Neuroplasticity and brain injury: with Professor Sitskoorn

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Table of contents:
00:45 Professor Sitskoorn
06:19 Neuroplasticity: how it works
12:31 Neuroplasticity after a concussion
21:19 Neuroplasticity and brain injury

Introduction to this episode on neuroplasticity

Neuroplasticity, or brain plasticity, means the ability of the brain to form and reorganize new connections, in response to learning and experience or following injury. If you want to understand why you need an active approach toward post-concussion syndrome recovery as opposed to one of rest and wait-and-see, you need to understand neuroplasticity. 

And who better to learn about neuroplasticity from than Professor Sitskoorn? As the author of numerous books on this topic, you could say “Neuroplasticity” is her middle name. Together with Melanie, she completely brings the topic to life in this episode of Concussion Stories!

Concussion Stories

[0:00 Melanie] Welcome to Concussion Stories, a Lifeyana podcast series filled with hope. I’m here to let you know that you are not alone in your concussion recovery. I’m Melanie and I spent more than six years experimenting, training and learning in order to heal myself from a very bad case of post-concussion syndrome. And today, I feel better than ever before. 

In Concussion Stories, we dig deep while discussing hopeful stories of recovery, as well as the hard stuff in the messy middle. If you’re struggling to focus, be sure to take breaks. Down in the description of each episode, you can find a table of contents – in case you want to skip ahead. Let’s dive right in.

Professor Sitskoorn

Image credit: margrietsitskoorn.nl

[0:45 Melanie] Today is an exciting day. I’ve been waiting for about six months for this day to arrive. And that’s because today I’m going to speak with Professor Sitskoorn. And Professor Sitskoorn is one of the two people who completely turned my concussion recovery around. I will talk about that later on in this show. But let me first introduce Professor Sitskoorn: she is a Dutch neuropsychologist and a Professor in clinical neuropsychology. 

I got to know her through one of her books, and I’m just so excited to share her insights and wisdom with you today. So without further ado, let’s just kick off this episode and get started right away. Welcome, Professor Sitskoorn, and thank you for sharing your time with us.

[1:27 Professor Sitskoorn] Well, thank you for inviting me, it’s a pleasure to be here.

My concussion recovery & professor Sitskoorn

[1:32 Melanie] I’m glad. I had a special reason for contacting you, because I wanted to invite you to my podcast. But more importantly: I wanted to thank you for helping me turn my life around, essentially. 

Because when I was recovering from my concussion, and later on from post-concussion syndrome, I was hearing the same… I’d say: medical soundbite all the time. “You need to rest”, and there was nothing more that I could be doing but wait-and-see whether I would be one of those lucky ones who recovered or whether I would never fully recover. And this left me completely isolated and, I’d say, in a victimhood mentality. And in the end, I even got depressed

And then I found your book. And in it, you explained how I could sculpt my brain myself. And you even wrote specifically about how improvements would be possible after brain injury. And it was like you wrote that book for me. I just needed your words back then, to kickstart my complete recovery years later. And I really want to take this chance to thank you with all my heart.

Why Professor Sitskoorn writes about the brain

[2:48 Professor Sitskoorn] Thank you so much. I’m very, very moved by hearing this, because it’s exactly the reason why I write these books. And it’s not often that you hear back the impact that you have on people’s lives. So yeah, you sent me that email, it was a very moving email. And I have to thank you, because it’s emails like this and interactions like this that also motivate me. So thank you very much.

[3:12 Melanie] I’m really glad to hear that. And I’m so glad that we get to spend this time together. Because you’re very busy. You have written a lot of books, you’re a professor, you’re lecturing, I believe… What is your story? Why do you write the books that you have written so far?

The brain and human behavior

[3:28 Professor Sitskoorn] Well, there’s different aspects of that story. First of all, when I was a very young girl, I always wanted to be a writer. That was one of my dreams. I had no idea what to write about – I was writing poems at the moment. But I will always wanted to be a writer, so writing in itself is motivating for me. 

