Step of Mind

Step of Mind Kaiser recruitment ad

While random, chaotic acts of violence in the Middle East often trigger fear, some scientists, healthcare advocates and businesses in that region are teaming up to actually embrace chaos and randomness in a clinical setting. Their work may aid those with cerebral palsy, brain damage, the aftereffects of stroke, as well as the elderly whose loss of balance can lead to injurious falls. The Israeli firm, Step of Mind, is one such company with plans to develop a line of products for improving motor behaviors based on the implementation of chaos theory.

ABILITY Magazine's editor-in-chief Chet Cooper visited the organization in their Tel Aviv offices, meeting up with Dr. Simona Bar-Haim, the scientific director, and Jacob Witkowski, the Chief Executive Officer. They talked about their work and the healing products they seek to bring to market. Together, the three made a trip to Jerusalem’s Princess Basma Centre, which serves the Palestinian population, to speak with Bar-Haim’s peer researchers and see their work first hand.

[ABILITY Corps Update Project - Video added June 2015]

Chet Cooper: How did you come up with the idea of using chaos theory?

Bar-Haim: It started as part of my master’s degree project, when I met a scientist from one of the cosmonaut programs in Russia. He was a new immigrant in Israel. By the beginning of the ‘90s, when the communist regime was finished, many new Jews who came here from Russia were scientists. I was studying walk physiology, when I learned that he worked with the idea of chaos theory as well. My master’s topic was the rehabilitation of movement disorders. The ex-cosmonaut scientist and I started to talk and he became my mentor. I studied physics and specifically chaos theory as it affected systems in nature, including thermodynamics, river turbulence and acclimation.

Cooper: Acclimation?

Bar-Haim: These are examples in nature where systems work in a chaotic way or in a non-deterministic chaos. As I continued my research, more and more institutes and scientists found that chaos theory exists in some systems in the human body, such as heart rate variability or non-linear brain functioning. The first step was to determine how to measure this. These days it’s recognized all over the world that you can measure functions of the heart and brain in a non-linear way and find characteristics, data and important clues that you cannot find with conventional analysis.

Cooper: How do you measure these functions?

Bar-Haim: You need to use non-linear or non-deterministic equations, such as fractal analysis, approximation and entropy, which can show if your heart or your brain is working in a chaotic or variable way or is working in a deterministic way. This is the opposite of what is widely believed today in conventional medicine: That order is healthy and disorder is pathology. Today we know that there are disorders, which you can measure with fractal analysis, that will show that your heart is working in a variable way, and yet is still healthy.

Cooper: So you’re saying that the heart should be working in a variable way?

Bar-Haim: If you are healthy and young, your heart is variable. There are heart rate monitor watches that are best for measuring heart rate when you are walking or participating in various sports. These are special devices that can measure your heart beat by beat. The mean average may be 80 beats per minute, but if you are measuring bit by bit, and you are healthy and young, it may be 79, 78, 77. It will vary.

Cooper: But within a parameter of order?

Bar-Haim: If suddenly it fell from 80 to 60, that would be dangerous. But this small variability–

Cooper: I guess I’m having a problem with the word “disorder,” in that we consider disorder being ill.

Bar-Haim: Pathology.

Cooper: But you’re actually saying that, to a degree, disorder is perfectly healthy?

Bar-Haim: Right. This degree has two characteristics: One is very delicate changes, not drastic ones, which are dangerous. Delicate changes mean your heart has degrees of freedom to adapt to the environment. This adaptation can be to temperature, to climate, to your emotions, physical activity, etc. As you age or face illness, then this variability, this delicate variability is reduced, and if it’s reduced you can’t adapt as well.

It’s the same story, almost, with the way our brains function. They also operate in a chaotic and variable way, meaning they have degrees of freedom. One example is the way you reach for a cup of coffee; there are 20 ways to do it. You could drink it like this or like that. Take it up with your left hand or your right. Basically, your motor functions have freedom in the way they perform tasks. If this cup suddenly became very heavy, I could choose another strategy for how I would pick it up. So chaotic is not the chaos of the Bible; it’s something you can measure by equations that are acceptable and known.

If you have brain damage, you may lose this adaptability, this variability, this chaotic way of functioning, and can pick up a cup in only one way. For example, someone with hemiplegia will do it only one way. Maybe he will succeed in some way to drink his coffee, but if the shape of the cup changes, or the distance between him and the cup grows or is shortened, he will not be able adapt.

Cooper: Was this information that came out of your research?

Bar-Haim: Actually this information has been known for about 30 years. What’s novel is the way Step of Mind is using it. We think we can apply this knowledge to develop training and systems to help persons with movement disorders when there’s brain damage.

We say, if the brain is working in a chaotic way when a person is healthy, then you should challenge him in a chaotic way in training to bring him back to this healthy chaotic brain. And it’s again very opposite to conventional therapy, which tries to “correct.” If you are doing an abnormal movement, and you know how the normal movement is done, therapists will try to make it as normal as possible. But when the brain finds its own solutions, the restored function is optimal.

