In the previous week, I explored ways of weaving immersive experiences in the context of MRI machines, but for those patients with an operable tumor, there is another facet to their story: the surgery. As a general rule, an operable tumor can be surgically removed with minimal risk. That is, it is neither located deep within the brain (i.e., the brain stem), nor is it near a sensitive region of the brain that regulates vital functions (i.e., movement).
When considering movement on stage, a dancer jumps into the air, but is brought back to the floor thanks to gravity. In relation to physics, the force that is applied to floor is an action, while the reaction to that force is a sound. Similarly, during intra-operative motor mapping, the surgeon will electrically stimulate discrete cortical or subcortical pathways of the brain that control movement. As this step is performed prior to removing the tumor, their hope is that mapping these stimulation sites will help guide the resection more efficiently and accurately, as tumors with poorly defined borders may often be mixed with healthy tissue. Thus, in this case, the action is the electric stimulation and the reaction is involuntary movement of the arm or leg.
Yet, there is more to the physics of dance than merely gravity and applying forces. It’s important to also consider displacement, a term used to describe an object’s overall change in position. In dance, displacement is the distance traveled by the dancer. So, when a surgeon simulates a pathway, the direction or degree to which an arm will elevate, for instance, is going to vary and there are a multitude of patient-specific reasons of why this is the case. Perhaps the patient is older and has restricted arm movement, and so, the displacement is short. So then, how would you demonstrate this on a stage? You would need to also consider the complex interplay of additional factors, like time, speed, and equilibrium. As expected, each dancer will create a space for themselves, but the distance traveled will inevitably vary.
On Monday of last week I was recovering my strength from a virus that forced me to crash pretty hard, and after a few days of weakness and sense of ennui I believe I’ve made a good recovery.
When your body forces you to rest, even as a little kid being home sick from school, I would find my mind would become more active, becoming the stronger sense in a way and taking over for the movement that my body couldn’t necessarily do. There’s an empathetic understanding that overcomes someone as well, if they’re willing to see it, for the blessing that is a “healthy” and “able” body.
Over the weekend I participated in an Advanced Training Workshop for Dance for PD teachers from across the country and even the world, getting to talk theory and teaching techniques, as well practicing somatic exercises for ourselves as well as our students. Gyrokinesis, Somatics, and Anatomy were standouts, and understanding them comes from the idea of experiential learning with the body and mind becoming united in their efforts to learn through movement and exercise. I’ve learned in my Basic Body Work classes at West Side Dance Project that it is through skin sensation that we discover our proprioception, our sense of where our body is in space. In fact, 90% of our proprioception comes from skin sensation from the time we are infants, but as adults we start to lose that sense, and rather than go throughout the world touching and rubbing against every object our visual field (not an especially healthy idea in NYC), one must accomplish this knowledge from experiential learning, and over time perhaps in a dance studio lying on the floor, guided by repetitive motions with a knowledgeable teacher who can cue you with sensitivity, imagery, and anatomical analysis.
Pandiculation is a cool, new word I learned this weekend, and something my cat apparently does over 40 times a day - perhaps why she is so graceful! Basically it’s a stretch, but not the static stretch forcing muscles to their set point to promote eventual lengthening by allowing time to act on our own muscle’s inhibitory response; pandiculation is more about the movement of the spine for example, through your own range of motion, in a gentle and juicy kind of way. This word promotes the importance of a healthy, reflexive spine, and healthy posture throughout the day, not by harsh words like: “sit up straight, chest open, head back…” because although these are decent ideas, they promote tension in their approach. A big thanks to one of my first teaching mentors in Dance for PD, Megan Williams, for this experiential Anatomy lesson in what will be an inspiring new approach to my classes, as well as my own body. Sometimes it is easier to “open up or stand up straighter” when you have experienced a more extreme iteration of the opposite. Try this for example, seated: rather than just thinking “chest up and open(!),” which may cause undue tension in your back and neck, try softening your chest first, by closing off your shoulders and accentuating a hunch bringing your chest towards your spine, letting your head relax down. Try resetting to “neutral” and then repeat the activity by adding an exhalation to the “softening” movement. Now try opening up by bringing your chest/sternum up towards the sky. Repeating this activity, paying particular attention to your jaw and tongue may be of interest (as it was with me). Repeating this activity nice and gentle, can increase awareness of where you might sit naturally, where undue tension may be, but also just give you a nice thoracic mobilization. Ah…
Especially in diseases like Parkinson’s, human interaction can dwindle leading to isolation and eventually depression. Promoting solo exploration in class that includes patting, tapping, rubbing, massaging etc., one can engender a sense of knowing in the simplest of ways. Partnering also helps accrue some of this knowledge, but if you are alone try this:
Thinking more critically about this, one can start to unpack the inherent difficulty and added challenge when dealing with certain Parkonsonian symptoms such as reduced arm swing, heavy and lowered head, thoracic kyphosis, and a contracted lateral pull. Think what it’s like to experience this while seated, but also while standing, and especially while walking.
