Monthly Archives: July 2013

Mirror Neurons – Who is the Mirror?

Butterfly Hunting

We’ve been traveling a lot. This picture is from this past weekend when Zoe and Mia spent a lot of time hunting butterflies in Vermont.

Modern neuroscience is fueled by brain imaging and many new theories about how we learn what we learn. One such concept is that of mirror neurons, that by watching someone else do something, one can gain neural activity in the corresponding neurons.

Another is that “Cells that fire together, wire together.” This theory is attributed to Donald Hebb but popularized by Norman Doidge in The Brain That Changes Itself, worth reading for anyone interested in better understanding neuroplasticity.

A friend shared a short TED Talk with me that I include below. It’s an honest emotional account by first time parents of a young stroke survivor who is a year-and-a-half younger than Mia. Much of it resonates with me. While I was not a first-time parent, I was taking a leap in having a second child as a single mother about to turn forty. When Mia was a full-term healthy baby weighing 9 pounds 5 ounces with excellent Apgar scores, I was relieved and so happy. I too was not ready for the sudden hospital transfer when Mia was two days old, the news after many tests that she had had a stroke. I also asked impossible questions. Why me? What will she be like? What can I do to make her better? Mia wasn’t part of a Mirror Neuron Pilot but she has piloted her share of therapies and approaches. She has definitely taught me more than I’ve taught her, and she is an incredible gift. As the parents in the TED Talk conclude, “Consider what you have as a gift, what you miss as an opportunity.”

When Mia was about two months old, a wise friend gave me sound advice to love her as a whole child, not less than because of her stroke. There’s been an active discussion within the community of parents of pediatric stroke survivors about the risk of treating the affected arm or leg at the expense of the child’s sense of wholeness. Many of these kids face challenges with anxiety as older kids, teenagers, and young adults. And, their parents find themselves wondering once again if they chose the right therapies to do and not do.

I embrace the approach of the parents in this TED Talk. Shower all children with love, and show them what you know and love. The world is an incredible mirror. They will find their way.

Neurologist Visit – 4 Years Old

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Mia and I went to see her neurologist yesterday afternoon. It took most of the afternoon. She was nearly asleep when we arrived at the hospital in Boston which made her kind of cranky for the wait, compounded by her accidentally spilling her orange juice and then requesting another one. I said no. A young resident came out to tell us it would be another 15 minutes after it was already 15 minutes past our scheduled appointment time. I later learned that the resident is an adult neurology resident on her mandatory 3-month stint in pediatric neurology.

When the nurse came to take Mia’s vitals, Mia did not want to get on the scale. I said she weighs almost 40 pounds. She just had her physical. I don’t want to fight with her about this as it’s not really relevant to her appointment today. Mia then cooperated to get her height measured and to have her blood pressure taken, also both not particularly relevant.

When the resident did finally call us into the room, she asked me some questions that were annoying and not particularly useful, like, “So I was reading her chart, and it looks like everything’s been fine since she was 3 months old?” Yeah, I guess, if you define fine as no seizure medications needed since then. I simply said yes. I continued to answer her questions. She tried to engage Mia and Mia decided not to talk but to giggle instead. She asked Mia to touch her finger and then to touch her own nose. She asked her to do it with the other hand. Mia did. She asked her to jump up and down on one foot, and the other. She tried to test her reflexes. It wasn’t clear she got the response she was seeking.

After about 10 minutes, the resident went to get the attending physician. Another wait. Mia asked for my iPhone and I gave it to her. So when the attending came in, he had to persuade her to look at pictures in books instead of at the pictures and movies that she was trying to show him of her great skills in skin-the-cat, the monkey bars, bicycling, and others. He asked me more relevant questions, did a cursory neurological exam, had her name various objects and animals in a book and talk about their categories and functions. She sailed through all of this. He said she’s doing great.

The resident asked the attending if we should come back in a year. The attending paused to have a conversation with me. I questioned the value of hearing him say that she’s doing great. I know that. I explained that we go to the stroke clinic next month and will continue with that every two years until Mia is 10. In the end, we agreed that the resident would write “as needed” on the form, I will call the attending to discuss Mia’s progress in a year, and maybe he’ll see her in three years when she’s seven, if he hasn’t retired by then!

