Neuroscience Unit
Day 1

Procedures:
o Procedure 1 (Notes): 20 minutes
o Have a diagram of the brain already drawn on the board.
o Cerebral cortex: ‘Cortex’ means bark. This acts like a bark to protect the lower
brain. It is the outermost layer of the brain that is made up of 4 lobes & is
needed for very high level thought.
o Fissure: A depression from the front to the back of the brain that marks the
division of the two hemispheres.
o Hemisphere: The two sides (left & ride of the brain). These sides work
together to accomplish many tasks. They blend together what the two eyes
see & what the two ears hear.
o Corpus callosum: A bundle of fibers in the middle of the brain that connects
the two hemispheres & enable them to work together.
 Split brain: A surgery where the corpus callosum is severed in order to
cut off the communication between the two lobes, which would help to
stop extreme seizure cases.
 In 1961, two Los Angeles neurosurgeons, Phillip Vogel &
Joseph Bogen, speculated that major epileptic seizure were
caused by amplified abnormal brain activity that reverberated
between the two hemispheres.
 Each eye sends information to the opposite hemisphere of the
brain. Without the corpus callosum enabling the hemispheres to
communicate, the different hemispheres of the brain could be
tested separately on tasks.
 In an early experiment, Gazzaniga (1967) asked split-brain
patients to stare at a dot as he flashed HE*ART on a screen.
Thus, HE appeared in their left visual field (which transmits to
the right brain) and ART in the right visual field (which transmits
to the left brain). When he then asked what they had seen, the
patients said they had seen ART. But when asked to point to the
word, they were startled when their left hand (controlled by their
right brain) pointed to HE. Given an opportunity to express itself,
each hemisphere reported only what it had seen. The right brain
(controlling the left hand) intuitively knew what It could not
verbally report.

o
o
o
o
When a picture of a spoon was flashed to their right
hemisphere, the patients could not say what they had viewed.
But when asked to identify what they had viewed by feeling as
assortment of hidden objects with their left hand, they readily
selected the spoon. If the experiment said, “Right!” the patient
might reply, “What? Right? How could I possibly pick out the
right object when I don’t know what I saw?” It is, of course, the
left hemisphere doing the talking here, bewildered by what the
nonverbal right hemisphere knows.
 People with split brain surgery often at first have to deal with
their right & left hands working independently.
o One buttons & one unbuttons a shirt.
o One put things into the grocery cart & one takes things
out.
 Dominance:
 When dealing with small, fine movements such as writing or
placing your finger in your ear, one hemisphere has dominance.
 The right hemisphere controls the left side of the body, while the
left hemisphere controls the right side of the body.
 Tasks of the cerebral hemispheres
 In general, the left hemisphere deals with:
o Speech, language, logic, & writing.
 In general, the right hemisphere deals with:
o Spatial reasoning, art, music & emotions.
 Disclaimer: The hemispheres work together in virtually
everything that they do.
Lobes: The four major sections that the cerebral cortex is broken up into.
 Frontal lobe: The frontmost area of the brain.
 Prefrontal area: The frontmost part of the frontal lobe. This is
where you reexperience personal memories.
 Frontal association area: Behind the prefrontal area. This is
where associations between ideas & the forming & planning of
activities happens.
Motor cortex: This is behind the frontal lobe. ‘Motor’ means movement. This
control all movement in the body.
Parietal lobe: The area behind the frontal lobe. It interprets sensory
information.
Sensory cortex: This is behind the motor strip, & it interprets the sensations
that we feel.
o Association areas: These are responsible for integrating the information that
the brain receives. They are found in all four lobes (parietal, occipital, frontal,
& temporal).
o Occipital lobe: Located at the very back of the brain, it interprets images
(makes sense out of what we see).
o Temporal lobe: Located underneath the other lobes. The major center for
hearing.
o Procedure 2 (What Could Happen): 10 minutes
 Read the Phineas Gage story:
 Phineas Gage: In the 1840s, a railroad worker with the unlikely name
of Phineas P. Gage was injured in a freakish accident, which gave us
clues into the nature of the frontal association area. He was pushing
some dynamite into a hole with a four-foot-long iron bar in the shape of
a toothpick, about an inch in diameter. The dynamite went off, firing the
bar upward through his jaw, through the frontal association areas, and
on out. Remarkably, he survived, because none of the vital parts that
control breathing, movement, or physical control had been damaged.
Still, the injury to his frontal association area resulted in some major
changes. While he had been friendly and normal, suddenly he become
someone who swore all the time, undressed whenever he felt like it,
urinated in public, and had temper tantrums. Thus, this complex area
of the brain must play a large part in what we call social control as well
as in our basic personalities.
 So, what could happen with an injury to the frontal lobe?
o Procedure 3 (notes continued): 20 minutes
o Lower brain: Located deep inside the skull, the cerebral cortex is fits over &
around this. This is the part of the brain that keeps the body running.
o Thalamus: It is an oval mass of nerve cells. It acts as a relay station for
incoming & outgoing messages in the brain.
o Hypothalamus: ‘Hypo’ means below, & this sits below the thalamus. About the
size of a pea, it controls rage, pleasure, hunger, thirst, & sexual desire.
o Limbic system: This involves structure (the amygdala & the hippocampus)
that control emotions, & some aspects of memory.
 Amygdala: Also located below the thalamus, this controls emotional
responses, especially aggression.
 Hippocampus: Another located below the thalamus, but beside the
amygdala, this is where memories are formed (they are sent to &
stored in the prefrontal area of the frontal lobe).
 What could happen if the hippocampus was injured? What
would happen to the memories you had already formed?
o Cerebellum: This looks like a ball of yarn attached to the base of the brain, &
it is responsible for your ability to stay balance, remain coordinated, & get you
where you want to go. This is where automatic actions, like muscle memory is
stored (actions that were once conscious efforts).
