at least utility. The following is the first field testing of the multiple camera system. This video demonstrates progress during the visit. (11:56), You can watch as she intensely resists movement and tracks movement. Margaret’s base knuckle joints began to move with heavy but not in response to her intentions. Her fingertips did move a little.

Figure 5 - Margaret provides the 1st field-testing of PhotoMed's multiple camera system. This clip shows the development of strategies that might accelerate unlearning “learned non-use”.

 

One week later, Margaret had achieved some additional flexibility in the base knuckle joints. These videos show her intention and attention for helping her little finger move under her command. By the end of this visit, she was able to move her fingers in both grip and extension.

Two methods appear to accelerate the process of differentiating her fingers and finding the movement intentions.

  • Push against to resist a load that overpowers her strength. Her strength rapidly increases after a few attempts.

  • Track against a load that is moving away from her finger. That is, to relearn which muscles work in each direction.

 

This video of testing her little finger includes an interview beginning at minute 4:00.

Figure 6 - Margaret continues her progress during the next week’s visit. This video shows clips of testing her little finger. You can see where the clip lies on the timeline at the bottom of the screen. This was the first field test of the Vari-Chrome Pro and three cameras. The software tracks the wavelength emitted by the device. (5:05)


Figure 7 - Margaret successfully focuses her intention and attention on her thumb as she attempts to get it moving again. (5:25)

 
Figure 8  - It appears that overpowering a resisted movement and tracking a receding movement with the stimulation active may extend the useful range of motion. The same method may be applied to improve the opposing direction of movement. Margaret’s force in resisting or tracking movements increased within a few cycles. She began to recover some extension movement of her fingers during this visit. Passive movements during several previous visits had not been successful in awakening her finger straightening movements.

Figure 8 - It appears that overpowering a resisted movement and tracking a receding movement with the stimulation active may extend the useful range of motion. The same method may be applied to improve the opposing direction of movement. Margaret’s force in resisting or tracking movements increased within a few cycles. She began to recover some extension movement of her fingers during this visit. Passive movements during several previous visits had not been successful in awakening her finger straightening movements.

Machine-learning methods

Machine-learning (ML) methods yield models that solve problems based upon data collected for a different purpose. PhotoMed’s development studies recorded events, in real-time, when volunteers received the therapy with no expectation of improved functions. In fact, the astoundingly quick and large responses puzzled our anesthesiologist and neurologist advisors. The events appeared to conflict with texts on pain and neuroscience.

Examination of the recordings sought a common thread among unexpected recoveries that involve sensation, movement, thermoregulation, and non-healing wounds. The answer appears to be a return back-to-normal function. That is, the event marks the switch between a chronically impaired state and “normal”. Evidence for “normal” accrues while improved functions persist after therapy ends.

Our team was concerned about versatility of non-invasive therapies being considered a curse. A curse in a pharma-world where medications only support a studied hypothesis. The versatility of side-effects may be ignored. The methods that aim to achieve a predicted outcome are called “programmed” learning (PL).

Why is this distinction between ML and PL important?

Because the ML methods are about discovery of a solution whereas PL methods may aim to confirm that discovery posed as a hypothesis.

For example, the volunteers provided the clues when they reported that they felt more normal. Their spontaneous remarks about being “normal” again were occasionally noted by the operators but was not considered relevant. ML methods, run by humans, found the “normal” concept interesting. The remark was frequently coupled with the volunteer’s surprise at the unexpected event. The intersection of surprise, “normal”, and long-lasting outcomes, irrespective of innate function, led to the “back-to-normal” concept.

Tailored therapy

The methods of opposing forces and tracking receding movements shown in the videos likely do not depend upon stimulation from the Vari-Chrome Pro. ML methods suggest that a common “feature” of the nervous system may account for the rapid improvements.

You might hear the term “noise” applied to the stimulation. Volunteers in studies suggested that the not-quite identifiable sensations might be “noise” like a symphony tuning or the noise at an ocean beach with crashing waves. The speculation continued with the noise making it harder to maintain bi-directional communication, like trying to hold a conversation in a noisy location. Margaret appeared to confirm that guess with her report that the stimulation made it easier for her to move her fingers and that flashing seemed even more effective.

Who will write the first paper?