Psychoeducation: Neurophysiology 101 (simplified) for

Persons with Neurologic Conditions

Mike Martelli, Ph.D.

One of the most sensitive parts of the brain is in the Limbic System. This is the part of the brain in the very middle, just above the base and it is in close proximity to the primary sources of blood supply in the brain. It is especially sensitive to changes in blood flow, blood oxygen and blood sugar, infection, and sudden acceleration and deceleration of the brain (i.e., closed head injury and traumatic brain injury), as well as brain swelling. Some of the important functions of the Limbic System include Memory, which derives in history from mammals and sense of smell, and complex attention. A useful acronym for the functions of the Limbic System is: F.E.S.T., or Fatigue, Emotional amplification, Sensitivity to stimulation, and Temperature & Taste (& smell).

Importantly, the brain, after injury, brain cells have to work much harder to accomplish the same results. Thus, the brain becomes more sensitive to demands in any of these areas. That is, if one gets fatigued, which will happen much sooner, emotions will get more intense and increased stress will be experienced, and sensitivity to stimulation (e.g., conversations, two people talking at once, noise, crowds, light, patterns and flickering light, etc.) and reduced tolerance of heat or temperature change will also result. Importantly, different structures of the limbic system control different functions. For example, the Amygdala regulates anger, fear and stress responses, while the Hippocampus controls memory. When these areas are injured, they require more blood. Therefore, when angry and under stress, more blood is used by the Amygdala, and less is available for the Hippocampus. Therefore, memory becomes very poor under stress.

Even more importantly, all healing requires relaxation. All stresses produce increased physiologic arousal or a fight-flight emergency nervous system response. Stress is the normal, healthy way our bodies respond to stressful demands in the environment. This response is biologically programmed and is based in the "fight-or- flight" response that enabled our ancestors to mobilize their strength via our Sympathetic or emergency nervous system (e.g., increases in muscle tone, heart rate, breathing, etc.) to fight off or escape such stressful dangers as saber tooth tigers. When the stressor ends (e.g., tiger is killed or escaped from), our physiological systems relax and recuperate (i.e., Parasympathetic Rebound, when blood flow increases through relaxed organs to heal the damage caused by increased arousal or injury) and then return to normal baseline.

Unfortunately, after injury, the natural stress response seems to selectively arouse (irritate) organs weakened by injury. So, for instance, instead of blood pressure and muscle tension and breathing and alertness all going up equally, muscles that were injured will differentially get very tight, or attention in an injured brain will cause confusion or distraction, or the Amygdala will steal the blood away from the Hippocampus memory center. This presents a problem because stress can become a chronic response pattern such that even mild stresses have the potential to block the relaxation necessary for healing. Even more importantly, emotions caused by stresses resulting from the injury (e.g., loss of abilities, pain), and a "catastrophic reaction" to changes caused by injury, disruption of regular activities, etc., represents a constant source of stress that can prevent shutting down the fight-flight stress response (i.e., parasympathetic rebound, relaxation & recovery) & preventing natural recovery & recuperation necessary for healing. Further, because the Limbic system that controls emotions was damaged, it produces amplified emotional reactions and catastrophic reaction to losses and stresses of injury, which even further elevates physiologic arousal beyond what would happen if another part of the brain had been attacked (i.e., the double whammy. The disease want to destroy, and almost as if by design, it knows it can perpetuate itself by keeping you distressed, so it attacks the emotional controls centers that then amplify your distress). In response, as a kind of means of protection from catastrophic anxiety, chronic stress, and chronic pain, your brain can slow down in terms of EEG waves and blood flow, which slows thinking and produces cognitive inefficiencies. .

Importantly, healing can only occur when the nervous system is relaxed and blood can produce healing through normal flow to muscles and nerves. To the extent that patients with lingering problems can learn to make their damaged organs relax (despite having amplified stress responses), and allow blood flow and healing despite the stresses that follow injury, they will Recover/heal.

TMS/PTBS DAILY REMINDERS

• My pain and brain problems were initially due to structural injuries. Now, however, they are related to Tension Myalgia Syndrome and Post Traumatic Brain Sensitization.
• My pain and cognitive problems are mostly due to mild oxygen deprivation that is blocking normal function and healing of muscles and brain nerve cells.
• The oxygen deprivation in my muscles/ nerves is caused by emotions making them tight and disrupting blood flow. Emotions are preventing healing by keeping the muscles tight and brain stressed, which blocks the blood and oxygen flow needed for healing.
• The principal emotions which block healing are anger/rage, fear (e.g., of losing control or not being in control, or being uncertain), and perceived mistreatment.
• Pain & cognitive problems have become a distraction from my emotional pain
• Anger / Fear about being blocked, inactive, etc.;
• and __Worries:
• Fear of being out of control; __Fear of uncertainty;
• Fear of being rejected; or __ Fear of Being abandoned;
• Fear of being inadequate; __Fear of symptoms and not getting better;
• Fear of not achieving internal goals and expectancies
• Fear of dying;

  It has learned that it can sustain and replicate itself like a virus by distracting me from the emotions that keep the muscles tight and brain stressed, thereby ensuring it's survival.