 Ex: Walking a straight line, sticking your finger in your ear, getting from
one class to the next during the day.
Day 2

Procedures:
o Procedure 1 (notes): 50 minutes
o Brainstem: This begins where the spinal cord enters the skull & swells
slightly, forming the medulla. This area of the brain is responsible for
automatic survival functions.
 Medulla: This is the control for your heartbeat & breathing.
 Reticular activating system (RAS): Also called the reticular formation,
this sits right at the base of the brain inside the spinal cord. Imagine a
mesh net with one end of a hose stuck through it by a few inches, &
that’s basically what it looks like. It is responsible for arousal/alertness.
It interprets the impulses between the brain & the body to regulate how
sleepy or alert you are.
o Neuron: This is a nerve cell, which is a part of the system that sends
messages around the brain.
 Action potential: This is an impulse, which is a brief electrical charge
that travels down the axon. It is activated when it receives a signal
from its sense receptors (dendrites).
 There are excitatory singles & inhibitory signals.
 Threshold: This is when the excitatory minus inhibitory signals exceed
a minimum intensity (the threshold) & trigger an action potential.
 Dendrites: Meaning ‘tree,’ these short fibers look like branches & they
receive information from other nerve cells & send it through the cell
body to the axon.
 Axon: This is a very long fiber that carries a message from the cell to
the other neurons. At the end of an axon there are thousands of
terminals sitting opposite the receptors for another neuron.
 Synapse: The space between the ends of axons & the ends of
dendrites.
 Vesicles: This is just before the end of the axon, & it contains
chemicals for transmitting messages called neurotransmitters.
 Myelin sheath: A fatty layer of tissue that insulates that axons of some
neurons & helps speed their impulses.

Multiple sclerosis: This is when the myelin sheath breaks down
& therefore slows the communication to muscles & the eventual
loss of muscle control.
 Glial cells: “Glue cells,” these guide neural connections, provide
nutrients with insulating myelin, & mop up ions & neurotransmitters.
 Neurons are like queen bees. They can’t take care of
themselves. Glial cells are like nannies.
 Neurotransmitters: Differently shaped molecules that send specific
messages. They transmit information over a synapse.
 Acetylcholine: This sends the message when we are getting
ready to move some part of our body. It is also involved in
learning & memory.
o Dysfunction: Alzheimer’s disease.
 Dopamine: Involved in movement, learning, attention, &
emotion.
o Dysfunction: Excessive linked to schizophrenia; lack
linked to Parkinson’s.
 Endorphins: Involved in relieving pain & increasing our sense of
well-being.
 Reuptake: This is the reabsorption of a neurotransmitter after it has
already been fired off by a neuron.
 It allows for the recycling of neurotransmitters in order to
maintain the level of the neurotransmitters.
o Nervous system: The body’s electrochemical information network.
o Central nervous system: Made up of the brain & spinal cord.
 Spinal cord: Handles all impulses from the brain to the body & from the
body to the brain.
 Reflex: An automatic behavior of the body involving movement that is
activated through the spinal cord without the use of the higher brain.
o Peripheral nervous system: All the nerves outside the brain & spinal cord; it
links all the body’s sense receptors, muscles, & glands to the central nervous
system.
 Somatic nervous system: A part of the peripheral nervous system
containing sensory & motor nerves.
 Sensory neurons: Send information from the body’s tissues &
sensory organs to the central nervous system.
 Motor neurons: The way that the central nervous system sends
information back out to the body’s tissues.
 Interneurons: Between the step of sensory input & motor output,
these process the provided information.
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Autonomic nervous system: A part of the peripheral nervous system.
Regulates breathing, heart rate, digestion, etc.
 Sympathetic nervous system: A part of the autonomic nervous
system. It energizes us & prepares us for emergencies.
o Fight or flight. Things that alarm, enrage, or challenge
you.
 Parasympathetic nervous system: A part of the autonomic
nervous system. Works in opposition to the sympathetic system
to calm us down after an emergency or a ‘near’ emergency.
Reflex: Our automatic responses to stimuli. This is composed of a single
sensory & a single motor neuron.
 When your touch something hot.
 Knee-jerk at the doctor.
Neural networks: A cluster of neurons in a work group. With experience,
networks can learn.
 Practicing an instrument, your handwriting, through a ball, singing a
song, reciting the pledge.
Hormones: Chemical regulators that control bodily processes such as
emotional responses, growth, & sexuality.
Glands: Units of the body that contain the hormones.
Endocrine system: System that includes all the glands & their chemical
messages together.
Pituitary gland: The master gland; it activates other glands & controls the
growth hormone.
 Growth hormone: The hormone that regulates the growth process; it is
controlled by the pituitary gland.
Thyroid gland: The gland that controls & regulates the speed of bodily
processes, also known as metabolism.
 Metabolism: The speed at which the body operates or the speed at
which it uses up energy.
Adrenal gland: Glands that cause excitement in order to prepare the body for
an emergency or for some other important activity.
 Adrenaline: Chemical that prepares the body for emergency activity by
increasing blood pressure, breathing rate, & energy level.
Gonads: The sex glands; they make sperm or eggs for reproduction.
 Androgen: The male sex hormone.
 Estrogen: The female sex hormone.
EEG: Electroencephalogram. Electrical activity in the brain’s billions of
neurons sweeps in a regular waves across its surface. The EEG is an
amplified read-out of these waves.

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Comparable to studying a car engine by listening to it hum.
 However, by presenting a certain stimulus repeatedly & having
a computer filter out the unrelated brain activity, you can identify
the electrical wave evoked by the stimulus.