Taking processes like somatic and subcortical learning to dance (or physiological) concepts like effort and counterbalance, and complicating it with the addition of performance filters like variances in time, space, and touch in partnerships or solo work can be quite compelling, lending their own narratives to rather quotidian movement. Continuing thoughts from previous conversations, I know that immersive theatre techniques can be exciting, but I also am searching for ways to exemplify brain phenomena, like communicating dendrites or failing dopamine molecule structures, in essence, not through anthropomorphic means, because the brain is very much a living entity, but through personification, seeing humans in motion depicting patterns within the chaos, which I believe do exist. I believe there is an internal rhythm and architectural beauty within the mysterious brain, and a loss of structure and rhythm when in the face of illness such as neurodegeneration.
During our most recent Skype conversation, my SciArt collaborator, Michael, Kate, and I discussed the power of immersive experiences. That is, what if you could bring the audience “inside” of a MRI scanner in an effort to minimize fear? These tube-shaped machines are relatively dark, and because of their narrow tunnels, it is not surprising that many would feel claustrophobic. It’s a concern many first-time participants share, and as someone who is usually on the other side assisting with the image acquisition, I often forget this, unfortunately.
While brainstorming ways to simulate this experience, we initially considered manipulating the lighting, but if you are having a structural brain MRI, it’s completely dark. Though, if you are asked to partake in a task and respond, then you’ll likely see images flash across the during a portion of the scan, in which case you’d be having a functional brain MRI (fMRI). However, “darkness” and “lightness” are merely terms used to describe human perception - simply put, it’s an experience that we all perceive.
So, what if we explored sound? Certain sequences are known to be louder and may slightly shake the patient’s table. As one example, diffusion tensor imaging provides valuable information regarding the location and orientation of the brain’s white matter tracts. Prior to administering these sequences, patients are reminded that these ones are going to be particularly loud and to not be alarmed if the table underneath them moves a bit.
But, what does it really mean to have a MRI scan? Our bodies are primarily water, and so, we are comprised of several hydrogen nuclei, which have a positive charge and normally spin in random directions. When we’re inside a scanner, though, these hydrogen nuclei will pause and align either parallel (pointing up) or anti-parallel (pointing down) due to the scanner’s magnetic field. Yet, they will continue to move - more precisely, they will precess (or rotate) around the magnetic field lines.
Hence, should we selectively choose aspects of sound, like pitch and intensity, to manipulate, and which features of light and color can we modify? Do we restrict ourselves to what we’d expected: black and white? Or can we incoporate other colors, and where do our emotions fit in all of this?
My thoughts have been mostly about Parkinson’s Disease (PD) as of late, and how I can bring this mysterious neurodegenerative disease to its unfortunate place in the center of the self-care, brain-health conversation - really, to the forefront of societal consciousness. I had some great conversations with my SciArt partner Devika and Kate a few days ago, and it compounded in my mind with an inspiring chat I had with Lisa Cox, a PD research advocate in South Carolina. I’ve come to the realization, or maybe we all did(!), that many people with mostly able bodies and minds actually suffer from the spirit of Parkinson’s, if not the letter of the disease. The symptomatic realities that affect many a working folk day in and day out are synonymous with the realities that PD brings as well.
The often silent symptoms that affect the mental, emotional, and spiritual states of being can be found in distinct iterations within people who don’t have PD. Stress and fear can immobilize; one’s voice can be taken away; and, as a result besides accessibility issues being common, isolation and immobility become part of everyday life - even if not manifested physically, then emotionally and spiritually. Though it may be more heavily pronounced in PD, it is no less apparent in most everyone’s lives at some time or another.
How many times have we felt powerless? Voiceless? Or tired, even useless? And how many times has a stressful or traumatic event left us immobile, or paralyzed, stuck inside our own racing mind? In chronic states of pain and stress, how often are we found stagnant, both mentally and emotionally?
As a theater maker, in order to find a solid narrative for an audience to latch on to, I have come to realize the story being shared onstage should be as specific as possible. It’s an ironic but solid truth. By shining a light on one person’s problems, and the subsequent quagmire through which they trudge, we are actually able to highlight commonalities between more persons and families with any given stress. When we combine technical elements, like lighting, sound (binaural audio with the aid of earphones or in the space), projections, and set design, we can transform worlds and transport people to our liking. When we combine, or selectively curate other sensory elements (by either aggrandizing or subtracting) we can push the boundaries of reality - placing an audience inside the story for a more experiential awakening.