• I will not be intimidated by the pain or cognitive problems.
• Since the pain and brain problems are maintained by emotions, physical and cognitive activity, as long as I pace and use a consistent, graduated approach per doctors orders, it is not a danger.
• I intend to be in control - not my emotions or pain or cognitive problems.
• Through vigilance and brute will, I will not let my stresses and emotions go to my pain sites and brain centers. I will teach my body and brain not to react to my emotions. I will send messages to my brain (limbic system habit centers) to halt emotion from attacking my body and brain.
• I will strive to uncover and experience all of my hidden emotions so that they cannot control me, and resolve them so they lose their power and control.
• I will think psychological at all times, not physical.

Adapted from John E. Sarno, MD (M.F.Martelli, Ph.D.)

Catastrophic Reactions, the Propagation Imperative & 5 Commandments of Rehabilitation

Mike Martelli, Ph.D.

Pinnacle Rehabilitation & Concussion Care Centre of Virginia

Early after injury, the discovery of losses of accustomed abilities, especially ability to perform simple physical

movements or express intentions or needs through speech, can be overwhelmingly devastating to the affected individual. The sudden loss of function in a limb, the inability to stand or the inability to control one's bowels or express a need through speech or understand another persons words can produce a powerful reaction characterized by incredible despair and distress.

This response has been observed after stroke, brain injury and other neurologic insults for a very long time and has been labeled a "catastrophic reaction". The acute despair that is experienced usually lessens with time, and usually fairly quickly, although a fair amount of distress can remain. As the closeness to injury passes, the distress becomes much less visible. However, based on observations of patients over long periods of time, one can argue that although lessened, this reaction can continue to operate on persons long after injury and even forever.

From the perspective of a habit retraining model of brain injury rehabilitation, brain injury recovery is conceptualized in terms of replacing lost habits through an incremental rebuilding process. The 3 P model for habit retraining based brain injury rehabilitation stipulates that this process requires a well designed

• Plan (usually based on a thorough task analysis),
• Practice, repeated and consistent, over many trials and months, and finally,
• Promotional attitude maintenance that facilitates and shapes continued practice, incremental (baby step) expectancies, self-reinforcement for incremental gains, and resistance to such attitude poisons as significant anger, frustration, depression, fear, pessimism, feelings of victimization, self pity and, importantly, the kind of low grade chronic catastrophic reaction that is left over from the early days after injury.

Clearly, this kind of left over reaction, now less visible and more hidden, can continue to exert the kind of despair that contaminates progress generating hope and energy with feelings of powerlessness and helplessness and being overwhelmed by the challenge of coping with impairments. In fact, the remnants of early catastrophic reactions seem to frequently underly the negative, energy robbing emotions that deplete precious energy, effort positive goal directness and patience necessary for successful goal achievements.

Another important concept with regard to rehabilitation is the Propagation Imperative. Basically, this imperative dictates that every force and organism, good or bad, strives to expand and grow and take over. For instance, have you ever heard of a fungus that only wants a little piece of an apple? Or a cancer that only wanted a little piece of skin and was satisfied?...or a sperm cell that had a headache?...or an army that wanted to give up territory? In traditional psychoanalytic theory, two basic forces in life are seen as battling for supremacy. These are Eros, or Life Instinct, and Thanatos, or Death Instinct. Life for psychoanalysts is a struggle between life forces and energy versus death forces and energy. The two are seen as opposites engaged in a battle for life or death.

Rehabilitation can be viewed using this conceptualization. Brain injuries and strokes represent death forces with an ultimate goal of progressing from disease and disability to death. Recovery, in contrast, strives for expanding health and life.

Importantly, energy multiplies in a cyclical fashion that feeds itself with increasing momentum. If it proceeds in a negative direction, more and more energy will be robbed from the healing life reserve, wasted in poisonous attitudes and made unavailable for relearning and accomplishment. For example, an anger or depression habit in response to physical losses can reduce activity and hence relearning, which will lead to more depression by depletion of brain chemicals that protect mood, and, in turn, lead to poorer progress and more reason to be depressed. Propagation means growth towards disease, disability and death, or the opposite of life.

The antidotes included in the "Five Commandments of Rehabilitation" should be considered life force medicines that interrupt rehabilitation poison growth cycles. Antidotes like the "Five Commandments", a positive vision of a gradually improved future, and planning and practicing compensatory strategies serve to protect the healing reserve by inoculating persons against depression, anger, and destructive emotion. This ensures that energy and motivation will be available so that desired life goals can persistently pursued, with each step of progress adding new energy, momentum, hope and effort for the next step.

With the utilization of incremental goals and achievements, energy is turned toward protecting the life forces and healing reserve, using the Rehabilitation Commandments as antidotes against poisonous attitudes, and letting positive, baby step life achievements pull survivors toward a more desirable future. Remember, anything that is consistently repeated will become a habit. Therefore, promote the attitude and activity routines that will produce facilitative habits that turn energy toward protecting attitudes, taking antidotes and letting your healing reserve pull survivors like a magnet toward their positive life goals.

