Myelination and Acquiring Skill

When Alex was born, doctors talked to us about a substance called myelin. We learned that it acts like insulation on nerve fibers. We asked some questions but remained confused, and then moved on to other topics of more pressing need at the time, like whether Alex was able to swallow and poop. That was 2007.

What we didn't realize was that breakthroughs in understanding myelin had only been around for a few years, and that the doctors probably didn't yet have answers to the questions we were asking. We also didn't realize that an understanding of myelin would be crucial to our approach to Alex's therapy. Fortunately, research we had done on the brain indicated that children can build new pathways (nerve fibers) in the brain for physical function. For example, if the area of the brain that controls the hand has been damaged, with repetitive use, hand control nerve fibers will form a new path around the area of the damaged brain.

With that in mind, we engaged Alex in repetitive motion, hoping that he might build new pathways around the damaged part of his brain. Even motions that Alex was unable to perform independently at first, such as lift his left foot, we practiced with him by simply using our hands to maneuver the foot. The same was true with swimming and the use of his left arm. In the early days, he was physically incapable of making a free-style stroke with the left arm, so we did it for him, lifting and stretching the arm in our hands. Now, he can do both actions alone. We thought that by feeling the movement, Alex would learn the action, which he did, but we couldn't exactly explain how this happened. We understood that new pathways had been established, but we didn't understand the importance of repetition in strengthening those skills.

The Talent Code by Daniel Coyle, explains elements of why Alex's repetitive motion, even when assisted, has grown into actual use. I have only recently stumbled upon this book, published in 2009, which is one of the best reads I have had so far on the brain. Coyle expertly explains the importance of myelin in acquiring skill. Myelin is a substance that wraps and insulates nerves, like electrical tape around an electric wire. What we thought we understood when Alex was born was that myelin wrapped nerve cells naturally, once, in childhood, and once wrapped they were protected, and if the nerve didn't exist at birth (because, for example, the brain cells had been damaged), then you lost out on your opportunity to form myelin. In reality, myelin continues to form throughout your entire life. As you practice a skill, myelin wraps the nerve cell, again and again, and the more myelin, the greater the skill. Myelin enables the nerve impulse to travel more quickly, and with greater strength and accuracy. Which is why, the more you practice a skill correctly, the more skilled you become. (And the more you practice bad habits, the harder they are to break.)

In Coyle's book, one of the important elements of practice is to focus that practice on fixing mistakes. He gives the example of a little girl learning to play an instrument. During one 6 minute session, she focuses intently on studying and slowly practicing the difficult parts of the music. Eventually she acquires the skill to play through it. He states that she made a month's worth of progress in just 6 minutes with focused practice that targeted the trouble spots.

Another interesting aspect of practice is that it doesn't always have to be original. Coyle uses Emily Bronte as an example. People once thought she was born a brilliant writer. In reality, she and her siblings began writing at an early age as a form of play. They wrote terribly, and often copied from other texts. But, because they worked so hard at their writing, and because they copied from texts with established literary discipline, they were acquiring skill.

And so with Alex, we have a greater understanding of why our physical manipulation of his body helped him learn the movement. We were assisting the myelination process. Until last week, we had been working with his left foot, trying to get him to pull his toe back toward his knee. Until last week, he was unable to even give it a twitch. But, we have been working it. This week, he did it. And then he did it again, and again and again. Then he did it 100 times. Now that we understand myelination, we will refocus our therapy and attack the disabilities with more patience, and hope.