Rewiring the Brain: The Promise and Peril of Neuroplasticity

foreign [Music] enhancement has long been the stuff of myth and science fiction from Adam and Eve biting into that apple to Icarus and his prosthetic Wings to the film Limitless which features a pill that makes you capable of easily mastering the most complicated information proverbial Magic Bullets that modify or extend or enhance our natural abilities and help us overcome our weaknesses they have been depicted as having great potential to help but also to hurt Humanity in unpredictable ways and when it comes to truly enhancing performance of overcoming our limitations some of the most promising work being done right now is in the area of brain plasticity Cutting Edge research suggests that a whole arsenal of tools from video games to brain stimulation to Pharmaceuticals they may make it possible to rewire our brains in ways that take our neural Pathways back to their early childlike States opening up what are called critical periods these are periods of development when our minds are most open to learning new things conferring upon us the ability to master new languages to pick up a new instrument to jump higher to run faster to overcome debilitating brain injury to cure depression possibly reverse autism slow dementia and help us focus more deeply but even with such promising development moments we still do not fully understand the long-term effects of such interventions on the estimated 100 billion neurons in the trillions of synaptic connections within the human brain so tonight we are going to focus on the promise and The Perils of this young and evolving science which seeks to go beyond our all to human frailties and limitations by leveraging our brains incredible plasticity [Music] I'd like to welcome all the scientists in tonight's program who are doing some fascinating work in brain plasticity each using a unique tool to experiment with opening up critical learning periods in the brain John krakauer joins us from Baltimore Maryland where he is the director of the center for the study of motor learning and brain repair at Johns Hopkins school of medicine and the director of the brain learning animation and movement lab next we have takao Hench who joins us from Cambridge Massachusetts where he is joint professor of Neurology at Harvard Medical School and professor of molecular and cellular biology at Harvard Center for brain science and finally we have Brett wingeyer who joins us from Burlingame California he trained as a biomedical engineer and over the last two decades has invented a series of devices aimed at neuromodulation he is currently the CEO of a company developing a transcranial stimulation device meant to treat depression welcome to you all so takao if we can just to get us going what are we talking about when we use this term brain plasticity yes in a very broad sense brain plasticity is the ability to alter brain function in response to experience experiences of any kind but if we step into it a little deeper as far as the brain is concerned any ability translates to some molecule or a molecular basis and brain functions are typically defined by specific neural circuits that must be changed and experience translates into patterns of electrical activity in the brain so the general definition I think everyone can appreciate is that repeated experiences will shape the way we think the way we act and that's brain plasticity now John I gather it's the case that I think we all have this intuition I don't know exactly where it comes from but we have this intuition that there are periods when our brains are more susceptible to the brain plasticity that the cow just described and like later on as we get older our brains I don't know they kind of Harden in some sense and aren't able to respond to the environment with the nimbleness that they might have or the dexterity that they might have when we're young is that the case and and and what do we know about the periods when the brain is most open to change yeah I mean I I will definitely uh talk about this for a moment although takao has done sort of seminal work at the molecular and cellular level on this but I'm particularly interested in how you can sort of have these windows of you know critical period reopened um by injury but now there are also people working on sort of more controlled ways to recapitulate these critical periods um later in life pharmacologically maybe with brain stimulation and and so the cow yeah do what do we know about those critical periods are they specific to certain learning tasks do they open and close at fairly well-defined moments in the development of a human brain well we've known about critical periods or the malleability of the brain changing across development for centuries from Aristotle to Montessori to the present day and this comes from careful observation of children infants and children and their ability to acquire new skills at an astonishing rate do you know an age where that closes I think this is an important question so um there are probably Myriad number of critical periods is really the important message that brain function translates to particular circuits that change whether you're talking about Vision or hearing or speaking and so on and so each one of those could have a slightly staggered window of plasticity and in fact there is a sense of hierarchy that perhaps the primary sensory areas are first filters to the outside world are shaped earliest and perhaps most stringently which then feeds into multi-sensory areas that integrate the different kinds of input and ultimately build up a complex cognitive machine like the adult brain so I think it's important to keep in mind that there's not just one critical period and that there are sequential on a series of these that allow for the complex behaviors that we're capable of and Brett we're going to talk about some of the work that you've done a little later on in terms of trying to manipulate the brain perhaps harness some of the brain plasticity that we're talking about but do you consider the task of trying to harness brain plasticity a fundamental Science question or is it an engineering problem I mean how much detailed understanding of the brain do we need to have to be able to harness these qualities yeah you know it's it's both and it's one of the interesting things about this field is you know we we certainly have ways with technology where we can we can encourage plasticity and you know just just to be clear we it's not just with technology that we can do that you know as adults we are all still plastic and we're not plastic in the same way that our kids are you know I watch my kids trying to learn a second language and it's amazing and I you know I I so I feel that very personally but um you know the if um you know we're we're we're plastic every day and that we we we learn things as adults and we have mechanisms where if if we're particularly emotionally engaged you know they then we we we learn things better um now with you know with technology to encourage and increase plasticity we're on a journey of learning where we're informed by uh we're informed by the basic science we're informed by the applied science of of how do you interact with the brain in a better more targeted way and there's a lot of there's a lot of interplay between the fundamental science and what we can do with technology and in general you know any any kind of neurotechnology or neuromodulation whether it's on the medical side or the um the human potential side it just gets better and better the more we understand about the underlying mechanisms and change things from basic science questions to uh to engineering problems where we understand the science yeah well I certainly feel your pain on the language acquisition is I have started to return to playing piano and my 17 year old son also returned you know and and I can't I can't keep up with him I mean he's zooming ahead he's like five pieces in and I'm still struggling on one before so there's definitely something going on inside my head that isn't as flexible as I I would have hoped it would be so John when we think about critical periods and plasticity from an evolutionary standpoint do we have a sense of why it is that the brain is structured in such a way that it goes through these periods why is that the route that Evolution took well I mean there are all sorts of arguments um you know it's a big job to get to being a fertilized egg to a very large you know millions of times larger organism so there's a job that needs to get done to set the system up and have it respond to experience so it gets set up with the right structure right but you don't want that runaway plasticity indefinitely right I mean there are consequences to unbridled plasticity um so it has to be controlled you know with great power comes great responsibility right and this is a form of plasticity that um would not be very good I mean just like plasticity and the ability to duplicate in cells if it goes uncontrolled you get cancer right you could have you know analogously the same kind of problem with just morphic tissue seizure dangers and all sorts of things like that you know um the kind of thing that you have to do once you've reached cruising altitude and learn things is not the same big lift as how you have to get to cruising altitude in the first