As a socially engaged artist, I believe there is a larger domain at play in the context of intimate art making within a community, and that every artist has a responsibility as a citizen to practice art through the paradigm of education, beneficence, and justice. We need to be cognizant; therefore, of how we might empower people with PD as well, to allow them to break free and explore their own creativity and prowess as performers. We aren’t simply depicting their story onstage, for I believe such stories necessitate the real heroes (who fight every day against an incurable disease) to voice their own stories. It is vital to devise a cast of professional actors, dancers, and musicians, with PD and without to speak their truth.
Throughout my own acting, clown, and dance training, as well as from direct observation and research, I realized that, onstage, there are emotional states of being that are more accessible than others. And especially with those who have PD, I have seen fear, anger, and sadness, beneath the surface of frustration, but I have come to realize it is only through a sense of joyous wonder, curiosity and playfulness that certain emotional states of being can be unlocked. It is in the pursuit of fun and self expression, through creative explorations and exercises, theatre games, and the like, that we can empower ourselves, and find our greatest tool: our imagination. And in doing so, I think we can utilize the arts to build community and creativity as means of advocacy and empowerment.
In attempt to predict the direction of intra-operative brain shift, I conceptualized the series of events leading up to that precise moment. Following the removal of the dura, the pressure in the brain changes and we witness a loss of cerebral spinal fluid (CSF), the clear liquid that surrounds and nurtures the brain. As a result, the brain collapses under the force of gravity and seeks to inhabit the space previously occupied by the CSF and the tumor tissue that is removed during surgery. But, what drives this movement?
In physics, we know gravity is a force that attacks a body toward the another physical body with mass, and that that for every action, there is an equal and opposite reaction. That is, these forces (action and reaction) come in pairs - when one object directs pressure to another, the second one will respond equally, but in the opposite direction.
However, anticipating the direction of brain shift is not as straightforward. Soft neural tissues deform non-linearly. And so, this movement is neither linear nor perpendicular to gravity, but rather a consequence of the dynamic interactions between the plethora of forces (i.e., gravity) and the resected regions of the tumor tissue?
That is, is intra-operative brain shift a dance with gravity?
Dance has been around since the dawn of human existence, whether as a form of expression, entertainment, or education. And although what dance is could be hard to define depending on who you are speaking to, I would argue that all life form, on some fundamental level, moves in a rhythmical pattern, unique to them, and perhaps even unique to all other life forms. So what if something that is innate becomes lost or something most people take for granted suddenly becomes seemingly impossible? What happens to systems within the human body that run without much conscious effort when they are suddenly disrupted by disease or trauma? Is there a way to acquire them again?
Is there a way of connecting to a system within the human body that doesn’t usually require conscious interference? And if so, might we be able to repair it if need be?
For the last four years, I have worked with the Parkinson’s community as a teacher, volunteer, and assistant in Dance for PD® and PD Movement Lab℠. I have really enjoyed getting to know the brave and beautiful people who come to class week after week, meeting the demand of Parkinson’s disease head on, with an open heart and keen eye on exploring their bodies with creativity in a community that thrives together.
Dance, and its stimulating effects on the body and the brain, has been the subject of many recent studies, as has the study of yoga and meditation and other ayurvedic modalities. For one thing, they both encompass the voluntary communication between the mind and the body, and the undivided attention of one to effectively create change in the other. Of course one could say there is a symbiotic relationship at play in terms of touch and proprioception as a building block for movement learning, but it’s safe to say that whichever way the flow of information is going, it’s a crucial one for not only development, but also healing and nuerorehabilitation.
I’ve experienced the transformative power of Dance, both as a physical training tool, and one of creative expression. In conversation with my partner from across the country, I have been inspired to delve deeper in some research I’ve had on the periphery over the last year or so…
Ever since my studies of Performance Psychology with Dr. Noa Kageyama, I’ve had the interest to see if my Dance for PD students would benefit from such encoding, consolidation, and retrieval methods spelled out in Make It Stick: The Science of Successful Learning - if long term learning might be attainable in what can sometimes be a tenuous brain body relationship. And how such development might be quantified and codified after time. I’m quite intent on putting such methods into practice while developing this show I’ve been co-writing with members of the Brooklyn Parkinson’s Group.
