[Art_beyond_sight_learning_tools] Esref Armagan article Boston Globe

[Lisa Yayla]

Hi,
Was sent this article from Joan Eroncel about Esref Armagan.. It 
appeared in the Boston Globe.
Best,
Lisa

Old brain, new tricks
New research on the blind is revealing the brain's ability to adapt -- 
and may lead to new therapies for everything from strokes to chronic pain
By Cara Feinberg  |  January 15, 2006
ESREF ARMAGAN is a 52-year-old Turkish painter who has been blind in 
both eyes since the day he was born. He has never seen a coffee cup, a 
toothbrush, an elephant, or a tree-lined street, but he can draw them 
each, from any perspective, with or without shadows depending on the 
time of day. His portrait of President Clinton, which he painted from an 
embossed photograph, looks, well, like Clinton-complete with grey hair 
and bulbous nose-and though Armagan has never had an art lesson, the 
streets he paints stretch into the distance as converging parallel lines.
For years, Armagan has been a phenomenon in the art world, displaying 
his work in museums around the globe. But it was not until two summers 
ago, when he traveled to Boston, that scientists were able to study 
precisely how he generates such images. Their hope was that he might 
teach them something about neural ''plasticity"--the brain's ability to 
reorganize its functions based on new information and experiences. If 
Armagan had never seen with his eyes, how had his brain adapted to give 
him visual representations of the world, and more importantly, what 
could it reveal about brain adaptation in general?
In July of 2004, at the Center for Noninvasive Brain Stimulation at Beth 
Israel Deaconess Hospital in Boston, Armagan agreed to have his brain 
imaged in a magnetic resonance imaging (MRI) machine while he drew with 
a pencil on a sheet of paper. He explored a set of objects by touch-a 
coffee cup, a toy elephant, a toothbrush-and then was told to imagine 
them and draw them all from memory. Each time, his drawings hit the mark.
''What we saw in the scan was quite amazing," says Dr. Alvaro 
Pascual-Leone, an associate professor of neurology at Harvard Medical 
School and director of the center. He and two colleagues in Beth Israel 
Deaconess's neurology department, Amir Amedi, PhD, and Dr. Lotfi 
Merabet, conducted a series of scans, each time challenging Armagan with 
more complex tasks. ''Esref's visual cortex lit up during the drawing 
tasks as if he were actually seeing," says Pascual-Leone. ''His scan, to 
the untrained eye, might look like the brain of a sighted person."
Armagan presented a unique learning opportunity for the scientists at 
Beth Israel Deaconess. Pascual-Leone and his colleagues had access to a 
blind person able to render-pictorially-what his mind's eye had 
captured. But more importantly, they now had the technology to look at 
his brain while he rendered it, and to glimpse how his visual cortex 
functioned after 52 years without vision.
For centuries, scientists held that the brain was a fixed entity, that 
it was hard-wired for each individual function, and incapable of 
reorganizing after injury. In the late 1850s, the French neurosurgeon 
Paul Broca was the first to argue that language was associated with a 
specific part of the brain, and other investigators soon followed suit: 
The visual cortex at the back of the brain, they hypothesized, processed 
only vision, the somatosensory cortex in the mid-brain processed only 
pain, vibration, and touch, the auditory cortex on the sides of the 
brain existed solely to process sound.
In the last half-century, however, new technology and cutting-edge 
experiments like those of Pascual-Leone and his colleagues, have 
exploded that dogma, revealing not only that the brain does in fact 
reorganize and adapt, it does so all the time. ''What we saw in Esref," 
Pascual-Leone explains, ''was that he was using his visual cortex. It 
wasn't lying dormant. It hadn't shrunk or disappeared. Instead, it was 
recruited by other senses."
The brain, as work like Pascual-Leone's is revealing, is a lot more 
resourceful than we ever knew it was.
Dr. Pascual-Leone has been studying the brain for three decades, 
examining its capacity to establish new neural connections, how to use 
the connections that exist, and how to harness them to create better 
rehabilitation strategies after trauma or sickness.
Pascual-Leone's patients and study subjects range from 
normal-functioning adults with special gifts like Armagan, to those with 
a range of neurological deficits, from sensory loss, to strokes, to 
chronic pain, to medically-resistant depression.
The blind, Pascual-Leone explains, provide an excellent opportunity to 
study brain plasticity. ''A large part of our brains is devoted to 
vision-some estimate more than half," he says. ''The question we are 
asking is what happens to that part of the brain when there is no input 
from the eyes?"
Over the past 10 years, Pascual-Leone and several other scientists, 
including his colleague Amir Amedi, have conducted experiments examining 
the brain's role in sensory perception, and much of their work has been 
with blind subjects. Using neural scans and transcranial magnetic 
stimulation (TMS)-a technique in which a noninvasive handheld device is 
used to stimulate or temporarily interfere with targeted brain 
functions-several studies have found activation in blind subjects' 
visual cortices, despite the fact they cannot see.
In an early study Pascual-Leone coauthored with Dr. Leonardo Cohen at 
the National Institutes of Health, results showed that during 
Braille-reading tasks, blind subjects' visual cortices lit up like 