place so you need to have control mechanisms homeostatic mechanisms in place to keep this in check right now it would be very nice if you could go in and manipulate these negative feedback loops these homeostatic control mechanisms so we could open up under control conditions but it makes a lot of sense to me that you don't want these growth environments to be on indefinitely right so so DeKalb we are starting to learn that's really the point of the conversation we're having here that there is something new in our understanding of brain Plastics today the older idea that we've just heard is that there are periods when the brain opens and it kind of closes down but now I gather there's evidence that we may be able to reopen brain plasticity in mature brains and adult brains why what's the evidence for that and and and why do we think that may be the case yes the um novelty and the new insight that has come about I would say in the past 20 years is twofold the cellular understanding of what determines the timing of these critical periods has become apparent so there are triggering mechanisms and then likewise there is a system of molecular breaks which seems to act in an active way to close these critical periods and it's this Insight that's really allowed us to manipulate the timing and to reopen it or extend it into adulthood and of course all of this starts with animal experiment animal models but in many instances the findings have been surprising and translatable based on pharmacology that's already out there being used or with a clever inference of what might be happening in humans as well and so John you mentioned that injury traumatic brain injury can reopen brain plasticity why does that happen yes I mean you know first of all you know as cow has also mentioning we've known a long time that you get most recovery from all sorts of brain injury early in animal models and in humans now you know we I can just mention we did a very slightly freaky experiment in the mouse where we basically gave a mouse a stroke and then delayed its training and it never really got back to normal behavior we found also that if you started the training very soon after the stroke in other words you don't wait a week you wait just a day then the efficacy of the training was much greater to the point that you couldn't actually tell the difference between the mouse is reaching before and after the stroke now the really freaky thing is if you did the original experiment and waited a week and then gave a second stroke in other words you actually made the mouse worse but you now didn't wait you actually recovered completely from the first stroke so in other words a very profound demonstration of being able to manipulate a critical period by injuring the brain right now in terms of um why that should be the case it seems to me um only sort of logical and parsimonious to imagine that there are repair mechanisms in the brain right just like you cut your skin break a bone damage neural tissue there's going to be some repair process set in place that will have some overlap with the kind of processes going on during development um now I'm not a molecular biologist by by any stretch of the imagination so I defer to people doing work at that level like decao to tell us how much overlap how much mechanistic sharing is there between the repair mechanisms that are triggered by injury and what's happening during development but I think you can see that there will be some sort of parsimonious intuition that repair and building might share some underlying mechanisms now again the degree to which you can exploit this and the way that you can actually potentiate it or even try and make it happen even if you don't go early in other words you have a chronic stroke patient can you somehow make it look like they're still early after stroke that's what's very exciting but you are saying I guess in principle that incredibly fast intervention in the case say of a human who experiences a stroke may make all the difference in the world you're saying yeah I mean it's very ironic you know I wrote a whole book about this several years ago and you can go back over 75 to 100 Years of literature in primate and rodent models and an alien from outer space I actually say this would look and go why on Earth wasn't this road taken right even before we knew the mechanisms I mean we essentially to this day um give homeopathic doses of Rehabilitation early after stroke in other words if you have a stroke you'd be better off being a rodent than a human in terms of the care that one currently receives so I have made a big effort to try and introduce intensities of doses of a particular kind of Behavioral intervention early to try and see if humans can have these very dramatic improvements that have been seen going back a hundred years in primate models and you know a little less but nevertheless dramatic improvements in rodent models so absolutely it seems to me that we what we have to do is to go much earlier and throw the kitchen sink at Patients right so so Brett you also have been developing tools to manipulate the brain in a manner that would help reopen critical periods and not through not through pharmacological interventions which we'll talk about in a little more detail in a moment not through brain injury but through brain stimulation so can you tell us a little bit about what that is and what you found yeah absolutely and before I answer that I just want to Echo Echo what John was saying there you know it's it's absolutely true that in in rehab you know the the dosing is the dosing is way off and there's the potential to have such so much more powerful effects from you know from a from a proper dose and really immersing in that rehab and you know again going back to uh you know the example of um you know why our kids can learn piano so much faster than we can part of that is you know part of that is because of plasticity and part of that is because at at that point in life you're able to just be so much more immersed in it but that makes a powerful statement as to you know what kind of training and you know in the stroke model what of rehab is really appropriate but then you know to get back to neuromodulation yeah I've spent uh spent about two decades now um Building Technology to stimulate and uh stimulate to enhance to treat the brain mostly on the medical side I've worked in epilepsy in um done some work in Parkinson's disease cluster headache and now at Magnus Medical in a new treatment for depression but then on the on the plasticity and Human Performance side at a company called Halo neuroscience and you know the the the the the the mechanisms behind plasticity are are complex and they're they're better understood by my colleagues takao and John here but because there's this electrical component to um you know to to to to brain activity and an electrical component to what to uh creating plasticity and and we think enhancing plasticity uh with you know with neurostimulation elect electrical nerve stimulation whether it's pulses that are timed or or waveforms that are geared to interact with this underlying brain activity it's possible to modulate plasticity now you know with with anything with the brain the the effect size can be can be small it can be moderate and it has to be paired with with the right with the right training activity to be effective right and and and so like how strong are these electrical signals I gather they must be minute but at a sufficiently high level that the brain actually feels something yeah and you know neurons neurons are very sensitive Detectors of of electrical Fields because that that's how you know that's how neurons work you know cell membranes are amazingly sensitive now you know that at the micro scale you don't need a lot of energy but at the macro scale you know you step back and you're you're interacting with the brain you know let's say through a wearable device well you you need a certain moderate amount of electrical electrical current or electrical field if you're it magnetically then you need a um you know a strong fast current pulses to induce the right fields in the brain and so on but but at the at the micro level and neurons are amazingly sensitive yeah so John you've also developed a wearable device that as I understand it is meant to try to be a therapeutic regimen for stroke victims where they play a kind of video game where they use their arm to direct emotion of a dolphin I'd like to talk about that but let me just show the audience a brief clip so I have a sense of what that game is all about the way the experience works is the 3D tracker tracks your body position and it tracks your hand and we're able to map kind of any direction you're pointing or moving in whether it's come here or go far or go up or down into the animal so you can literally control it in any kind of way within the entire 3D space I am dolphin two is a neuro restorative neuro animation experience that we built which exploits the residual nervous system after brain injury through a combination of high intensity high dosage and something which we call dexterity or creative exploration which we think engenders a kind of cortical stimulation or or brain stimulation that helps recovery so the game is you embody a dolphin it's kind of simple in the sense that it's a series of battles or dog fights you do with