A year ago, I was really disappointed that he told me to bring Mia back again in a year.

So, I’m relieved now that he and I were essentially on the same page. These appointments are hugely time consuming and must provide more value than the one yesterday to justify the time. I’m grateful to have had high-quality care from this neurologist since Mia’s arrival in the NICU when she was two days old, but we’re well past that point. If any new issues arise, I won’t hesitate to seek care, and three years is a long time. It’s very hard for me to say whether I will think it’s worth it to try to go see him again then, and to deal with whatever resident is on rotation at the time.

There’s one other thing that bothers me about taking Mia to all these appointments, now at age four. She has to suffer through them too and I think it has an impact, hearing me answer all these questions, hearing me talk to the doctors. I’m totally comfortable explaining everything to Mia but I’d like to reduce the need for Mia to spend hours in waiting rooms and exam rooms, time when she would be better served playing at home or school, further mastering her world.

Case Study: Skin-the-Cat

Mia taught herself to do skin-the-cat the weekend of her birthday party, days before turning four. This is one of many seemingly amazing milestones she’s hit this spring and summer. I’ve been celebrating them along with her and Zoe. In fact, the first time she did it I was not watching and Zoe helped her. Mia came to tell me and repeatedly told me, “I’m so proud of myself!” And, she was, she owned her new accomplishment.

Here she is, the morning of her birthday party in full action.

I have a series of posts in mind that I’d like to write over time to show and tell how I think it’s been possible for Mia to master so much. I happen to have a lot of photos and videos of her development. This is the first such post. Mia is incredibly determined and courageous and always has been. I’m quite attuned to her needs and goals and have focused a lot of attention on providing an environment where she can continue to thrive and learn, sometimes in surprising ways. Mia has been pretty persistent at mastering her world since infancy and that continues. Her repeated practice in different settings allows her many “successive approximations” until she masters a new skill. This notion of “successive approximations” is one that Feldenkrais wrote and spoke of often.

At four years old, Mia definitely owns her “I can” attitude. She has many experiences of watching her older sister, Zoe, master one thing after another. And, Mia comes along finding her own way to do many of the same things in her own time. Just this week, she surprised me in the lake where we swim. She’s swimming farther each day than the last without assistance or floatation and now she’s asking to dive under my legs, just like Zoe. And, she surfaces with rocks in her clenched fists asking me to guess which one has the rock and which one has just sand.

This story goes way back to when Zoe was an infant and some friends lent us this baby hammock for her to sleep in. Zoe was so mobile that she only lasted a couple of months in this hammock because I was afraid she’d end up on her belly in the soft hammock and obstruct her breathing.

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Those friends needed it to lend to another family so we gave it back but I asked to borrow it again when I was expecting my second child. I had it set up days before Mia was born, and Zoe discovered that it worked pretty well as a place to swing like a monkey. Zoe was nearly 2.5 at the time.

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Mia did sleep in it too for a few months. By the time she was done with it as a sleeping hammock, Zoe’s habit of swinging from it was so established that I put the hammock away and left the frame in my bedroom for daily gymnastics practice.

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Mia started to swing from it a couple months after turning two.

Zoe taught herself to do skin-the-cat on the hammock frame when she was 4 years, 8 months.

When Mia was nearly 3, she could swing from rings like these. Soon after this picture, we got our own set for our outdoor playset.

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At Zoe’s, sixth birthday party, when Mia was 3.5, Mia was able to support herself well on the bar and pull her knees to her chest.

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So, Mia’s seemingly sudden mastery of skin-the-cat on the triple trapeze swing featured at the top of this post really can be traced all the way back to Zoe discovering what a wonderful piece of equipment that baby hammock could be, without the hammock of course.

The frame remains in my bedroom. I’ll close with a video clip of Mia working and working to get her feet on the frame of it. She had done it several times before I started trying to capture it on video so by this time she was tired. But, you can still see her determination, intense persistent efforts and ¬†good attitude. Note how she experiments with placing her hands in many different spots to see how that feels and works. Allowing all of these attempts is what ultimately helps Mia build strength to master these skills and many others. And, she can transfer the same skills to doing the monkey bars.