PET: position emission tomorgraphy. This show’s brain activity by showing
each brain area’s consumption of its chemical fuel (the sugar glucose).
 Active neurons are glucose hogs.
 The person is given a temporarily radioactive form of glucose.
MRI: magnetic resonance imaging. Our heads of full of atoms that spin like
tops when they are put in contact with a strong magnetic field. After a brief
pulse of radio waves disorients the atoms temporarily, the atoms return to
their normal spin, & they release signals that provide images of their
concentrations. This results in a detailed picture of the brain’s & the body’s
soft tissues.
fMRI: This can reveal the brain’s functioning as well as its structure. Blood
goes to the parts of the brain that are especially active. By taking MRI scans
that are less than a second apart, researchers can watch the brain light up as
a person performs different mental functions.
Lesion : This is tissue destruction. A brain lesion is a naturally or
experimentally caused destruction of brain tissue.
 This can be used to destroy tiny clusters of normal or defective brain
cells, while leaving their surroundings unharmed.
Plasticity: The ability of the brain to modify itself after some types of
damange.
 This does not work with the spinal cord or certain assignments of the
temporal lobes.
 This does work with things like losing a finger, where the adjacent
fingers become more sensitive as a result.
 If a blind person uses a single finger to read Braille, the brain area
dedicated to that finger expands as the sense of touch invades the
visual cortex that normally helps people see.
 Brain plasticity is highest in young children.
Broca’s area: After an area of the left frontal lobe had been damaged, a
person would struggle to speak words while still being able to sing familiar
songs & comprehend speech.
Wrnicke’s area: After damage to an area of the left temporal lobe, people
could only speak meaningless words.
Angular gyrus: Reading aloud involves this brain area. It receives visual
information from the visual area & recodes it into auditory form.


When we read aloud, the words register in the visual area, are relayed
to a second brain area, the angular gyrus, which transforms the words
into an auditory code that is received & understood in Wernicke’s area,
& sent to Broca’s area, which controls the motor cortex as it creates
the pronounced word.
Depending on which link in the chain is damaged, a different form of
aphasia occurs.
 Aphasia is a damage to any one of the several cortical areas,
which impairs the use of language.
Day 3
o Procedure 1 (Case Study): 20 minutes
 Read the Case Study on pg. 78 together as a class.
 Have the students answer the questions on the Phantom Limbs Case
Study sheet.
 Go over the questions together.
o Procedure 2 (): 30 minutes

Phantom Limbs Case Study—Page 78
Name:
Date:
Period:
1. What is a phantom limb?
2. What causes a person to have a phantom limb?
3. What are the possible reasons that the brain would feel it needs to create a phantom
limb?
4. What parts of the brain are associated with a phantom limb?
5. What are the problems associated with a phantom limb & how can they be dealt
with?
Day 4

Procedures:
o Hook (Articles about Injuries): 25 minutes
 Split the class into 5 groups & give them an article about brain injuries
& their results on the body.
 Have the students use the provided worksheet to locate specific
information from the article.
o Procedure 1 (Presentations): 15 minutes
 Have the groups present their articles & answers.
o Procedure 2 (Reflection): 10 minutes
 Have each student write a half-page reflection talking where they have
to choose a part of their brain to be injured. What would you pick &
why?
Injuries to the Brain or Body & Their Effects
Name:
Date:
Period:
1. What was the injury (what parts of the brain and/or body were affected)?
2. How were these parts affected?
3. How did the person’s life change?
4. What is the job of the part of the brain that was affected?
5. How could we use the way the brain and/or body work to address the way the
person’s life was changed by the injury?
http://www.nytimes.com/2010/07/04/nyregion/04soldier.html?_r=1&ref=traumaticbraininj
ury&pagewanted=print
July 2, 2010
Spirit Intact, Soldier Reclaims His Life
By LIZETTE ALVAREZ
WASHINGTON
BRENDAN Marrocco and his brother, Michael, were constructing a summer bucket list, to get them out
and about, trying new things. A Washington Nationals game versus their beloved Yankees — sure, since
they were stuck here rather than home on Staten Island. Perhaps a ride on the Metro, with its reliable
elevators. Pizza: definitely.
…
Each would be a major accomplishment for Brendan Marrocco, who a year before had come so close to
death that doctors still marvel over how he dodged it. At 22, he was a spry, charming infantryman in
the United States Army with a slicing wit and a stubborn streak. Then, on Easter Sunday 2009, a roadside
bomb exploded under his vehicle, and he became the first veteran of the wars in Iraq and Afghanistan to
lose all four limbs in combat and survive.
In the nearly 15 months since, Specialist Marrocco has pushed past pain and exhaustion to learn to use his
four prosthetics, though he can walk for only 15 minutes at a time. He has met sports stars like Jorge
Posada and Tiger Woods — and become something of a star himself here at Walter Reed Army Medical
Center, where his moxie and humor are an inspiration to hundreds of other wounded service members.
He has also met, fallen in love with and proposed marriage to a young woman who sees what is there
rather than what is missing, though Specialist Marrocco has lately been questioning the relationship.
Now he is preparing for a rare and risky double arm transplant at the University of Pittsburgh Medical
Center that could profoundly improve his independence. One of the first things he will ask of his new
arms is to drive a stick shift (the one time he got behind the wheel, in an empty parking lot, his rubber
hand became unscrewed and was left dangling).
There have now been 988 service members who have lost limbs in combat since the first of the wars began
in 2001, but Specialist Marrocco’s many wounds raised so many questions. Would he crumble mentally?
Was his brain intact? How would he ever cope with daily needs like eating, bathing, even simply getting
out of bed and putting on clothes?