But then when I grew up, and I got educated more, and I learned a lot about the brain. And I started learning about the brain, because I was interested in behavior. Behavior is my main interest. It’s not the brain that’s my main interest, but its behavior and it’s development that got my interest. So I learned more about the relationship between brain and behavior and the brain and development. 

And then at one point, I came to understand that this was information that I had to disseminate into the world. That many people would be helped by this information. And as you said, at the time when I wrote The Mutable Brain, this was around 2006. 

Even though The Mutable Brain isn’t available in English, you can read Train Your CEO Brain by Professor Sitksoorn. A link will follow shortly.

The dogma of the static brain

And at that time, I worked also in the hospital, and many times I heard what you were telling me that you heard over and over again. Like: the brain is static, it cannot develop very much once you reach adulthood, where you just have to live with it, et cetera, et cetera. And in my search, I can remember this very clearly, I had the time in my life that I was saying: “Well okay, I’m reading a lot in my own field of work. But let me also explore a lot more information. So what is ground breaking new scientific evidence?”

And in that search, I came across neuroplasticity, which actually was a bit strange because neuroplasticity in itself and research into neuroplasticity has existed for more than 100 years. But somehow it never… there was another dogma that was stronger. And that was the dogma of the static brain. 

The need to share about neuroplasticity

Yeah, so once I educated myself more on the topic of neuroplasticity, I was overwhelmed by it myself and decided more people need to know this. And that was the start of The Mutable Brain.

[5:50 Melanie] I understand. So it really came from passion, I’d say.

[5:55 Professor Sitskoorn] Absolutely, absolutely. For the passion of knowledge, of the passion of writing, and the urge to share information with other people.

[6:06 Melanie] Yeah, and also information that can really help people. Not only people with injury, but also people who are aging, people… also young people: anyone who wants to keep their brain fit, I’d say.

Neuroplasticity: how it works

Neuroplasticity: how it works

[6:19 Professor Sitskoorn] Indeed, basically, it’s about getting the power, or at least a part of the power of your own education, of your own transformation, of your own development. We all have been taught more or less in a way that makes us think: “how you are is how you are”. And maybe even many people say a sentence like: “Well, my father is that way. So I am that way. It’s what it is.”

Neuroplasticity makes rehabilitation possible

And when you know more about neuroplasticity, then you understand that, of course with limits, neuroplasticity actually opens you up to the world. It makes it possible to develop, makes it possible to rehabilitate, makes it possible not only to develop yourself or other people, but in essence (because of the inside world in your head) and the outside world develop in synchrony with each other. So it’s also about developing the world.

[7:25 Melanie] You see how inspiring you are? You’re sharing this hope and you’re also sharing it in a tone that’s really energizing. You can understand how you helped me back when I was so depressed. That I was like: “Wow, there’s a whole world out here that I didn’t know about. And that’s going to change everything for me.” And it did. And I really hope that your words right now will help a lot of people, too.

What doctors (don’t) know about neuroplasticity

So you already shared about the static brain, the common dogma that was present, but I’m sad to say is still present. I hear it a lot from people who come to Lifeyana, who find me, that they are being told that there’s not much that they can do. Or even: that after having had brain injury for two years, no recovery – no further improvement – is possible. Which isn’t true. 

How do we see this? Is it like an old way of viewing the world and a new way? Or how do we frame this advice that a lot of us are given?

[8:32 Professor Sitskoorn] Well, what we need to know is that a lot of the timing in the research in the past years has been dedicated also to the influence of genes, right? And then people were thinking: the more we know about genes, the more we know about genetic makeup, and how people develop and why people are as they are.

Exposure changes your brain

We have the whole nature and nurture debate, for example. And there are people on one side and the people on the other side. And, of course, it’s the interaction between the two. And apparently, this was a new insight for a lot of people also in science and it still is that we now realize how influential it is to expose yourself to certain things. 

If you’re exposed to this, your brain develops differently from when you’re exposed to that. And it’s the interaction that is very powerful. So of course your genes also determine how you develop what you can do. But on the other hand, it’s only in the interaction with the environment – and that is what is possible because of neuroplasticity.

The medical field needs to change

[9:47 Melanie] And that so how does that relate to this? Is it then a worldview that needs to change in the medical field?