lamps. But the mere fact that there was activity in that section, he 
pointed out, did not necessarily prove it was vital to that function. 
That, he said, is where TMS comes in.
''If you use TMS to temporarily interfere with the visual cortex during 
certain tactile tasks, like reading Braille, you'll find that 
early-blind subjects suddenly have trouble performing them," says Amedi, 
whose own independent studies have revealed similar results during 
language-based tasks. In the blind, unlike the sighted, the TMS 
interference, researchers believe, shows that the visual cortex is 
engaged-and in fact required-for certain nonvisual tasks.
So if, as scientists' findings suggest, the visual cortex need not be 
devoted solely to sight, how does the brain adapt after injury or new 
environmental influences? Does the brain forge new connections that did 
not exist before, or are the connections already there lying dormant, 
pressed into service by the circumstances?
Pascual-Leone's current work with his colleagues at Beth Israel 
Deaconess aims to answer those questions. For the past few years, they 
have been studying sighted subjects who volunteer to be blindfolded for 
five days and learn certain nonvisual tasks, including rudimentary 
Braille. In every case, before subjects donned the blindfold,functional 
MRI (fMRI) scans revealed little activity in their visual cortices 
during tactile tasks. After the subjects wore the blindfolds for two 
days, however, the scans showed bright patches of activity in the visual 
brain when the subjects used their fingers for tactile or 
Braille-reading tasks. By day five, the visual cortex glowed steadily 
during these same tasks. Yet two hours after the blindfolds were removed 
and the subjects' eyes had readjusted, scans of the visual area of their 
brains were as dark as they'd been on day one. Once the blindfolds were 
removed, touching, handling objects, and Braille-reading no longer 
activated ''sight" in the seeing.
The cortical adaptations that occur in the blindfold studies appear-and 
disappear-too quickly for any new nerve connections to grow, 
Pascual-Leone believes. He compares the adaptive pathways in the brain 
to detours after road blocks; building a new street takes a long time, 
he explains, but if there are other existing surrounding roads, they can 
be used right away. These immediate neurological detours reveal the 
brain's capacity to adapt in response to environmental factors, but it 
is sustained sight loss that will more likely result in lasting 
adaptations, he says.
Over time, if the brain continues to follow the detour routes, he 
believes, it starts to modify them to make them better, and might even 
make new structural connections. The fact that change occurred so 
immediately in the blindfolded subjects, he says, indicates that the 
visual cortex may inherently possess the machinery necessary to process 
nonvisual information.
Pascual-Leone and his colleagues believe that humans work with a reserve 
of existing connections dictated by their specific genetic make-up that, 
depending on their use, will become masked or unmasked by the 
individual's circumstances. ''What Esref and the blindfold studies show 
us," he says, is that lacking sight, the brain draws on information from 
the other senses. ''Even in the absence of vision," he says, ''the 
visual cortex is involved in creating images." In other words, the work 
of Pascual-Leone and others suggests that the brain has many additional 
capacities it can call on in a pinch.
. .
As both a physician and a researcher, Pascual-Leone aims to put his 
findings from his studies of the blind to use in developing 
rehabilitative therapies for other types of conditions. But his lab is 
not alone in its development of new treatments.
Other breakthrough therapies have arisen for strokes, autism, 
schizophrenia, spinal cord injuries, epilepsy, chronic pain, and many 
other previously ''untreatable" conditions. At the University of 
California, San Francisco, one neuroscientist has developed a computer 
program to teach language skills to dyslexic children through what is 
called, ''neural retraining." A professor in the department of 
psychology at the University of Alabama has used these developments to 
help stroke victims restore movement in their limbs. Two scientists at 
the University of Rochester have found that playing action video games 
can enhance a range of visual attention skills.
Yet despite the dozens of medical therapies that have been developed as 
a result of breakthroughs in thinking about brain plasticity, says 
Pascual-Leone, in both our scientific understanding of these mechanisms, 
and our ability to apply them clinically, we are still at the starting gate.
For researchers studying the brain, the next steps lie in learning 
enough about plasticity to harness it for individual needs. Through 
their work with the blind, Pascual-Leone and his colleagues hope to 
learn more about how visual images can be processed nonvisually in the 
brain-both for what it will tell them generally about how the brain 
works, and how, specifically, they might help the brain to work better 
for the newly blind or those who regain sight.
Subjects like Esref Armagan, says Pascual-Leone, help jump-start that 
process. ''We can never know what types of images were actually being 
created in Armagan's brain," he says. ''But we know now that when he 
draws those images, we can understand them visually without a doubt." 
This makes it seem as if he is seeing, says Pascual-Leone. ''And when we 
looked at his brain, we could see how."