fish and sharks but what it's really designed to do is give you the sense that you've become a dolphin that you've kind of jacked into its motor system you're learning the Dynamics of the dolphin and exploring in its world how you move becomes a kind of foreign puzzle where you're trying to understand the physics of the dolphin the hydrodynamics of the water and when you learn that you're able to then Target fish and sharks and eat them if we lose the functionality or the ability to do something because of brain damage how can we get to a state where we're exploring again where we're learning again so John just running instance of your motivation for this game is it coming from more or less what Brett was saying regarding immersion into an activity is that the power of video game technology this is a long story I'm going to try and compress it yes thank you um um I think that this game um was the represents the Confluence of multiple observations in humans and in animal models one way to think about it is that there's been 75 years of work on what's called enriched environments in other words you put rodents in a cage full of ramps and balls and toys and friends and places to explore you get multi-scale changes in the nervous system and the rest of the body okay one but that notion of enrichment which is still very much investigated but it's an emergent phenomena you can't zero in on just one thing to explain it it's a multi-scale phenomena has never really been tried in humans surprisingly second as I said before you need to do much higher Doses and intensities of particular kinds of training because you need to sculpt the plasticity especially in this post-injury critical period you need to maybe make it enjoyable and social I mean that's very important too so you're immersed so the question was how do you translate the enriched background and the high intensity High training foreground into a simple experience that takes somebody out of the reality of their injury all right so and then of course there's this notion most importantly of combining cognitive challenge cardiovascular exercise and skill learning simultaneously with a full body experience now there's a lot of I can say about this but basically that was the idea is you have to find a way of doing a training regimen that has all those factors that is focused on capacities of the nervous system not on tasks of everyday living because you want to avoid the curse of task specificity which is what happens when you learn particular tasks so you want to sort of trick the system into upgrading General capacities all right and you're more likely to be able to do that in a critical period than outside because outside of a critical period the muted plasticity almost always is Task specific all right so that was the idea all right an immersive environment recapitulating animal data making you be both cognitively motorically and physically challenged and then do it at high dose and high intensity and have you been able to take patients like within a day or two after suffering a stroke and put them into this environment have you done that um yeah that's a great question so we did a um a pilot study first of all trying to do this in the current Healthcare System and offer many more hours in addition to regular rehab is a massive challenge so in fact in our pilot study which ends up showing the dolphin was twice as effective as a regular rehab right we had to do it about three weeks post-stroke which is when in our other work the window begins to perhaps close a little bit but it was just logistically too difficult to give that much I mean they're covering with an hour in the morning hour in the afternoon time on task five days a week for three weeks imagine having a squash lesson 20 twice a day every day five weeks or three weeks okay so we did it but it was after they had been discharged from acute rehab in New Zealand now we have a much larger trial ongoing where they are being enrolled after about a week of their stroke so that's very exciting but that's going to take you know we've only had about 22 patients enrolled it's 150 patient study but yes the patients can tolerate it they love it and it's effective okay and I think we're going to hit a Tipping Point where these kind of immersive technology inflected interventions will take the burden of therapists to have to try and give such high intensities and high doses and allow them to do what they're good at which is just to learn compensatory um strategies to do task by task so takal we're going to talk about your pharmacological interventions in just a moment but I want to just stick on the theme of immersion do you also in your work find evidence that the kind of immersive experience that both Brett and John are talking about is also vital to plasticity from your perspective oh absolutely and it's not just our work so if we think about children they are very plastic and they learn things very quickly but the reality is that immersion and attention arousal are extremely important components of this and so in work that was done at the University of Washington in Seattle for example infants were brought into the laboratory American infants who spoke English at home to interact with a native Chinese speaker and it was found that those children in their critical period several months of age were able to acquire or more accurately retain the ability to hear native Chinese speech sounds with a fairly modest amount of exposure 30 minutes three times a week four or five weeks but what was so brilliant about that study was that they also filmed and audio taped the sessions and they had two other groups of children who were brought in to only hear the audio tape or watch the DVD essentially receiving exactly the same input that the children who had the live interaction were getting and neither of those groups were able to discriminate native Chinese speech sounds after the same amount of exposure and so the manner in which the infants are exposed that serve and return interaction which is somehow rewarding to them in the live setting was instrumental and so there's an active component of motivation arousal and attention that seems to be important even in the most plastic moments during the critical period so it's no wonder then that John's approach in the adult post-critical period brain requires all this effort I wonder what implications that might have for things like online education and even doing programs like this in sort of a digital delivery system but we'll put that to the side for the moment um fascinating uh study the one that you just mentioned to Cal but but Brett um a few years ago as you mentioned already you were developing a device called Halo which as I understand it was a stimulation device that the user would wear and in that setting it wasn't so much therapeutic right I gathered was to try to enhance the performance of um was it athletes I think that was one of the applications what what did you find there and and are there concrete results that you can point to showing the efficacy of stimulating the brain when trying to learn to do something yeah yeah so so that that device was uh was called Halo Sport and it was a a brain stimulator for athletes and musicians but you know really anybody anybody who was in gay aged in in training to uh to to to to have better movement and um you know that's that goes goes beyond just athletes and musicians certainly but uh the underlying technology was transcranial electrical stimulation so specifically a type called transcranial direct current stimulation and that puts a it puts a small electrical current on the surface of the head and enough of that makes its way through the scalp and through the skull that it um it changes the it in a uniform way it changes the electrical fields around the neurons and uh you know there's still some learning yet to be done around what exactly the mechanisms are but part of plasticity is this saying that when neurons fire together they wire together now if you if you dive in in a little bit more specific way there's there's certain timings of one neuron firing and causing an output in the in the postsynaptic neuron and when you shift that timing around to some extent then you you can you can modestly increase plasticity and that's the that that's a a lot of the underlying mechanism now the the there there were um there were great results not just from us at Halo but from uh you know some some colleagues in Academia doing similar things um one of the you know one of the best studies in um uh in uh in improving movement and it was a study from the UK that looked at um you know what you call motor Synergy and motor sequence and basically basically your ability to to fire the right muscles at the right time and the right amounts together and then to string that together into into a sequence of movements which as a again yeah they're all these parallels to music you know motor Synergy is making the chord and then motor sequence is stringing together the chords in the right sequence so you know there's a there's a body of work that shows um in in good sham controlled studies shows nice results um and shows that we can we can increase plasticity but yeah I've said the word moderately a few times and that's because so much about how something like this works it depends on it depends on um careful rigorous