Another research opportunity will be to reach out to, Julie Worden, a fellow teacher from Dance for PD, and a Kundalini Yoga Teacher, with whom I had the honor of assisting and co-teaching over the last year. There are many speculative connections between mudras and brain reprogramming, so it is something I need to explore, and a conversation I would love to start, which brings me to another book on my shelf that’s been calling me back: Eastern Body, Western Mind.
I’m interested in finding out how certain narrative elements of Indian classical dance might benefit dancers with Parkinson’s, especially in aiding memorization efforts towards mastery of material, and subsequently if improvisation was then added to the mix to ensure a sense of freedom, authority, and creative self-exploration.
In terms of Mudras in Indian classical dance, I now realize the amazing journey in which I find myself. With the help of my SciArt partner I have come to find out that mudras aid in the storytelling, while also conveying specific actions, creatures, or even a certain object to a person.
There's also an emotional component represented by the hand(s), but it’s the dancer’s emotional state, and their natural expression of that state, that guides their intent, making the use of their hand(s) to visually convey those feelings a visual byproduct and not necessarily the meaning of the gesture itself. And finally, a new detail for this particular style, that dancers don't sing or speak while performing, “Hence,” as Devika puts it, “for the audience to understand and to feel engaged, you need to find other ways to express feelings. It's a communication tool and that's partly why most mudras are elaborate and can be a bit complicated.”
She also mentioned to me the importance of the development of certain skills over time, from a young age, building a base for certain moves and rhythmical patterns, and building up in complexity, through practice and repetition, in a sequentially based learning, or cumulative curriculum. I’m thinking what exercises might help people with Parkinson’s develop more dexterity with their fingers, and perhaps, as a result, more strength or control in their shoulder girdle. (Reminds me, I must ask a PT about that correlation between shoulder control and strength, and usage of the pinky and ring fingers).
And the wheels keep turning! Until next time!
This week, I spent some time delving into the literature of brain shift. What fascinates me the most about this phenomenon is that it is both slow and time-dependent. That is, while it is something we expect, we can never predict the outcome. Rather, it changes throughout the procedure. When opening the dura (the tough outermost membrane that covers the brain), the brain will start to deform, or misshapen, as a result of the release of intracranial pressure. This experience is almost like watching a remarkably slow motion scene in an action film. While the intention is not for dramatic effect, of course, observing this in an operating room is highly variable. The displacement of the brain expands, but does so in a subtle manner and is difficult to discern immediately because the effect is normally a few millimeters. I am reminded of a single water droplet generating a ripple - breaking the surface tension, but ever so gradual.
Yet, as the surgery progresses, the shift continues to evolve, because the degree to which it changes depends on the volume of tissue that was removed, and that is the challenge. Does the direction of intra-operative brain shift sink or expand as a result of tissue resection? Or is there some interim state where both of these actions are occuring? These are questions to explore in the coming weeks.
There are numerous studies exemplifying that distinct gestures help promote the memorization of words, especially over the long term; and it got me thinking about how I was taught to memorize Shakespeare in college, and how I’ve taught my Dance for PD classes to learn parts of monologues too, by adding gestures to it. It seems to work best with a combination of both pedestrian everyday “well known” gestures, and poetically derived ones that make sense to us in context. By adding the gesture to the word like a simple arm movement or point of focus, something said out loud and simultaneous to the action, it helps to ensure forward momentum in the storytelling by recruiting other parts of the brain (i.e. the motor cortex) to assist in doing the job.
Classical Indian Dance, from my meager experience, and Hula, which I’ve only also had an introduction to; seem to utilize this method of crafting a story into a dance with specific narrative gestures. What I also find most interesting about Classical Indian Dance is its use of mudras, which I believe has a long history in Hindu and yogic meditation. Not only do they mean something specific to the culture in which it was created (it probably still contains that innate direct meaning to those who understand), but mudras, it is thought (in Ayurvedic medicine) also come with some sort of healing properties - realigning or resetting certain brain patterns. All this is beyond my expertise, however, and I’m looking forward to learning more!
I went through some shoulder rehabilitation after sustaining a whiplash injury onstage, and it took very specific actions sometimes led by the pinky and ring finger to avoid the “winging” scapula and get my shoulder blade back in contact with my rib cage. As a piano player ever since I was young kid, I also remembered reading the meaning behind those repetitive Hanson exercises: among other things, to strengthen the pinky fingers, which over time weaken and become less efficient as far as fingers are concerned. Even now as I type this on my phone (although I love the Home Row, trust me!) my thumbs are superheroes compared to my pinkies, one of which simply cradles my phone at its base, and the other interlocked with part of the other hand’s ring finger seemingly not working at all!