[9:57 Professor Sitskoorn] Definitely, definitely. And it has already changed a lot in the past two years. Since I wrote The Mutable Brain in 2006, you see a lot of research has come free. Back then there was already a lot of research, but it’s become more and more. And you also see that with this research now, these findings find their way into clinical practice. And they find a way into the general public also, right?

So more and more, we came to understand that it’s very, very important what you do, what you think, what you feel, what you are exposed to. Because every second that we live, that changes our brain in structure and function.

[10:42 Melanie] Yes, and it can be for the positive and it can be for the negative.

Neuroplasticity has no direction

[10:46 Professor Sitskoorn] Indeed, neuroplasticity in itself has no direction, right? It’s just the mechanism. So if you expose yourself to compassion, to good information, to violin playing, to playing soccer, or whatever, then the networks in your brain develop in such a way that you get better in compassion, better at violin playing and better in playing soccer. 

But then the other way around: if you expose yourself and train yourself, for example, to nagging a lot, the neural networks develop in such a way that it’s easier and easier for you to nag. And then nagging becomes like a really easy thing to do. So it’s positive and negative. And it depends on what you expose yourself to or what other people expose you to.

Concussion recovery: choose your environment

[11:34 Melanie] That’s very well explained. Yes, and that’s a very important thing about concussion recovery as well. It’s very important who we surround ourselves with. Because it has a major influence on our recoveries, for example, if we are surrounded by people who are constantly reinforcing a culture or stress or a situation of stress, which is very bad for recovery. 

And on the other hand, it’s very good to be surrounded by people who are very aware, for example, about taking care of themselves first as being caretakers of us, and then having a lot to share with us as well. That’s a very important realization that I learned very late. But that’s what I’m here for: to share all those lessons, 

Neuroplasticity after a concussion

Neuroplasticity after a concussion

[12:31 Melanie] A lot of doctors are spreading the message still, that after two years of brain injury recovery isn’t possible. And there are a lot of doctors who are doing this in the new way, they are really helping, but there still are a lot of people coming to me who heard the same message recently from their doctors. Do you know where this one is coming from: the two years? What is that?

Lifelong brain plasticity

[12:46 Professor Sitskoorn] Yeah, when you look into literature and also older literature, then you see that there’s always like six months and two years, like a lot of recovery in the first six months and then in the next two years slower recovery. 

But what we need to realize is that because of all kinds of insights that we get more and more, we more and more see that we have neuroplasticity until we die. Right until we die, new connections come into place in the brain, and the brain is still changing all the time. 

Neuroplasticity in rehabilitation programs

What we also know now is because of way more research, that even though hypothetically neuroplasticity is very strong and it can work et cetera, we basically did not have many programs (rehabilitation programs) that used neuroplasticity in the right way. Or that were used to specifically enhance certain capabilities and also emotions, et cetera, of patients. 

So it’s not that there is no more chance to adapt and change and to use neuroplasticity. But the actual evidence-based programmes that we have to enhance cognition, to enhance acting, to enhance emotions, and to rehabilitate people who suffered damage in their brains and damage in their capabilities… we just don’t have enough programs yet. We need to develop a lot. 

Brain injury recovery after 2 years is possible!

So I think that is also because we thought: “Well, it’s two years and after that, well, there is no more hope.” Yeah, we know better now. 

[14:36 Melanie] Yes, okay. So listeners, this is very important to note, okay? There’s hope for brain injury recovery after two years, and I’m living proof of that as well. Most of my recovery came after five years, so that’s a lot later.

[14:55 Professor Sitskoorn] So we need to realize that most of the time we follow up patients in research, it’s in shorter periods, right? You come to your neurologist or the clinician and after you are pretty much capable of taking care of yourself, you don’t come back all the time, right? So it’s hard to monitor that improvement also for clinicians. 

Neuroplasticity as a lifestyle choice

Also, neuroplasticity is not a quick fix. I also try to explain that to people a lot. It’s not that all their plasticity are there and I trained for one month, then everything is okay. That’s not how it works. It’s basically a change in living almost.