…
A contrarian by nature, Specialist Marrocco has become a bit of a homebody, preferring the haven of
Walter Reed — where he is a role model — to the awkwardness of the larger world. And despite 14
operations, he refuses to let a dentist’s needle near his mouth to replace the eight teeth he lost in the blast.
…
It is difficult, though, to train for hidden bombs, which is what makes the wars in Iraq and Afghanistan so
insidious. All he can recall of that Easter Sunday drive back to his base is the flash of light against the
black of the early morning. “I hit a pressure wire,” he said. “It was across the road.”
The bomb, a particularly lethal one known as an explosively formed penetrator, shredded his armored
vehicle. His best Army buddy, Specialist Michael J. Anaya, was killed. Another soldier was wounded; the
fourth man in the truck walked away unharmed. Roadside bombs do that — choose the soldier on the
right but not the left, the one from Florida but not Georgia.
…
Private Marrocco was rushed in. Within eight minutes, his clothes were off and he was connected to a
giant bag of intravenous fluid. Both arms and a leg had been sheared off. The other leg, the left, “was
hanging literally by a thread,” Major Aydelotte recalled.
Doctors quickly began pumping blood into Private Marrocco’s body, but it sprayed straight onto the
ceiling and walls. Aghast, Major Aydelotte looked more closely. One of the two carotid arteries, which
carry blood from the heart to the brain, was severed, an injury so lethal it can kill within minutes. “When
fragments fly, they make tons of holes in you,” the doctor explained. “He had a hole in his neck. But we
didn’t suspect it to be a carotid injury because it wasn’t bleeding.”
It was not bleeding because there was so little blood left in his body — 80 percent of it had spilled out in
the field. “Any one of his injuries was life-threatening,” Major Aydelotte said. “It’s incredible.”
The medical team cleaned out each amputation wound, took a vein from his groin to reconstruct the
carotid, and sewed him up top to bottom. The same day, he was transferred 85 miles to a larger base in
Balad, and then on to Germany. He had survived the initial trauma and surgery. But other serious threats
loomed: Infection. Pneumonia. Brain injury.
…
The official-sounding voice, hoping to cushion the blow, asked when he had last spoken to Brendan. The
day before. They had talked about a motorcycle that the father was eyeing. The son, a motor head, was
urging him to buy it; one day, they could ride side by side.
…
“How did he live?” Mrs. Marrocco asked.
“We don’t know how he lived,” the doctor said.
The parents, who separated seven years ago, flew together to Germany, where their son was in a medically
induced coma. He was swollen and burnt and stitched, with a patch over one eye. His hair was the texture
of a Brillo pad. His lips were puffed out of proportion.
“Had I not been told it was my son, I would not have recognized him,” Mr. Marrocco said. Mrs. Marrocco
struggled to see beyond the wounds, the respirator and the missing arms and legs. Her son, who was small
to begin with, had all but disappeared. “I could not accept it,” she said last month. “And I haven’t accepted
it.”
…
By Wednesday night, about 90 hours after the blast, Private Marrocco was in Washington in Walter
Reed’s intensive care unit. He drifted in and out of consciousness. In time, he began to realize something
was wrong with his arms, though he could not see them well at first, in part because one eye was swollen
shut.
“He looked up at me and lifted his arms up,” his father recalled. “He kind of looked at them and realized
they were bandaged and they were different sizes. He couldn’t talk. He had a tube down his throat. But he
mouthed the words, ‘I have no hands.’ I nodded to him. And that was it. He put his arms down. ‘O.K.’ ”
Mr. Marrocco did not have the heart to tell his son about his legs. “During that first week, Brendan kept
pleading, ‘Dad, Dad, take my boots off. My feet are burning. My feet are burning.’ I would say, ‘Brendan,
your boots are off.’ ”
…
The family wondered about Brendan’s brain. Bomb blasts are notorious for shaking up the head so
severely they leave tracks of destruction, despite the Kevlar helmets. Soldiers who return home with even
moderate brain injuries can have trouble holding jobs or remembering to pick up a child at day care.
“You can’t rehab a brain-dead individual,” Mrs. Marrocco said. “How would you show him to do a situp if
he doesn’t understand that?”
After Private Marrocco’s brain passed a battery of tests, his family then fretted about his mental health.
Could he avoid the powerful punch of depression and post-traumatic stress, a one-two so harrowing it can
cripple a soldier as easily as a bullet? Not long after Private Marrocco regained consciousness, Sgt. Justin
Minisall, who had been wounded in the bombing, ducked in for a visit. Private Marrocco asked how
Specialist Anaya, the gunner in the truck that day, was doing.
…
Then his brother did something nobody expected: he volunteered to leave his friends, his social life and
his job in information technology at Citigroup, and move to Washington.
…
Since May 2009, the brothers have lived on the Walter Reed campus in connecting dormitory-style
rooms, with a kitchen and maid service. The Army does not charge Michael rent and it gives him $64 a
day for living expenses. The military also underwrites all of Brendan’s expenses, including the hand
transplants, and pays him a $2,400 monthly salary.
…
He mastered standing in his prostheses within two months, and walking a few steps shortly after that. But
walking long stretches is infinitely more difficult, a bit like balancing on stilts, only without the benefit of
knees or real arms for balance. He spends a lot of time doing situps and side body lifts to build up core
strength, then transfers to the parallel bars to walk with support if he needs it. Unlike other soldiers, he
does not listen to an iPod while exercising, so he can fully concentrate on the instructions of his therapist,
Luis Garcia, a former medic in the Army Reserve.
Of all the leg amputees Mr. Garcia has worked with over five years at Walter Reed, Specialist Marrocco
has been the quickest to adjust to his legs. “He has incredible balance, incredible drive,” Mr. Garcia said.
