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!