training it depends on training thoughtfully so that you're so that you're training the right things and you're not um you know I think John phrased it better better than yeah better than I am here but when you're you know when you're engaged in um trying to increase plasticity so you can have some you know effect on learning then um you know whether that's through a rehab program or whether it's with a a brain stimulation technology that that modulates plasticity um you you want to make sure that you're um you know you're you're improving in a thoughtful way pairing it with good training and you know creating more more Global capability and instead of you know something that's very this is very you know maybe a very task specific adaptation so and I read somewhere and um I'm sure you can tell them the details that some professional football players use it I guess some from maybe even the Oakland Raiders and there's one study I read where one player increased the vertical jump that he was able to attain dramatically is that is that do you point towards something like that as the evidence for how powerful this can be yeah so you know on the on the sports side there was um we had we had great data from the U.S national Ski and Snowboard team they did a uh a sham-controlled study with the the ski jumpers and you know one one thing that they do they they they're great scientists over there they they instrumented everything and they they they do a training program where you're you're doing a vertical leap that simulates the conditions right at the lip of the jump and how how powerfully and how smoothly you do that it has a lot to do with with how much distance you get in the jump so um you know that that was um you know there there were um reliable uh reliable increases in the both the smoothness and the power of the jump um what in in football the the metric that you know as you say folks were trying to increase was was vertical leap and again you know it's um it it seems like a very simple thing it's actually great to train on because it's because it's so measurable and again it's not just the it's not just the raw power it's not just the muscular output um and here here's where the neural component comes in it's the it's the the the power and the the smoothness and how you fire everything in the right sequence to do an amazing vertical leap the player who was you know who had such dramatic results his name was TJ Carey and he was uh his player for the Raiders and um he uh you know it got you know he I've he dramatically increases the vertical leap but you know the thing to highlight there is he did that by by being really thoughtful about his training measuring his outcomes um he was very immersive about it and all of these things you know whether it's whether it's um you know improving performance plastically with neuromodulation or just in the Natural State it's it's thoughtful practice it's immersion and all these things that come together so that so that your brain can learn and so from the outside and part of me if this uh sounds critical I'm just wondering it sounds like a very coarse approach to manipulating the brain to just have some vague electrical stimulation that's on the surface of the head is is is it as coarse as it sounds are we at sort of such an early change well at some point we direct that stimulation in a more precise manner or is it just enough to have some overarching vague stimulation and that's all that the brain needs to respond in the ways that one would want yeah so you know we're certainly there's there's a a lot more to understand and the um the the in particular about you know how do we how do we better Target um any kind of brain intervention but the key here the key here is that the focality doesn't come from carefully placed transducers or electrodes or whatever the focality comes from the interaction between the broader effect and the exact training you're doing so you're you're inducing a an effect in you know in a portion of Cortex where you're you're making it moderately more plastic and you know the and then you're you're pairing it with with focused training that's exercising exactly the the the the neurons and the synapses and the networks that that are that are causing your effect and that are key to what you're doing yeah so so take how it is just following on this theme of plasticity and learning I mean how well do we understand the molecular processes that you made reference to earlier when it comes to the brain's ability to say learn new languages or learn how to play an instrument right and and and how can we apply that molecular understanding to sharpen the capacity to reopen critical periods right so um of course those examples which you listed are very complex behaviors which as I said earlier are probably the endpoints of a series of plastic events and so a lot of the work has been done in the very first or earliest types of critical periods such as the ability to see through two eyes and understand why a lazy eye early in life might lead to the permanent loss of depth perception for example and these models can be studied in animals where it's possible to investigate the cellular mechanisms involved and so the interesting findings have been that um there are particular types of cells that are especially important in determining the time Windows of plasticity and their maturation is what opens them and brake-like factors are layered on top of those circuits and we've talked a bit about electrical activity in the brain well that's really the consequence of the fact that there are only two types of neurons excitatory and inhibitory cells whose dialogue is generating those electrical impulses and so these approaches of applying a current from outside the brain are tapping into these kinds of fundamentals of of Neuroscience but the brake-like factors interestingly raise other cell types of Interest as well I'll just go back if it's okay to the issue of neuromodulation in the brain that translates to chemicals like dopamine acetylene choline norepinephrine and this is a kind of third player that's layered on top of excitation and inhibition and it adjusts the gain or the the communication between such cells and interestingly video games are almost perfectly optimized to engage these neuromodulatory systems they're eminently rewarding and they grab your attention and players are fully immersed that's what we mean by immersion as far as the brain is concerned and so interestingly we've discovered that there are brake-like factors on The receptors for say acetylcholine which dampen the response of neurons to these chemicals and so if you remove this break then in fact the adult brain remains as attentive as in the the juvenile or immature stage and so that was done through genetic tricks in mice but it led to a fairly obvious experiment that if you in fact can boost acetylcholine have it linger longer for example in the brain then perhaps you could override that break and there are drugs that do that at such as acetylcholinesterase Inhibitors drugs that prevent the breakdown of acetylcholine and this in fact improves plasticity in the Paradigm of a lazy eye for example something which we've taken from the mouse to clinical trial at Boston Children's Hospital to try and treat patients who are older than the age of 10 to recover binocular vision and so these are patients if I understand For Whom for whatever reason one eye was not functioning properly during a critical period for the brain to understand signals that the eye is presenting to it and because of that that eye even when it's functioning properly subsequently doesn't yield the inner experience that we're used to from functioning vision and you're saying that that is something that you've been able to reverse through opening up a critical period later on right so the stress strategy was to extend this window of plasticity into older individuals previous Dogma would have said that it's once and done in childhood and this would be impossible but the discovery that there are active brake-like factors to prevent the engagement of plasticity allowed us to do this experiment first in mice and then attempt a therapeutic approach in humans and and have you gone beyond a lazy eye syndrome are there instances where both eyes weren't functioning for whatever reason during a critical period and then they were able to function later on can you open that critical period and restore the capacity for normal vision if you've lost Vision entirely early in life that's a much more severe situation where damage has happened to the nervous system and would require more effort to try and restore But ultimately a plastic window will be called for to get to that point and so so John when it comes to to video games which perhaps to someone watching this program they might be surprised at the number of times we've made reference to them I mean as most parents when my kids play video games I have an intuitive reaction that they're wasting their time and they should be doing something else and so your work certainly has made clear that they can play a role in Therapeutics but do you think they might even play a role beyond that in terms of enhancing healthy brains taking them to a place that they might not otherwise be able to get yeah it's a complicated question I mean first of all I mean as Wittgenstein wrote you