Before and after lunch in the cafeteria he has occupational therapy: writing, picking up small items like
popcorn, positioning a pin on a beret, baking a cake, opening a can. In his wheelchair, a BlackBerry
balanced on his thigh, Specialist Marrocco pecks furiously at the keys with his rubber hand or with his
“fluffy finger,” an upside-down pencil contraption created just for this task.
Unlike using the prosthetic legs, using mechanical arms does not hurt physically. But the tasks are
mentally taxing, and Specialist Marrocco occasionally nods off at the table.
…
THE donor has to be a man. The blood and tissue types have to match, of course. But so do the skin tone
and size. The call could come at any time, and the Marrocco brothers will jump into Michael’s black
Monte Carlo and high-tail it 237 miles to the University of Pittsburgh to prepare for surgery. They have 10
hours to get there to give the doctors enough time to do their work.
Dr. W. P. Andrew Lee, the hospital’s chief of plastic surgery, will lead four teams of more than 20
surgeons to give Specialist Marrocco, as he put it, the chance to live “a normal life” (a fifth team will
handle the donor). His legs would still be missing. But new, human arms would mean he could put on the
prosthetics himself. And: hug tightly, drive, twist open pill containers, catch himself when he falls, fix an
engine, play Modern Warfare 2 and greatly increase his chances of getting a job.
“It’s going to give me so much more independence to do more stuff on my own,” Specialist Marrocco
noted.
Nine people in the United States and about 34 others around the world have received hand or arm
transplants since the first successful one in France in 1998. Dr. Lee has performed three in the past 14
months; in May 2009, his team did the first double hand transplant in the United States, and in February,
the nation’s first double transplant that extended above the elbow, like Specialist Marrocco’s.
The transplant is mind-boggling in its complexity. The doctors must attach nerves, blood vessels, muscles,
tendons and elbow joints, all within about 11 hours. A new antirejection protocol that Dr. Lee formulated
should reduce the risk of infection, organ damage and diabetes.
…
Unlike a heart or liver transplant, “a hand transplant does not save lives,” Dr. Lee noted. “It improves the
quality of life.” He added, “We have to be very careful to balance benefits versus the risk.”
…
He expects to spend six months rehabilitating in Pittsburgh (his brother will move there with him). The
time there may set back his leg progress, so he will likely return to Walter Reed for further therapy.
Back home in Staten Island, several charities — the Stephen Siller Children’s Foundation, Building Homes
for Heroes and a fund dedicated to Specialist Marrocco — have been raising money to build him a
wheelchair-accessible house. In August, the actor Gary Sinise, who played a combative double amputee
Vietnam veteran in “Forrest Gump,” is scheduled, with his Lt. Dan Band, to support the effort.
Ms. Barto is still hoping to move to New York with him, after a wedding at the National World War II
Memorial on the Mall here in Washington. She said they had talked about having children, and that
Specialist Marrocco wanted a girl, if only so he could answer the door when a date arrived and say the
words, “You should see what happened to the other guy.”
http://www.nytimes.com/2011/02/14/us/14giffords.html?sq=brain%20injuries&st=cse&sc
p=13&pagewanted=print
February 13, 2011
Word and Lyric, Giffords Labors to Speak
Again
By MARC LACEY and JAMES C. McKINLEY Jr.
PHOENIX — Representative Gabrielle Giffords, an eloquent speaker before she was shot in the head last
month, is relearning the skill — progressing from mouthing words and lip-syncing songs to talking briefly
by telephone to her brother-in-law in space.
With a group of friends and family members acting as a backup chorus, Ms. Giffords has been mouthing
the lyrics to “Twinkle, Twinkle, Little Star” and “I Can’t Give You Anything but Love, Baby.” And as a
surprise for her husband, who is celebrating his birthday this month, a longtime friend who has been
helping her through her rehabilitation videotaped her mouthing the words to “Happy Birthday to You.”
“It’s not like she’s speaking the way she spoke, but she is vocalizing and making progress every day,” Pia
Carusone, Ms. Giffords’s chief of staff, said in a telephone interview on Sunday. “She’s working very hard.
She’s determined. It’s a tight schedule. A copy of it is hanging on her door.”
Outside specialists say it remains unclear, despite the hopeful early signs, what functions in Ms. Giffords’s
mind were affected by the traumatic injuries she suffered when she was shot at point-blank range on Jan.
8 at a constituent event in Tucson.
It is not uncommon for patients with a similar injury to have trouble communicating or undergo
personality changes, brain specialists say. Everything from ambition and concentration to short-term
memory and social inhibitions can be affected, doctors say.
But relatives and friends who have been at Ms. Giffords’s side as she undergoes rehabilitation at a hospital
in Houston said in interviews and e-mail exchanges that though her recovery was slow and exhausting, it
was marked by significant progress.
Ms. Carusone said that on Sunday afternoon, Ms. Giffords’s husband, Capt. Mark E. Kelly, put the
congresswoman on the phone to talk to his twin brother and fellow astronaut, Scott, who is aboard the
International Space Station.
“She said, ‘Hi, I’m good,’ ” Ms. Carusone said.
With the help of therapists at TIRR Memorial Hermann in Houston, the congresswoman known for her
active, outdoorsy ways now labors through the halls clutching a shopping cart and does squats and
repetitive motions to build her muscles, her mother, Gloria, said in an enthusiastic e-mail she sent about a
week ago to friends that recounted her daughter’s progress. Others who have visited Ms. Giffords recently
have left similarly upbeat.
Aides conduct bedside briefings for her, telling her about the events unfolding in Egypt, for instance, and
the decision by Senator Jon Kyl, Republican of Arizona, not to run for re-election next year.