[15:42 Melanie] Yes, I completely agree. That’s also the basis of the Cure My Concussion course, in which I convey all of my lessons and everything that I needed to learn in order to make my full recovery. And the method is based on active recovery, but it’s grounded in lifestyle changes. Because you can… for example, for one day, you can do something right, but the next day, it will still be hard to do it right if you’re feeling worse because you trained your brain, for example, on day 1.

Different neuroplasticity mechanisms

[16:09 Professor Sitskoorn] That’s important to realize also, that recovery can have different mechanisms, right? You have compensation, for example: maybe your old skill is not coming back to the same level as before, but you develop other skills that make your living very worthwhile. 

So it’s also important to note that going back to being the same person, of course, is not possible for many people. But developing in a certain way, whether it’s in skills, or whether it’s in emotions, or whether it’s in priorities, or whether it is in finding what’s important for you in life – that’s also very important. 

So I also need to stress that this is not only about getting the same level of skills back, right? It’s not only about repairing what was broken, to say it in a way – it’s also about compensations, about finding new ways. 

Quality of life and meaning

And it’s also about… and I think it’s very important in our culture: we always talk about health in a way. Like, everybody needs to be thinking fast, memorizing fast up to them, etc. And that is not what health and quality of life only is about. 

It is also about your emotions, it is also about what’s important in life, and it is also about adding to other people’s life, for example. So, neuroplasticity is more than only enhancing skills. Do I make myself clear?

[17:51 Melanie] Yes, very much. And this is so well-spoken. And it feels like you understand the journey. I can only speak for myself, but I know a lot of other people’s stories as well, and it has been breaking down their… and for me, it has been breaking down my identity while I was recovering, 

And I, in the end, I’m very grateful for that. Because in its place came something so much more meaningful to me. And it’s so meaningful to do these kinds of things, which I had never imagined when I was back at university, that I would be doing. But now this is my life and yes, that is replacing the other things that were before. 

And I think the moment… or, it wasn’t a moment, more… the mindset of being open to whatever may come to be, instead of trying to get back to who I was, was the moment that I truly, truly made the most progress.

Concussions and inclusivity

[18:58 Professor Sitskoorn] Yes, well, that’s very good to hear. Because I think that’s very important not only to people with concussions, for example, but also to a society in large. Because, we are living in an age where we are talking a lot about inclusivity, we talk about all kinds of ways to be inclusive. 

But basically, we still also live in a society where most of the time we have a norm about what is normal, what is good, what is bad. And I have the feeling that people with brain damage have to fight that all the time. 

Because we started to believe that only when you can do math in a certain way, or read in a certain way, or talk in a certain way, or walk in a certain way, that that is a full life. And that is a battle that you all should not have to fight anymore. But I see that battle every day. So I think what you’re doing is so meaningful because it also helps to change society.

[20:06 Melanie] I have goosebumps, goosebumps right now because it’s so it means so much to me that you recognize the visibility of it all. That’s a really big part. 

Every brain injury is invisible

I’m trying… On the one hand, I’m trying to help people one on one. Then I’m trying to change the medical field, and I’m also trying to give people recognition that they are not alone in what they feel and that it is okay how they feel. And it’s such a struggle that every brain injury is invisible.

[20:36 Professor Sitskoorn] Yeah, indeed it is. And, and, well, patients tell it of course, right? Some, they look very good. And people say: “Well, look, you’re doing well, you’re walking well, you’re talking well.” But there’s so many other aspects that you have to fight basically, and that you have to figure out for yourself. 

But that… I think when you can bring up the energy to do that… that path will really really enhance your life, not only your skills. And you need other people with that, so it’s very good that you build the community and make us all aware of the things that crossed your path, basically.

Neuroplasticity and brain injury

Neuroplasticity and brain injury

[21:19 Melanie] Thank you. Can you maybe share a bit of what you already shared about the use of neuroplasticity for people with a brain injury? You could name an example so that it comes to life a little bit more for people?