know it's very difficult to find what a game is right and I and I don't think the very same parents who worry about video games they're not going to be worried if their children engage in a sport or physical exercise but once you develop a video game that is actually a new form of sport or exercise which hours is I think that concern goes away um I think a addictive app on a phone is a very different thing from an immersive new kind of sport okay and the distinction between a sport a game and an exercise is interesting right but they're not the same okay so once you start thinking that way you can dispense with most of the concerns that people have in my view um now in terms of healthy I mean we've completed a pilot study um of the of the minepod dolphin in an assisted living facility outside Baltimore for healthy aging because we know that being engaged cognitively and physically is good to maintain Health after the age of 65 if not before obviously so there yes and we have signal it leads to both physical and cognitive benefits it's pilot data but I'm sure that you know knowing that the who have reported that up to half of everyone over the over 65 worldwide does no physically physical or cognitively challenged activity of any kind right so there's an epidemic of just being unchallenged physically and cognitively at a certain point So to that degree I think that there should be an immersive experience on every High Street um now how one starts to talk about the younger generation and how to develop these experiences to sort of enhance going to school enhance going on to the football field you know I I that's an open question but I would be very surprised if we don't start to do better with VR AR immersive activities across the spectrum of human life you know health and in disease um it seems to me obvious you just want to make sure it's a race to the top and not a race to the bottom yeah well that actually was my next question the next question was look if and we're going to talk to count just a moment about the pharmacological approaches to opening critical periods but we've made reference to drugs playing a role and electrical stimulation magnetic stimulation playing a role if opening critical periods and immersion immersive experience is such a powerful combination it would seem that virtual reality is the real place where you'd have the greatest coming together of those forces so have you have you tried that have you had a virtual reality immersive experience as opposed to just the flat video game yeah I mean Festival yes we've absolutely played with the virtual reality version um you know I have mixed feelings about what's more immersive in fact um large screens you know some people have looked at this as just as immersive as VR um VR can lead to um you know cyber sickness it's you know in in medical environments having those goggles on can be problematic people don't like having them on for hours and hours which is the doses that we gave in our trials um they when you have the screen you can also have someone coaching you you can have family members watching so in other words you know it's it's you're trading off on other things there is a slight infatuation with VR um I think it has is going to have its moment I'm actually more interested in AR where you can actually layer things on top of reality so you can get the best of both worlds I'm in the end I'm agnostic to the empirical data what the best form of immersion is but you're absolutely right I think the key point you made is this combination of non-invasive stimulation pharmacology in immersive training experiences is really going to be very multiplicative and I think that it's it is the future um both in health and disease and it's very exciting and of course VR will begin to have the killer app once we get these com these ingredients right yeah and you know just just to jump in there for a second and you kind of you know kind of echo John what you're saying um you know I I you know there is a lot of excitement around around VR are and you know it's a it's a cool technology um you know I think I think real reality is still more immersive than virtual reality um the fact that you can you can watch a movie on your phone with a with a four inch wide screen and you can get emotionally engaged and cry at the ending you know that's um you can get emotionally engaged with the characters in a video game that you know you're you're playing on a monitor you know the fact that that can happen it means that our our brains are so powerfully good at having you know having that kind of immersive response to to any kind of to any kind of content if it's the right content um and that yeah that that's the key challenge is is having that content you know having um having immersive engaging uh emotionally physically cognitively engaging content you know that's that's a challenge in any medium and it's one of the one of the core challenges of VR is um it's it's great in theory but it all has to be based in based in the content and um yeah and also the The Experience fitting into somebody's life and carving out the time to uh to to use the the technology and and having the being able to put together that whole picture that's really important here which is um there are two ways to think about these immersive environments um one is by an you know recruiting these neuromodulatory systems and attention and emotion they're actually having a direct gain effect on plasticity mechanisms themselves in other words that's one way that these environments seem to be working they are actually jacking in to the gain on the plasticity mechanisms like cow mentioned right the other thing these immersive environments are doing is they're just making it more fun to keep time on task and to practice longer right now it just turns out that to get good at anything you have to practice a lot and the vast majority of people on Earth never practice anything very much right now that's okay that's why we admire athletes and musicians people who've just spent all that time at the sacrifice of everything else to actually become expert at something okay now what I've been arguing others is that unfortunately if you have a brain injury or maybe even if you're aging you're going to have to become an expert in your attention to that deficiency right not the low levels of rehab people usually get so then the question is how do you provide the incentive to have to do the Absurd amounts of practice that healthy experts do but you're going to have to do it just because you're now injured right and what we're arguing here is that by through the combination of pharmacology stimulation in immersion you can do the levels of practice that are going to be required to have an effect and that there are two mechanisms in play here just sheer time on task and these modulating effects on the plasticity itself it's extremely important to understand that these two things are happening at the same time absolutely so it's a cow let's now let's now turn to that interplay between time on task as as John describes it and the requirement of putting in the effort to gain the expertise and the relationship to that to pharmacological interventions and just to get us going some in the audience may recall the film Limitless right a film in which if you recall Bradley Cooper and other characters they take a pill right a single pill that suddenly allows them to use I don't know 100 of their minds making them like super smart and the film was demonstrated at one point by one character not putting in the time of tasks that John referred to but rather one character takes the pill and reaches an absolutely stunning intellectual achievement let's take a quick look when he told me about this amazing new drug I was like Down the Hatch and it was it was amazing you know I read Brian Green's the elegant Universe in 45 minutes and I understood it well there you go right reading my book in 45 minutes and then understanding it right my mom put in 45 minutes got to the acknowledgments and that is as far as as she wanted to go but but the serious question of course is to come you know what are we able to do with drugs with pills in terms of reopening these critical periods making the brain more plastic yes so um the approaches that have been working so far are um I would say opening a permissive gate for learning but you still have to put in the work and so uh we have done uh very interesting study with colleagues at the University of British Columbia where inspired by animal research where we lifted the brakes on epigenetic controls so I can explain that um bit more the idea is that critical periods might eventually wind down because Gene programs are closed and no longer available for plasticity so one one strategy was to open them again with pharmacological tool and there are such drugs which are actually used clinically for mood disorders and if we give such drugs to adult rodents for example we can rescue their lazy eye condition for example so because the the drug is clinically safe and well tested we were able to design a study of just two weeks of exposure to the drug or a placebo unbeknownst to the subjects and during that time we had them go online and try a variety of critical period type tasks such as discriminating native from non-native speech sounds or identifying individual monkey faces which babies