My questions thus started revolving around innervation points for such underutilized nerves, and consequently, muscles; and how one can continue to use things like pinkies (toes too, but that a whole other entry!) most efficiently…
If the muscles weaken over time, what happens to the nerves that run the signals to those muscles? Do they shutdown after a while of non use? And if so, what else is lost as far as function is concerned? What must aggrandize or take over to help compensate for such loss; and eventually, what else happens along the kinetic chain, along the fascial lines of support and tensegrity? Where does the brain fit into all of this hard work in compensatory patterns? If we’re neurologically hardwired to have a dominant side, are we flawed by design, or are we meant to work in harmony - “two households both alike in dignity,” let’s say, one basically better at some jobs than the other - or do other emotional and environmental factors bombard our inherently pure system (see healthy infant and toddler poise versus awkward teenage stances?)…
And for now, I must stretch, for it is the morning, and my cat, reminds me to do so!
Why do you want to engage in science-art collaboration?
Dance has always been an integral part of my upbringing. Whenever I visit my childhood home, I’ll most often find my mother (an Indian classical dance teacher) hunched over her dimly-lit workspace as she prepares her next lesson plan. Papers filled with hand-drawn stick figures depicting various mudras (hand gestures) will be scattered across the table, and brief descriptions of these gestures are scribbled underneath. I’ll pull up a chair and listen as she describes her unique choreography. She’ll begin with an explanation of the story behind the dance piece is she currently teaching and follow with her reasonings as to why she selected a specific mudra to convey a character’s emotion.
From these conversations and my own experiences as a student and performer of Indian classical dance, I’ve come to appreciate this style of art as a fundamental form of human expression, and as someone who works in a cancer research lab, I often think about what do these two disciplines share: movement.
A major limitation in neurosurgery is intra-operative brain shift, a complex spatio-temporal problem that is often the result of removing cancerous tissue during surgery. During the procedure, surgeons use brain navigation systems to note precisely where the tumor is positioned in the brain, but these medical devices assume the patient’s head and brain is rigid, as MR brain images are acquired pre-operatively.
So, how do we account for this inevitable repositioning of the brain? Aside from gravity and specific properties of the tumor, like size and where it resides in the brain, we may also need to consider its programmed behavioral characteristics. How does it interact with, or rather influence, surrounding healthy tissue? Do those interactions partially contribute to tissue swelling, thus resulting in brain shift?
I’ve always enjoyed the scientific process especially when taken out of scientific context. As a little kid I loved finding out how things worked - through observation, deduction, or trial & error, I was always a curious learner. In fact, I still enjoy discovering how things work, especially on a social level. While my curiosity thrives in conversation, collaborative fieldwork, source-material research, and devised work, my wonder lies in the human body’s ability to take in moments of quotidian learning, and moments of trauma as well. Especially present in my work as a theatre-maker and a Dance for Parkinson's Disease teacher are the questions: Where does trauma go after time heals superficial wounds? Does the body hold on to pain after our minds aim to let that pain go? How might we best serve our present selves when our past remains insistent on being heard?
Like in the glymphatic system within the brain, if certain proteins build up and aren’t expelled, neurodegenerative diseases may stem as a result. Through proper sleep hygiene and other healthy habits, one can help our glymphatic system do its job, but how might we learn from this rather self-sufficient system? How might we let go of, let’s say, emotional junk to help clear the way for the emotional tasks at hand? Is there a way to stay in the flow during emotional peaks by moving through stressors with a sense of excited resolve rather than a sense of stagnant, static negativity? Perhaps we can become healthier all around, by seeing something as a bump in the road and not the whole road, as an opportunity and not a dead end. Of course, this is easier said than done, especially if such stressors appear to exist in a vacuum leaving those affected in a chronic state of stress…
Another nascent thought I had since our first conversation is how the kinetic chain might reveal why there’s intra-operative brain shift on a micro level. When the body is under stress, at that precise moment, there are instantaneous physiological reactions that happen, even faster than our conscious mind has time to process that stress. Is there some way to place the body in some sort of state of perpetual rest before such stress strikes, in order to affect less brain shift at the moment of surgical biopsy, etc.? Or is this phenomenon simply another example of our fight or flight response ensuring our own survival?
I enjoy multidisciplinary collaboration, especially because I believe in the cumulative and communal effects of socially engaged art and research. Through a selective cross-pollination of words, music, and movement, along with immersive, sensorial, and documentary style theatre tactics, I hope to broaden the audience experience. In essence, I hope to link the audience’s point of view with that of the subject’s, so to share in the storytelling, leading to a more lasting empathetic experience. I believe science can act as a guidepost and Dramaturg, bringing an audience closer to a story than ever before.