Experience-based neuroplasticity

[21:34 Professor Sitskoorn] Yes, well, when you talk about neuroplasticity, there’s basically different ways of neuroplasticity. And what is important for I think for your listeners, is what we call experience-based neuroplasticity. And experience-based neuroplasticity means that your brain will develop in relation to what you expose yourself to – specifically you. 

Like: you already gave you the example that if you are surrounded with people that are responsive to you, kind to you, who provide you with certain information, then your brain develops in a certain way that will help your life of course, and help your own development. 

Sujit Kumar

But it’s such a strong principle that… Let me share a story that you must have read about, again, in The Mutable Brain. It’s about Sujit Kumar, and I met him several times. He lives in Suva, in Fiji. And Sujit his mother died, his father died, and he was raised – because of all kinds of circumstances – in the chicken coop for the first years of his life. So for years, he was in the chicken coop and he was basically raised by chickens. He hardly had any human interaction. 

And of course, Sujit has human genes, right? We all can be clear by that, but the environment was the chicken environment. So Sujit learned to hop on one leg. Sujit actually tapped into his food. Sujit made chicken sounds when he was found by his guardian, Elizabeth Clayton. 

Neuroplasticity enabled neural change

And so Sujit developed (even though he had human genes), he had developed chicken behavior when he was found by Elizabeth. And she exposed him with so much kindness, so much love and to a really, really good environment with people that were sweet to him, people that took care of him. He was surrounded by language, by music, by motor skill training, et cetera, et cetera. 

And even though Sujit still is far from normal development, because there are also limits about what you can change – Sujit now is happy. Sujit now is capable of social interaction. He can kick a ball, he plays in the water. He can eat… he likes to eat with his hands, but he can also eat with a spoon or fork. 

So that is a huge change, because Sujit was found when he was already an adult. And because of neuroplasticity, he was capable. Because he was exposed to a very nurturing, rich environment. He was capable of changing to more human-like behavior.

Relearning after brain injury

[24:34 Melanie] That’s a beautiful example. And it shows that even from such a very… you would almost say: alien way of raising a child… he could make these changes and adapt to it. 

Yeah, and that’s also what is possible after brain injury, right? So, if we expose ourselves to the things that we want to learn – or relearn – then we can build these muscles in our brains, so to say, in order to be able to do that in the future. But it takes consistent and conscious practice, that is my experience.

Adapting to what happens in life

[25:18 Professor Sitskoorn] And also you will experience a lot of frustration, of course. Because in their minds, most people have a level to which they want to develop. Or they have an idea: I want this or I want that. And maybe that is not always completely possible, and you have to adapt to that. But that’s also what life is about, right? 

If we look at the times we are living in with COVID, we all have to adapt constantly. And most of us are able to do that. And that’s also because of, well, because your brain is an open system. It’s not a closed system. It’s an open system, continuously in interaction with the people around you, with the environment around you. And that is how you will develop.

Leave a comment below

[26:08 Melanie] I think you have shared so much wisdom in this… what is it… 28 minutes! And I really want to thank you for everything you’ve shared, I really hope that it has helped a lot of our listeners.

Anyone who feels helped by this: do not hesitate to share a message with Professor Sitskoorn or me by leaving a comment, so that we also know that you have heard us and it makes us happy. And it motivates us, as Professor Sitskoorn also said, to hear about your stories, and how it helps you. 

I want to thank you, Professor Sitskoorn, for your time. 

[26:50 Professor Sitskoorn] You’re welcome. 

[26:51 Melanie] And I really enjoyed talking with you.

[26:55 Sitskoorn] Me too. And thank you again for all your efforts. It’s inspiring.

[26:58 Melanie] Thank you so much. 

What do you take away?

Now I would love to hear from you. What do you take away from this episode? Is there something that you can apply to your life right away? Head on over to lifeyana.com and leave your comment now. 

And if you want to hear and read more Concussion Stories, actionable steps and inspiration, be sure to subscribe to the Lifeyana email list while you’re there, so that you never miss out on new materials we constantly make for you. 

If you want to support this podcast, head on over to patreon.com/concussion stories. Thank you for listening to this Concussion Stories episode by Lifeyana. May you be well, and may you be happy.

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