and children and do well because they care but as adults we don't care as much and they're all lumped into one category another was absolute pitch the ability to detect the pitch of a note without a reference tone these are skills that if you don't acquire them before the age of seven you would lose and so some languages like Chinese relying on tones retain a high level of absolute pitch capability or musicians certainly who've been training since childhood but the average adult who hasn't had that experience cannot acquire absolute pitch after those ages and so with just two weeks of exposure thankfully perhaps we discover that the adult brain is very tough to change and even if they were on this epigenetic drug not much was altered except we found absolute pitch performance improve and these were subjects who had no multilingual background or musical experience before and so highly unusual to see with just two weeks of training and this forced us to go back and see why is this possible and um we think that perhaps the absolute pitch was the most stringent in its design perhaps inadvertently and it might be well worth revisiting a language task if you want to learn a second language or the ability to hear a second language with more stringency and um the point is that these pharmacological tools are really just opening the gate for intensive training and as was mentioned before this is what gives the specificity of the outcome and which drugs are I mean is this like Prozac Paxil I mean antidepressants is that what right so the drug in this particular study is a histone diacetylase inhibitor which is a mouthful but um valproic acid was used and it's used in mood disorders in fact um so these otherwise healthy individuals in fact for safety reasons were also sampled uh in their blood content but also answered questionnaires about their mood among other possible side effects and even their mood improves significantly being exposed during this trial so they are clinically available drugs already and of course we can probably do better with more specific versions in the future and so doing Vision a time when if an individual wants to learn something new you know an instrument a language mathematics physics whatever they'll pop a few pills before they go in to the class in order to absorb the material more fully well certainly this possibility is out there and I'm sure many college campuses are already dealing with this kind of situation there is most recently in this category of thinking the use of psychoactive drugs as a way to reopen critical periods there was a very nice study from Hopkins in fact that published evidence of a social critical period in rodents and that this window could be reopened by the drug MDMA or ecstasy and and so this is not to Advocate rampant drug use but it's to show a proof of principle that with a very well-measured hypothesis-driven approach we might be able to tap the neuromodulatory systems that are dampened with age through this enhancement but that alone is not going to produce plastic change it requires the training to go with it absolutely so so Brett sticking with this theme of of mood disorders and their relationship to brain plasticity I know some of the the more recent work I guess you may be doing this right now you made reference to it you've been working with a company to take your transcranial direct stimulation as a therapeutic tool I gather for depression can you tell us what's that about how are you going about it and what you found so far yeah so so there's there's a company called so just to to be clear there's a company called flow Neuroscience which is carrying forward Halos technology which is transcranial direct current stimulation and they're they're working on using that in psychiatric disease like depression now my current company is Magnus medical and at Magnus we're using a different kind of brain stimulation which is transcranial magnetic stimulation it's a it's an electro it's an electromagnetic coil it looks kind of like a figure eight that's the the physical layer so to speak but um you know like like any kind of neurotechnology the um the key is where are you stimulating and what is the pattern that you're stimulating with and what we're what we're working on bringing to the world is some technologies that was developed at Stanford University called the the saint treatment which is um it's it's powerfully effective because of a combination of personalized targeting that's uh you use functional MRI to figure out exactly which part of the the cortex of the brain is is most closely connected to the deeper networks that are associated with the symptoms of depression and then you stimulate that with a with a series of pulses and session timing and whatnot that's that powerfully leverages the underlying neuroscience and in in the data to date including a good randomized controlled trial it's 80 to 90 percent uh remission after five days of treatment in folks with really uh um very medication resistant depression and does that last is that is that have they followed that over a sufficiently long period of time yeah so there's there's good data out to the six month point and um in if for for many you know depression is episodic so for for many people um you know that that pushes them out of episode and they're they're well um either in the long term or until the next episode uh there's a population that relapses faster and we're Gathering data in that but that that also gets to one a theme here where um any kind of neurotechnology or um you know intervention that's helping people be more plastic or learn better or or treat a disease it's um there's this sometimes challenging question how do we make sure that this is relevant and it works in the long term that said I think there's a lot of room for optimism because um when when we learn something and when our brain changes especially if that's a an Adaptive as opposed to a maladaptive thing it then it they were fairly good at you know we learned something and it sticks around um and in a lot of fields of neuromodulation for medical purposes whether it's epilepsy whether it's uh stimulation for movement disorders like dystonia um and yeah I think other fields going forward the the stimulation actually gets better over time if you use an implantable brain stimulator for epilepsy you're getting way better results a couple years down the road than you are when it's first implanted even and you know part of the that is you know the the the the physician gets better at personalizing the technology and setting it up for that individual but another part of it is um the the brain learns and it learns new patterns of activity um if you're uh uh you know if if you're using some kind of intervention like that and so the saint treatment this is different from the the currently FDA approved magnetic stimulation this is a different protocol or a different dosage has it different from what's been out there already yeah so it's a it's a different it's a different treatment pattern and Technology you can compare it to um you know there with with any kind of Technology there's the physical layer and you know that's the the bits and bytes that are passing between us right now and then there's the the content and that's the the words we're saying and the thoughts we're exchanging so you know that that's that's the core difference is the is the the personalized targeted treatment technology now that that efficacy sound incredibly good right uh did you anticipate that level of success is that a shocking level so you know to to me um you know I'm the I'm the late Comer in the project um you know I'm now the co-founder and CEO but uh this was created by a team at Stanford University and they they dug into um you know what we know about the brain and about depression and about the networks that are involved and uh step back and tried to engineer every part of that treatment to make it more effective so those things certainly made sense to them and I you know I think they were you know they were really um you know gratified and you know surprised as we are all in this field because the brain is complicated um that that the effect size was so great now you know for myself as a as a lifelong neurotechnologist um it's the most profound effect size that I've seen in two decades of trying to interact with brains yeah amazing so I want to spend the rest of the time that we have turning toward the future and I just a couple topics I'd like to spend a little time talking about so uh John you know many in the public have heard about some of these devices certainly many have heard of you know Elon Musk talking about whatever it's called neuro link and things of this sort how does one distinguish between the hype and the reality how does one ensure as a consumer in the general public that you are not being taken advantage of or perhaps doing something dangerous if one's interested in experimenting with these kinds of brain stimulations you know Brett and I have argued over this in the past you know I was actually Dead with my colleagues you know one of the more cited tdcs studies of skill learning and healthy subjects right in the effects side was quite dramatic back in 2009 now there we were using the tdcs as a tool to ask a scientific question at least I was the goal at that time was not simply to say look we can make