Thursday, February 28, 2008

How do you manage a broken brain? We don't know.

How do you manage a broken brain?

What do you do when some skills are at the 75th percentile, and others at the 2nd percentile?

Much harder -- when some skills are at the 4th percentile, and others below the 1st percentile?

Do you create a profile of all the strengths and weaknesses, a visual representation to analyze and evaluate? An MRI of the mind?

Do we create programs to strengthen the weakest areas, or do we leverage the stronger domains? Or perhaps the middle range?

Can two or three areas of strength be combined to help an area of weakness? What role might cognition-medications have? What role do psychostimulants have?

How do we measure progress? How do we know when to change direction?

How do we intervene in infancy, when surgeons can remove half the brain and a child can still go to college? In early childhood? In pre-adolescence? During the teen years? In adulthood? In old age?

How do we leverage computerized, robotic, and remote human aides to support severely impaired cognitive functions?

We flippin' don't know. We're barely at the starting line. We don't have any science-based plans. Opinions, yes. Science, no.

It's not surprising. We know far more about kidneys than minds, and we don't really know how to manage an injured kidney. Is physical exertion good or bad? How low should the blood pressure be? Proteins good or bad? Which proteins? ACE inhibitors?

We're in the stone age of managing broken brains -- little improved from the best practices of the past 10,000 years of human history.

I can imagine ways to start to make progress. Ways to study developing brains and minds. Ways to create comprehensive profiles of strengths and weaknesses and use those profiles in discussion and analysis. What I can't see is how to make significant progress in my lifespan with the available political will and funding.

Anyone know a billionaire with a cognitively disabled child?


Anonymous said...

I take some umbrage with “the broken brain” statement. For a blog that focuses on those who have disabilities it just sounds too broken.

The manifestation of any disability that might appear to emanate from the brain, or any other organ, seems simplistic at best, but to think that very complicated disabilities can be “fixed” does not make much sense to me.

I have an old clock that broken, it can be fixed but my learning disability cannot!

Regards, Alan

John Gordon said...

I chose the wording deliberately - focusing on the reality that the truly injured brain cannot be repaired or even completely healed, but that we need to think of ways to work around the broken parts.

So if someone has a broken body (paraplegic, cardiomyopathy) we recognize that body can't be made whole, but the person can be "the best they can be" by working with what they have, and working around the things that can't be changed.

My frustration with the very weak science in this domain is we aren't even thinking clearly about HOW to work around a "broken brain", even though it's easy for us to think about how to work around a broken body, or a broken kidney.

Of course I think all brains are broken in one way or another, not least my own.

Anonymous said...

I had no idea that this was also your blog John, my comment was a bit terse, apologies.

I must say that over the years it has become very clear to me that whatever out instrument fails to manage to do to it's fullest, the spirit in each and every case has been whole!

Regards, Alan

John Gordon said...

I forget that it's not obvious which identity is which. John Gordon is a pseudonym too, though I put enough links in the blog that it's not hard to find my real name.