“We tell her everything that’s going on,” Ms. Carusone said. “Don’t get the idea she’s speaking in
paragraphs, but she definitely understands what we’re saying and she’s verbalizing.”
In long days that begin with breakfast at 7, Ms. Giffords, 40, has beaten one of her nurses at tic-tac-toe
and transformed herself, her mother wrote, from “kind of a limp noodle” to someone who is “alert, sits up
straight with good posture (in fact anyone in the room observing unconsciously sucks it up and throws
back their shoulders) and is working very hard.”
Ms. Giffords’s mother says doctors are regularly surprised by her latest achievement. They say, “She did
WHAT?” she wrote in her e-mail, adding that “Little Miss Overachiever is healing very fast.”
Reached by telephone on Sunday, the congresswoman’s mother offered a one-word assessment of her
daughter’s road to recovery. “As far as Gabby’s progress, you can quote me as saying, ‘Yippee!’ ” she said.
The rehabilitation center referred requests for comment to Ms. Giffords’s staff.
Dr. David Langer, an associate professor of neurosurgery at the Cushing Neuroscience Institutes at North
Shore University Hospital in Manhasset, N.Y., who is not treating Ms. Giffords, pointed to encouraging
signs.
“She’s obviously communicating, obviously verbal,” he said. The gunshot wound, he said, “probably didn’t
irreversibly damage her speech center.”
“Until she’s really talking, giving a speech,” Dr. Langer said, “you won’t know if there’s a subtle speech
problem. But it sounds like with rehabilitation, with time, she ought to be very functional.”
The use of singing, he said, is a standard technique to help restore speech in people with brain injuries. (It
is sometimes used to help treat stuttering, Dr. Langer said, citing the movie “The King’s Speech” in which
King George VI sang to overcome his speech impediment.) The part of the brain that controls singing is
not the same as the one that controls speech, though it is close.
Dr. Langer also said it was good news that Ms. Giffords was walking. “People’s ultimate endpoints are
often based on how rapidly they improve,” he said. “If there’s rapid progress, the recovery potential is
much higher. It sounds like she hasn’t plateaued yet and is improving really quickly.”
The specialized clinic that is helping Ms. Giffords recover has several gymnasiums equipped for people
with spinal and brain injuries, as well as a swimming pool for therapy. The main hallway is lined with
large photographs of former patients who have made spectacular recoveries, among them Kevin Everett, a
former National Football League player who suffered a spinal injury.
There are plaques with the inspiring tales of the survivors next to the photos. One shows a man hunting
ducks in a wheelchair, his shotgun up and a dog by his side. Another is a bride on her wedding day, who
had suffered a traumatic brain injury two years before.
Therapists push patients in wheelchairs along the hallways. Some brain-injury patients who have had
parts of their skulls removed, like Ms. Giffords, wear helmets to protect their brains. (In Ms. Giffords’s
case, her mother said, doctors are planning to reinstall a section of her cranium at the end of the month,
well ahead of schedule.)
Mockups of stairs, a kitchen and a washing machine help patients relearn basic skills. A therapist
encouraged one patient to try moving his leg and was caught by an unexpected kick. She winced as she
said, “Good, Jim!”
Ms. Giffords is receiving similar encouragement, by doting therapists and a network of friends, some of
them from the political world.
Brad Holland, a Tucson lawyer and old friend, has been a regular presence at her bedside. Senator Kirsten
Gillibrand, Democrat of New York, has spent the night in the congresswoman’s room in what Gloria
Giffords called a “sleepover.”
A visit by Representative Nancy Pelosi, the Democratic minority leader, is planned soon, and the first
President George Bush, who lives in Houston and visited with Captain Kelly recently, may stop by for a
visit as well, those close to the congresswoman say.
Despite some obvious signs of progress for Ms. Giffords, experts offer some caution.
The human brain has what amounts to redundant circuits for some simple tasks, like walking, and it is
possible for patients to make rapid progress on those skills and still have trouble with mental work and
speaking, doctors said.
“There are backup systems in the brain for the more basic functions that have been around longer in
human beings,” said Dr. Jonathan Fellus, the director of the Brain Injury Program at the Kessler Institute
for Rehabilitation in New Jersey. “Conversely, for things such as language, which are uniquely human, it’s
a highly specialized and delicate network that doesn’t get reconstructed so easily.”
But those close to Ms. Giffords remain optimistic that her recovery will be dramatic.
Representative Debbie Wasserman Schultz, Democrat of Florida, was at Ms. Giffords’s bedside in Tucson
on Jan. 12 when she first opened her eyes. She was visiting Ms. Giffords again, in Houston, last Monday
when she asked for toast with her oatmeal.
“It is an excellent development and a great indicator of the progress of her recovery,” she said.
Ms. Wasserman Schultz predicted that her friend would one day walk back into the House chamber.
Marc Lacey reported from Phoenix, and James C. McKinley Jr. from Houston. Denise Grady contributed reporting from
New York.
http://www.nytimes.com/2007/01/26/science/26brain.html?sq=body%20injuries%20affec
t%20on%20brain&st=cse&scp=1&pagewanted=print
January 26, 2007
In Clue to Addiction, Brain Injury Halts
Smoking
By BENEDICT CAREY
Scientists studying stroke patients are reporting today that an injury to a
specific part of the brain, near the ear, can instantly and permanently break a
smoking habit. People with the injury who stopped smoking found that their
bodies, as one man put it, “forgot the urge to smoke.”
The finding, which appears in the journal Science, is based on a small study.
But experts say it is likely to alter the course of addiction research, pointing
researchers toward new ideas for treatment.