people learn a skill to a greater degree than sham controls right now I certainly believe whether it's BCI whether it's non-invasive or invasive brain stimulation whether it's reopening critical periods pharmacologically when you're trying to take science which is very rigorous and try and make patients better with trials I'm all for it right and you know I I think that is very exciting what I don't like is when premature consumer versions of these Technologies are introduced right we don't know enough yet whether we should be doing this in healthy athletes or students and it's very interesting right on the one hand you know when people are accused of drug doping in sports they're immediately with even minute amounts of drug in their system you know they're expelled from the games right and yet at the same time there's a double standard that when you have Elon musks and the others hey let's get this technology up and running and enhance humans right now so I am extremely worried about a particular and it's a particular West Coast techno-utopianism that America suffers from where basically the technological tale Wags the biological dog and the real interest is to try and sell and to try and make money by making people think they're going to be bionic or they're going to be like the Matrix or it's going to be like that movie you showed um I I think that we have to be super careful and spend a lot more time doing the trials and the science and yes when there are diseases which are really refractory to drugs like depression and the and spinal cord injury now with you know it you know with spinal cord stimulation and is doing amazing things for walking um yes I'm all for that but I am just in general very concerned about the premature jump to consumerism and also the bad faith of claiming that you're doing this for medicine but really what you're desperately trying to do is get the consumer version right and that is a trend that I am very concerned about so so not to get us into a contentious stance here toward the end but I'm just wondering does anything that Brett described here today make you uncomfortable I am there are two ways to be uncomfortable one is I'm somewhat skeptical about anecdotes of jumping athletes and skiers I think that they're I mean you know to be quite honest big Studies have not really been reproduced of late in tdcs and there's been a lot of skepticism about it um so it there's the actual effect size and how reproducible it is and then whether one should be doing this in healthy people at all so yes should we when he talks about what they're doing in depression I think that's amazing right there I think if it's done right and it's really in a group of patients that really are paralyzed by their illness literally and figuratively in the case of depression yes but otherwise I I think when it gets to the healthy subjects there's a bit of a hype cycle when you get to disease I think it becomes more rigorous Brett I have to give you a moment to respond to that yeah and you know I I think you know John and I are are actually in agreement about a lot of things and a lot of the pitfalls here and you know the you know certainly um you know one one thing underlying this is you know what it it's it is hard to um it's hard to robustly improve anything that a healthy human brain is doing you know what what's the the the the most complicated most finely optimized thing that we know of in the entire universe well that's probably the human brain and when it's operating at Peak function um you know I I I I it's it it it's hard to have any effect sometimes and um it's certainly hard to have a profound effect and you know that's why um you know certainly when you use these Technologies to to treat disease there's uh yeah there's there's a network where there is some you know there's some pathophysiology in that Network and you can identify it and um hopefully you can identify it or you know maybe science is on a path toward identifying it and that gives you it gives you a lot of levers that you can then pull when you try to design Technologies to to address that um you know another another thing you know kind of stepping back to the the human performance and consumer applications one thing that we one thing that we learned and um you know saw very powerfully at Halo over over time especially was there's um there there's there's a there's an enormous Poll for this kind of technology and it's uh it's very very hard to communicate to uh you know to especially to to consumers in the world you know what exactly you know what is this technology what can it do what can't it do what what isn't it and you you know the the whole world in a way kind of expects it to be um you know more and more more powerful and much closer to the Matrix than than it actually is and um you know that that was a line that we we tried to um you know trade tread it carefully and be clear about what the technology couldn't couldn't do but uh you know it was a a learning experience as to as to how powerfully the world wants to interpret any kind of performance uh neurotechnology as as the Matrix and and there's and there's huge pitfalls in that you know we and it and it puts a lot of responsibility on on anybody engaged in the field to uh to to to to try to tread carefully and get it right so so maybe you can also just weigh in just so everyone has a voice here on potential consumer applications I mean are you bullish on that are do you think we need to proceed with great caution should be right I mean what's your take on where this is going I think caution is very much called for uh we need to be careful about this hype as has been mentioned especially with drugs because everyone is hoping for that quick fix pop a pill learn something new and there are reasons why these drugs are regulated from a safety point of view but I I assume we'll talk a bit more about the risks of reopening critical periods in a minute I just want to say that the um the study I mentioned on absolute pitch was a good lesson for us it uh you publish something like that it goes viral and uh to this day I get emails from musicians or want to be musicians who want to acquire or want to shake their absolute pitch somehow when in fact the purpose was approve of concept that what we've learned from Mouse models of brain development does apply to human biology as well and it's the the heartbreaking emails that I get of patients and patient families people who've had traumatic brain injuries or searching for ways to recover function that's the audience we are hoping to Aid in some way by careful study and so I too am very very concerned about a publication or papers that use drugs that are available freely and being misused and as I just pointed out even we don't fully understand what the optimal training Paradigm is to achieve effects in one domain like pitch versus language and so there's still some research that definitely needs to happen and so one we from there take it to where you suggestively might go which is when you hear about brain plasticity and critical periods at first sight it sounds come on open them up I want to get back to my young plastic brain which could do so much that now is so difficult what are the potential downsides that research has revealed of reopening these periods yeah so I'm reminded of a quote by Charles Lair a French poet who once said genius is nothing more nor less than childhood recovered at will and trying to refine that uh childlike State many artists have talked about this as well but I think the the key in that quote is at will and the ability to do it in a regulated way I think there are two answers to your question what the risks might be one is at a kind of thirty thousand foot philosophical level we've all gone through critical periods shaping who we are our identities are formed in childhood and our experiences are cultural background the languages we speak the skills we have if we were to actually be able to reverse all of that wouldn't we lose our self everybody hopes to add on to who we are but there is probably a risk if we could truly reverse a critical period at a more cellular level we actually know what the risks are at some level so another kind of break was identified in the early 2000s which is an extracellular coating around the inhibitory cells I mentioned earlier and if you enzymatically remove them which is a very invasive thing you can only do in an animal model the critical period reopens this was intriguing and has of course yet to be applied to humans because he would need to do something drastic like inject an enzyme but what we learned is that these nets are not only closing the critical period perhaps trapping synapses freezing them in place so they couldn't be pruned away as in childhood but they also protect these cells from oxidative damage and so by removing the Nets you've also made the circuit more vulnerable and an intriguing inverse correlation is seen in the pathological tissue from Alzheimer's patients so in those human brain areas that have evolved to be more plastic longer that allow us to do all the amazing things that animals cannot yet do those brain regions have less of these net-like structures and it's entirely consistent with the idea that lacking this break those brain areas are plastic longer well now that we live longer we realize that the first areas that