Remember the Five Commandments of Rehabilitation (see Above)

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Science, Sports and Rehabilitation Imperatives

Mike Martelli, Ph.D.

Concussion Care Centre of Virginia.

A psychologist was conducting experiments on rats and stress. White rats that have been handled by humans are known to drown after about one hour when placed in buckets of water. The psychologist raised rats in two environments and found that rats raised in high stress, crowded conditions lived five minutes less than rats raised with low stress and lots of room. He found that the low stress rats lived 5 minutes longer. One day, while conducting experiments, the water leaked out of the buckets, and the rats escaped without dying. He repeated the experiment the next day with the same rats. During the experiment, he got called away on an emergency and forgot about the rats. The next day, when he returned, he remembered the rats and expected them to be dead. He got a screen to remove the dead rats, but when he got to the buckets, they were all still alive.

He repeated his experiment and found that rats die after about one hour in water if it is the first exposure. However, if they are placed in water and removed just before they drown, they can live and tread water almost indefinitely.

Compare Surviving near death from TBI!

Psychologists (relatives of the Marquis de Sade) have studied pain tolerance in humans for a many years. In one interesting series of studies, college students were paid good money (e.g., $50.00) to place their hand in bags of ice and given one of two sets of instructions: (1) "Keep your hands in the ice for as long as you can and you will earn $50.00"; 2) "Keep your hands in the ice for two minutes and you will earn $50.00." Importantly, students paid $ for keeping hands their hand in ice for two minutes are almost all able to do so, most report that it is not that hard, and some keep their hands in longer asking if they could earn even more money. In contrast, students asked to keep their hands in the ice for as long as possible generally pull their hands out well before two minutes, usually complain of great difficulty, often complain about suspected frostbite, sometimes even cry and say that the money is not worth it.

Note: Rehab requires 3 P's: a good Plan for gradual improvement, Practice & a Promotional attitude

It was the world series in the 1950's and the Yankees were playing. The Yankees were the best team in baseball. It was the seventh and final game of the world series, the series was tied, and the winner of this game would win the world series.

It was the bottom of the 9th inning, two men on, two men out and a count of 3 balls and 2 strikes. The Yankees were ahead by one run and Whitey Ford, the best pitcher in baseball, was on the mound. The pitch would determine the game. If Whitey struck the batter out, the Yankees would win. If he let him hit a pitch, the Yankees would lose. Well just as Whitey got ready to wind up, the coach came running out to the mound yelling: "Whitey.. .whatever you do, don't throw a high fast ball...". Whitey, as he was letting go of the pitch, was overheard saying something that began with an "f" and rhymed with 'duck'. The batter hit a home run and the Yankees lost.

For many years, Whitey traveled the country doing motivational talks to businesses and athletes. He always repeated the World Series game story and admonished others against thinking about what they didn't want, as this could make it happen. Instead, he offered strong alternative advise that basically suggested "Always think about what you want, and program yourself to get it."

Your Vision Dictates Your Reality, Your Future, and Your Destiny!!!!!

Compensatory Habit Retraining is the use of strategies, self-talk, notes, log books, breaking things down into small steps, doing things one step at a time, using checklists, etc.

It feels like a Pain in the Butt.

Not remembering, however, is a Colossal, Gigantic Pain in the Butt.

So be aware, When Habit Retraining Strategies become Habitualized, they become Automatic and produce good memory and other skills, and are No Longer a Pain in the Butt.

Think of Retraining with Strategies As a Temporary Pain in the Butt that is really an Opportunity to Get Rid of Permanent Gigantic Pains in the Butt.

M.F. Martelli, PhD and J.B. Finkelstein, DC : 1999

© 1997: M.F. Martelli, Ph.D. & "Obstacle Busters" Cope Group Members: Jan Flowers, Tom Byrnes, Jack Hodges, Dr. Joel Finklestein, Brain Stephens, John Mitchell, Tom Hale, Jim Fenerty, Evelyn Phillips, Rick Peters, J.P. Gibson, John Mitchell, Tom Hale, Jim Fenerty, Evelyn Phillips, Rick Peters, J.P. Gibson, Danny Burnett, Chris Hignutt, Tommy Peden, DavidBrummet, Sarah Goldmann, Matt Tacey, Jay Weaver & Lynn Batley, David Mourer, Rudy Lee, Patrick Quinn, Dennis Weymouth, Laura Watts, Laura Hunter, Barbara Watts, JD Smith, Jamal Alkayed, Charles Smith, Linda Beales, and others...

For Additional Habit Retraining and Rehab Related Readings

Simplified Neurophysiology & Recovery Requirements, Catastrophic Reaction & Recovery, Etc.

Vulnerable Personalities, Sample Protocols for Emotional Management, Etc.

HeadsUp - A Great Online Survivor Newsletter with many features and good articles!