While no one is suggesting brain injury as a solution for addiction, the finding
suggests that therapies might focus on the insula, a prune-size region under
the frontal lobes that is thought to register gut feelings and is apparently a
critical part of the network that sustains addictive behavior.
Previous research on addicts focused on regions of the cortex involved in
thinking and decision making. But while those regions are involved in
maintaining habits, the new study suggests that they are not as central as the
insula is.
The study did not examine dependence on alcohol, cocaine or other
substances. Yet smoking is at least as hard to quit as any other habit, and it
probably involves the same brain circuits, experts said. Most smokers who
manage to quit do so only after repeated attempts, and the craving for
cigarettes usually lasts for years, if not a lifetime.
“This is the first time we’ve shown anything like this, that damage to a specific
brain area could remove the problem of addiction entirely,” said Dr. Nora
Volkow, director of the National Institute on Drug Abuse, which financed the
study, along with the National Institute of Neurological Disorders and Stroke.
“It’s absolutely mind-boggling.”
Others cautioned that scientists still knew little about the widely distributed
neural networks involved in sustaining habits.
“One has to be careful not to extrapolate too much based on brain injuries to
what’s going on in all addictive behavior, in healthy brains,” said Dr. Martin
Paulus, a psychiatric researcher at the University of California, San Diego, and
the San Diego V.A. Medical Center. Still, Dr. Paulus said, the study “opens up
a whole new way to think about addiction.”
The researchers, from the University of Iowa and the University of Southern
California, examined 32 former smokers, all of whom had suffered a brain
injury. The men and women were lucid enough to answer a battery of
questions about their habits, and to rate how hard it was to quit and the
strength of their subsequent urges to smoke.
They all had smoked at least five cigarettes a day for two years or more, and 16
of them said they had quit with ease, losing their cravings entirely.
The researchers performed M.R.I. scans on all of the patients’ brains to specify
the location and extent of each injury.
They found that the 16 who had quit easily were far more likely to have an
injury to their insula than to any other area. The researchers found no
association between a diminished urge to smoke and injuries to other regions
of the brain, including tissue surrounding the insula.
“There’s a whole neural circuit critical to maintaining addiction, but if you
knock out this one area, it appears to wipe out the behavior,” said Dr. Antoine
Bechara, a senior author of the new paper, who is a neuroscientist at the Brain
and Creativity Institute at U.S.C. His co-authors were Dr. Hanna Damasio,
also of U.S.C., and Nasir Naqvi and David Rudrauf of the University of Iowa.
The patients’ desire to eat, by contrast, was intact. This suggests, the authors
wrote, that the insula is critical for behaviors whose bodily effects become
pleasurable because they are learned, like cigarette smoking.
The insula, for years a wallflower of brain anatomy, has emerged as a region of
interest based in part on recent work by Dr. Antonio Damasio, a neurologist
and director of the Brain and Creativity Institute. The insula has widely
distributed connections, both in the thinking cortex above, and down below in
subcortical areas, like the brain stem, that maintain heart rate, blood pressure
and body temperature, the body’s primal survival systems.
Based on his studies and others’, Dr. Damasio argues that the insula, in effect,
maps these signals from the body’s physical plant, and integrates them so the
conscious brain can interpret them as a coherent emotion.
The system works from the bottom up. First, the body senses cues in the
outside world, and responds. The heart rate might elevate at the sight of a
stranger’s angry face, for example; other muscles might relax in response to a
pleasant whiff of smoke.
All of this happens instantaneously and unconsciously, Dr. Damasio said —
until the insula integrates the information and makes it readable to the
conscious regions of the brain.
“In a sense it’s not surprising that the insula is an important part of this circuit
maintaining addiction, because we realized some years ago that it was going to
be a critical platform for emotions,” Dr. Damasio said in a telephone
interview. “It is on this platform that we first anticipate pain and pleasure, not
just smoking but eating chocolate, drinking a glass of wine, all of it.”
This explains why cravings are so physical, and so hard to shake, he said: they
have taken hold in the visceral reaches of the body well before they are even
conscious.
Other researchers have found that the insula is activated in unpleasant
circumstances, like a bad smell or the anticipation of a painful shock, or even
in shoppers when they see a price that seems too high. Damage to the insula is
associated with slight impairment of some social function.
While antismoking treatments based on the new findings are still a long way
off, the authors suggest that therapies that replicate some of the physical
sensations of the habit, like inhalers, could be useful.
And at least two previous studies suggest that people can reduce the sensation
of pain by learning to modulate the activity in an area of their brain.
In experiments, healthy volunteers watched real-time M.R.I. images of a
cortical region linked strongly to pain sensation and learned to moderate that
neural activity, reducing the pain they felt from a heated instrument pressed
to their palms. The same kind of technique could be tried with addicts
watching images of their insulas.
“The question is, Can you learn to deactivate the insula?” Dr. Volkow said.
“Now, everybody’s going to be looking at the insula.”
http://www.nytimes.com/2007/01/23/health/psychology/23amne.html?sq=injuries%20to
%20hippocampus&st=cse&scp=1&pagewanted=print
January 23, 2007
Amnesiacs May Be Cut Off From Past and
Future Alike
By BENEDICT CAREY
In the movies amnesia is bizarre, and thrilling. The star is usually a former
assassin or government agent whose future depends on retrieving the bloody,
jigsaw fragments that restore identity and explain the past.
Yet in the real world, people with amnesia live in a mental universe at least as
strange as fiction: new research suggests that they are marooned in the
present, as helpless at imagining future experiences as they are at retrieving
old ones.
The new study, reported last week in The Proceedings of the National
Academy of Sciences, is the first rigorous test of how brain-injured people with
amnesia mentally inhabit imaginary scenes. The results suggest that to the
brain, remembered experience and imagined experience are reflections from
the same mirror, rich inner worlds animated by almost identical neural
networks.