degenerate in Alzheimer's disease are those very same areas that have been enjoying in plasticity for the longer period of time and I mentioned we also manipulated a break on the acetylcholine system well those mice that have been made somewhat more human-like are in fact more plastic in multiple tasks throughout life but they acquire a neurodegenerative phenotype after some time which is unusual for mice whose cortices their brains are closing critical periods more thoroughly and so I think there is a an important message here that critical periods are a moment of heightened plasticity but they are also Windows of vulnerability and if they continue for too long then you may in fact incur damage and the the extended lifespan of humans may be witness to that that is a sobering thought that makes so much sense and yeah I don't know about you guys but my young plastic brain did some colossally stupid things and you know we're uh the the way the way the brain works is is optimized to and it's optimized to learn from experience at certain points but then to to benefit from the you know from the the weight of that experience and you know that that's you know like like many of these things you know that's something that you know that we're kind of living as mid-career scientists now we uh you know we've um we wouldn't be able to do what we do without you know without that you know the kind of progressive tuning of the of the plasticity curve that lets us um you know learn and optimize our brains in in different ways as life goes on and you know I think you know one one of the you know getting back to to more of the themes that we've talked about here one of the ways to to um you know craft things that that let us learn faster um it comes back to immersive experiences and and the right kind of content um that we experience at the right time um you know and a lot of the time that that's more effective than you know than technology then other kinds of technological interventions or or Pharmaceuticals or what have you I just want to make you know take a big step back and just I think the real I think big Point here is that behavior in other words behavioral interventions modulated by drugs and Technology is what's coming back in other words there's always been a Magic Bullet desire please let's have a pill that makes us a helicopter pilot or pill that will cure our Alzheimer's or a helmet that will make us a great basketball player there's always this impatience this kind of let's make it quick right it's very male right and I think that what the real excitement the real wisdom here is to know that you need to put the work in you actually have to do the behavior and you need to sculpt it and then intelligently modulate on top of that but as soon as you try and jump the gun and try and just get it all fast then what takalso articulated so well you get in trouble and so hence why I'm so concerned about giving consumer drugs and consumer devices to people who should just put the work in right they should just practice like everybody else rather than trying to be enhanced right let us make the enhancement where we really need it which is in the medical space respect Behavior even in the medical space and then sculpt on top of that behavior intelligently with modulation pharmacological or technological but you it you you cannot get it for free and as soon as you try and do that you pay the cost yeah the the tech the technological intervention it needs to be I completely agree it needs to be layered on top of putting the work in and you know there's a there's a great example that I mean I think John John's you know more of an expert in than I am but uh it's just super relevant here it's you know what what are the what are the effective things that you can do if you have a if you've had a stroke that's led to diminished motor function and you know in in one arm hemaprisis what have you one of the more effective things you can do is just something called constraint therapy where you basically you put you put your good arm in a sling and it forces you day by day to to get more use out of the out of the bad arm and you know that's it it's it it's effective and it's so simple and it's a good example of a lot of these themes yeah well I think you're all right there's a lot of fantasizing about what interventions can do I think Hollywood certainly pushes this fantasizing to a yet deeper level with these visions of a transhuman future and who knows maybe we are heading toward that but of course as Yogi Berra said and I can paraphrase it's difficult to make predictions especially when they are about the future so let me just uh finish with one final question don't try to imagine 50 or 100 years from now but like John 10 years from now if if the research goes along the trajectory that you imagine it would if things go really well where will we be in the kind of work that you're undertaking well I'm going to try and distinguish between what is a prediction versus a desire right but I really think that we live in a world of chronic disease neurological or otherwise and these are basically behavioral diseases they're the deleted diseases of modern society and so they're not honorary infectious diseases right you can see it with covet it's the irony that on the one hand you had an amazing reductionist biology with the vaccines in other words you could go after the virus but all the people who died because they were obese hypertensive sedentary diabetic why didn't we have massive cures of those suddenly well because that requires behavioral intervention what I would like the future to be is that there will become a point where doctors and other clinicians will prescribe an immersive experience tailored to your particular deficit in the High Street so it'll be just as natural to go to that immersive space as it is to go to a restaurant or the hairdresser or the cinema and that space will be obviously regulated in some way depending on what you're going for healthy aging or a particular disease and there you'll also get some kind of brain stimulation some sort of drug infusion and you'll basically get a kind of brain body cocktail that will be for everybody whether it's in the supermarket or the High Street that's I think what the future will be but it has to be low-cost it has to be intelligently protocolized it has to be moral right and but that's why I think we'll go in so we won't have 50 of the world over 65 basically couch potatoing through the rest of their life that's what I think the future will be but it will be Behavior first not some magic bullet Brett five ten years from now work you're doing where do you imagine it possibly being yeah and I I feel like we're leaving all this on kind of a you know note of really really great optimism here um because I share a lot of John's thoughts you know I think also in the next five to ten years our understanding of the brain networks that give rise to um really tough chronic diseases like depression and bipolar disorder or OCD even things like PTSD chronic pain we're understanding more and more about those networks and I think you know certainly in a decade there are going to be treatments that are available to literally millions of people who suffer from these and um and the medications in many cases don't work very well so um the the amount of human burden that that lifts the the amount you know the the impact that that has on the world is is really amazing to come giving you the final word prognostication about where things might be five ten years from now well this is a very exciting time in this field our appreciation of the biology behind critical periods I think will give us new biomarkers to track and tailor as John mentioned approaches to any individual especially children we can improve clinical best practice not using certain kinds of drugs for example which might trigger premature critical periods or if you can track the EI balance excitatory inhibitory balance in children who are at risk for autism for example you might intervene early when the critical periods are open and hope for a better outcome with behavioral therapies and then of course what we've been talking about in adulthood can we come up with a very rigorous tailored yet safe and eventually reclosing of a critical period in adulthood paired with the optimal kind of training so I I think this day is coming soon in fact many people are already accessing drugs that is are probably doing this to them unbeknownst to them and we would be very very um responsible for pushing that in the right direction by providing the biological and scientific background for it yeah absolutely exciting exciting work and Brett I agree it is an optimistic vision of the future but it seems one that might be realistic as well so John to have Brett thanks so much for the fascinating conversation thanks for joining us and best of luck in your work going forward thank you very much thanks so much [Music] thank you [Music] thank you

Channel: World Science Festival

Views: 305,964

Keywords: #sciencefiction, #neuroscience, #neuroplasticity, #synapse, #humanenhancement, #criticalperiod, #brain_development, #spiderman, #superhero, #depression, #athletes, #braininjury, #lazyeye, #lazyeyetreatment, #Motorlearning #strokerehibilitation #brainrepair

Id: RDVgfFzZVsA

Length: 86min 30sec (5190 seconds)

Published: Thu Mar 09 2023