As a proviso to any post I make regarding medical or physiological information, I am not medically trained, nor gifted with any in-depth knowledge of the matter. Since having six TIAs and a stroke in 2020, I have bumbled my way through rehabilitation, mainly, gleaned from academic and medical papers on subjects related to my condition, and my own aptitude for nutting stuff out. I was given a minimal amount of physio information after leaving hospital, that information came my way via a few emails. After some research, I discovered that the exercises given to me were not really applicable to my disorder. In sum, they were ineffective, and I was wasting my time applying them to my rehabilitation regime. After two years, one gets to know what is helping and what is not. So, I wanted to share something that has helped me, and to explain the reasoning behind it.
I wanted to add this to my Cerebellar Stroke in a Nutshell post but it seems that once a post reaches a certain age, it can’t be edited by the author. Never mind, I can link it all together as a hypertext post down the track.
Back in January of this year, I became interested in auditory biofeedback, this is a process similar to experiments conducted with behaviourism in the 1930s, using sound to provide signals to the brain in order to evoke a response. Auditory biofeedback is conducted with equipment, a device for producing frequencies and a device for recording and displaying degrees of physiological response. Well, that’s not practical for someone like me, so I thought that the principle could be modified in a more organic and natural way, but serving the same purpose.
Here is my layman’s theory on the subject, keeping in mind that I am focussed on rehabilitating proprioceptive (vestibular) and oculomotor issues, that is, spatial and visual problems. For most stroke survivors, it is the cognitive injury that results in a physiological problem, unless a physiological issue has developed from the brain injury. So, if your leg doesn’t work, for most stroke survivors, it is not the leg that is the issue, but the brain. Same with sight, the blurred vision is not because of eye deterioration but in light of the fact, a part of the brain that communicates focusing control over depth of field is out to lunch.
There are some parts of the body that are autonomous and do not require messages from the main brain but, on the whole, our physiological motor function is controlled by electrical messages passed on by neurotransmitters. I say main brain because I view us having three brains, our cerebrum, cerebellum, and stomach.
When I look up, my eyes know what to do. The oculomotor muscles shift my eyeball upwards, and I am looking up. My eyes know what to do because my brain has told them. My brain has translated the concept and the word up so implicitly that I don’t even have to consciously say it in order to produce a result. I don’t even have to consciously think it. The word up is an Old English word (mainly used as a preposition or adverb), related to the German word auf (on top of). It has been part of our language since we started to shift from Anglo-Saxon to Old English. It is embedded in every English speaker as a word that denotes something higher. Even it’s Proto-Indo-European root word upér has not changed much in the development of our lexicon. It is a rather brief word with only two phonemes, possibly because it was used primarily for situations involving danger or predatory behaviour, or for theological check-ins, or for agricultural reasons, or maybe just to talk about the weather.
I can use all its synonyms to produce the same result; upwards, above, skywards, high, overhead, aloft, &c. All these words will direct my oculomotor muscles to raise to the heavens. So finely tuned is this word that it behaves almost automatically, however, without presupposition, if I command a person to look aloft, their movement is slightly delayed compared to asking them to look up. So, were I to be asked to look pookporkle, what will my eyes do? They would look confused. My brain has no directory input for this word. My oculomotor muscles would sit idle, waiting for the right command, or they may just roll in the ridiculousness of the instruction. it’s not my eyes that have the issue, it’s that my brain is not using the right command to exercise the correct control needed to look to the sky.
Obviously, the function came before the word. We didn’t know the word up when we were babies reaching for the biscuit tin. However, I must mention that linguistic systems are established within our genetics and DNA, so it is sort of superfluous to tag that notion along with this post.
So, let’s use blurred vision as an example. As with looking up, my brain has established a dialectical connection between the word focus and sharpening images across our depth of field. My eyes can focus, there’s nothing wrong with their capacity in doing so. It’s the part of my brain that recognises focus as a function that is not giving my eyes the appropriate command. It is essentially telling my eyes to pookporkle when it needs them to focus. I know I have focus in my input directory because prior to the stroke, I was able to focus. My eyes have not deteriorated. I have had them examined twice now, and my eyesight, in theory, is one hundred percent. So, focussing is probable but it is a matter of shifting that input somewhere else in the brain, so that it can resume that function. The only way I can do that is to retrain my brain to establish that function, and the way I can do that is to use the word focus as auditory feedback, because I know my brain understands the word and associated purpose. In theory, it should be possible to reinstate that sensorimotor function by utilising the conscious voluntary part of my brain that understands that process in order to reestablish the unconscious involuntary function I once had before stroke. There is an exercise where we perform this activity by focussing near and far, in order to rectify problems with our accommodation-convergence reflex, but without audio feedback. This principle is the same, it retrains the brain to recognise the functions that it already knows how to use. Our brains understand the concept of near and far but we have to retrain it to recognise this concept again.
Anyway, this is just a burgeoning theory that I have been putting into practice. I’ve had some efficacy with steadying nystagmus through auditory feedback. I’ve measured this by looking into a bright light while my eyes have been flittering, closing my eyes so that the flittering impression of the light is on a black background, and telling myself to focus and steady the flittering light until it remains still. I have delayed photoreceptor processing, so the light remains visible in my photoreceptors for longer than before, so this makes it handy for observing control over light for longer periods of time.
Apologies if all this unravelling is spelling out the bleeding obvious. I must deconstruct my condition as per I see it, otherwise, I fail to grasp what I ought to do in order to rectify it.