The findings provide a glimpse into what it might mean to truly live in the
moment. And they feed a continuing debate about memory. Some researchers
say that the brain region central to forming new memories — the
hippocampus, a sliver of tissue deep in the brain where the day’s memories are
registered — is not necessary for retrieving those experiences, once they have
been consolidated elsewhere in the brain.
Others, including the authors of the new study, contend that the hippocampus
in fact provides the stage on which inner mental dramas are set. Without its
help only the props remain — loose facts, people’s names, snippets from
favorite songs: the players without the play.
“The study suggests that these patients have fragments, the brick and mortar
to create new scenarios, but their descriptions lack coherence because they
don’t have the scaffolding the hippocampus provides,” said Morris
Moscovitch, a neuroscientist at the University of Toronto, who was not
involved in the study. “The other interpretation is they don’t have enough
brick and mortar to put it all together.”
The researchers, led by Eleanor Maguire and Demis Hassabis of University
College London, instructed five men with severe hippocampus injuries to
imagine themselves in familiar scenes, like a museum, a pub and a beach.
People with this type of injury, often from oxygen deprivation due to a heart
attack, can seem in conversation to be as mentally adept as the next person —
until it becomes clear they have forgotten comments made only moments
before.
The men, urged to fill out the scenes with imagined detail, described what they
could. The researchers analyzed transcripts of their answers, carefully scoring
each one for personal touches: projected emotions, sensations and actions.
They found that compared with similar descriptions produced by adults
without brain injuries, the five men’s imagined scenes were flat, barren of
personal dimension.
“We think that what the hippocampus provides is a scaffold for experience and
imagination, and that scaffold is spatial,” Dr. Maguire said. The brain’s record
of physical space, she said, appears to be necessary to infuse a scene with rich
personal dimension.
Other researchers said the dulling of imagination could reflect a more
fundamental dynamic. The brain may naturally draw on previous experiences
to inform imaginary scenes, said Peter J. Bayley, a neuroscientist at
the University of California, San Diego. If so, the only such memories
accessible to the men might have been childhood scenes, consolidated over the
years outside the hippocampus, which would not likely provide rich detail to
outfit, say, an imaginary pub.
“The differences between the two groups may reflect the difficulty the patients
are having retrieving information from the recent past,” Dr. Bayley said. He
and other researchers have previously reported on patients with hippocampus
damage who can recall childhood memories in the same kind of detail almost
everyone else does.
The distinctions the brain makes between loose facts and the richer,
wraparound ambience of an experience are important to understanding
memory, because people with healthy brain function tend to recall the gist of
experience, whereas those with hippocampus damage can often recollect
discrete facts with more accuracy. The difference is partly reflected in the
study participants’ words.
When asked to envision an open-air market, one brain-injured man said: “I
see people, very many people. Most of all ... um ... not many men, all I see are
young ladies. And basically they are all in a hurry.”
A participant without brain injury responded: “Right, so on either side of me
I’ve got stalls and it’s noisy. We have a person on my right who is selling fruit
and veg, and they’re telling us that bananas are on special offer this week, and
they’re shouting about that.”
In an essay published this month in the journal Nature,
two Harvard researchers, Daniel L. Schacter and Donna Rose Addis, contend
that this ability to richly imagine scenes, whether entirely dependent on the
hippocampus or not, is perhaps the most promising frontier for memory
research.
“For almost 100 years, memory has been the object of experimental studies
that have focused almost exclusively on its role in preserving and recovering
the past,” they wrote. “We think it’s time to try to understand some of
memory’s errors by looking to the future.”
Day 5

Procedures:
o Hook (Assigning of brain parts): 5 minutes
 Split the class up so that each group has a part of the brain.
 Cerebral cortex
 Left & Right Hemispheres
 Corpus callosum
 Frontal lobe
 Prefrontal area
 Frontal association area
 Motor strip
 Sensory strip
 Parietal lobe
 Occipital lobe
 Temporal lobe




Lower brain
Thalamus
Hypothalamus
Limbic system
 Amygdala
 Hippocampus
 Cerebellum
 Reticular activating system (RAS)
 Spinal cord
o Procedure 1 (Make a big brain): 10 minutes
 Have each team draw their part of the brain on the board. One lobe
version & one lower brain version.
o Procedure 2 (Tasks & Examples): 20 minutes
 Have the students describe the job of the particular part of the brain
that they have been assigned.
 They must give at least 3 examples of when this part of the brain has
been used.
 The students must cut out pictures from magazines to make a collage
that helps to demonstrate these examples.
o Procedure 3 (Half-page Story): 10 minutes

Have the students write a half-page story of what their life would be
like if their assigned brain part were damaged.
o Procedure 4 (Homework Assignment): 5 minutes
 Tell them that their teacher will bring in her flute.
 Tell the students that for the next day they need to bring in something
to demonstrate a dual task. Like playing the flute (two-hands working
together), dribbling a basketball while moving, rubbing their tummy &
patting their head at the same time, sign your name & rotate your leg in
a circle at the same time, etc.
Day 6

Procedures:
o Hook (Show & Tell): 10 minutes
 Demonstrate with the flute first.
 Have the student show & tell their dual tasks to demonstrate how the
hemispheres work together.
o Procedure 1 (Music & the Temporal Lobe): 10 minutes
 Have everyone hum a song that everyone knows (Row, Row, Row
Your Boat). Start by conducting, then stop conducting & have everyone
stop humming aloud, but keep humming in their head. Start conducting
again, & everyone should enter into the same part of the song.
 Beethoven continued to compose even after he went deaf!
o Procedure 2 (): 30 minutes