Cooper: Why do physical therapists go for what could be called a more robotic approach?

Bar-Haim: In the therapeutic environment, a person working with disabilities, especially with motor disabilities, tries to make them look and function like us, because our eyes are used to seeing typical motions, movements and reactions that we perceive to be aesthetic. But this doesn’t mean that it’s optimal for that person. Their brain may find ways to function in the environment that will be better and efficient for them, but not aesthetically pleasing to our eyes. They may not move as they used to and that’s okay for them.

If the brain finds its own ways to function in a clinic, then these skills can be transferred to the supermarket, the garden, the home and the broader community. But if a person with brain damage is just trained to do what looks normal in the clinic, we know he or she will have a more difficult time transferring these achievements into everyday life. For example, if you are retraining someone how to sit and stand from a special bench in the clinic, it doesn’t mean that they will come to a chair in a bar or a restaurant and know how to sit in that chair.

Cooper: That’s why they need to bring the bench with them.

Bar-Haim: (laughs) That’s one way to do it.

Cooper: In the case of a person who’s had a stroke, what benefits does your approach offer?

Dr. Simona Bar-Haim: There are situations where spasticity and brain damage lead to severe contraction of the hand, for instance. You can’t get effective movement out of it, meaning the muscles, ligaments and fascia are so contracted that the only solution is to operate, and we can’t help this person. But if you have a movement disorder of the upper extremity, and you have some passive range of motion, it is called a dynamic contracture. This may be a situation where you can increase the function by applying variability of training on this upper extremity.

The three situations are stiff contracture, where the only solution before training is an operation; dynamic contracture, where it is only spasticity and you can help through activity and training; and a mean position between the two, where there is a dynamic contracture, but it’s already going into a stiff contracture. In the latter case, you have to apply some other kinds of treatment, such as passive movement and stretching.

Cooper: So what results might you see in someone whose fingers are curled, will the fingers be flexible?

Bar-Haim: It’s not only assisting with that. It’s bigger than that. You have a major study being conducted in the U.S., and now branching out to the rest of the world. It’s called constrained induced therapy, meaning that for a period of some weeks you constrain the function of your healthy hand, and thereby force the brain to use the parts that have been affected by a stroke. We’ve seen some very good results with this. Our goals with this are transfer and retention. We intend to transfer the training from the clinic to the outside world, into a real environment. With retention, you keep the results for a longer time period, even when the training has stopped.

Cooper: When I was in the lab, you had equipment with variable engines for use on the arms and legs. Was that what was used in the trial you’re talking about?

Bar-Haim: Yes. We are calling it proof of concept, as we are proving the theory. The first stage was my Ph.D. This was done on the cycling station that you tried in my laboratory. Meaning children with cerebral palsy sat there for 10 minutes, and their lower and upper extremities, legs and hands, were moved in a passive, unpredictable, random way. They didn’t know where it would go by direction, speed or frequency, which relaxed their motor control abilities. I disconnected their motor controller from their use in the pathology of predicted walking.

The second proof of concept was done in a Middle East research cooperation study funded by the United States Agency for International Development (USAID), in cooperation with the United Cerebral Palsy Research and Educational Foundation. In this study, I instructed physiotherapists on how to use these methods. Once again, it was training that involved chaos and randomness: The child didn’t know how his training program would start or end. We used all kinds of strategies and we proved that with this kind of training, achievements last for a longer period, for more than half a year outside the clinic, in the community and in outdoor activities. Later, parents in Amman, Jordan, or in Palestinian villages reported that their children could function outside their home and schools. They went on to play football with friends outside.

Cooper: They actually started playing football?

Bar-Haim: Yes. Not all of them; it depended on their starting point in terms of brain damage. If it was greater, your chances were less and, of course, vice versa.

Cooper: The clinical trial involved children with head trauma?
.... continued in ABILITY Magazine

ABILITY Magazine
Other articles in the Herschel Walker issue include Green Pages—An Old Fashion Clothesline; Faucet Aerators;Pate—Winter Sports Clinic Highlights; Humor Therapy; Man’s New Best Friend; Headlines—Splel Chceker, Drum Therapy, HBO Film and more; George Covington—Nobody Walks In Texas; Ouch!—Relief for Fibromyalgia; Best Practices—Sprint Has Your Number; A Place Called Home—Disability Legal Rights Center; UCP—A Ride to Raise Funds and Awareness; Ability on Assignment—Qatar, Shafallah Forum; Essay—Spread Respect; ABILITY's Crossword Puzzle; Events and Conferences...subscribe

More excerpts from the Herschel Walker issue: (Vol 2008 June/July)

Herschel Walker — Interview

Documentary — Including Samuel

Step of Mind — Using Chaos For Good in the Middle East

Inclusion — Making Strides at the Boys & Girls Club

Ouch!—Relief for Fibromyalgia

Sport Clinic Volunteers

Humor — Man's New Best Friend

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