A  BOOK  ALL  FAMILIES  SHOULD  READ  -  IT  SHOULD  BE  MANDATORY  READING  FOR  ALL  ENTERING  THE  MEDICAL  PROFESSION  - Keith Hunt

The Brain's Way of Healing by Dr. Norman Doidge

II. A Mother's Voice

Born Halfway Down the Stairs

A thirty-four-year-old British solicitor, a woman I'll call "Liz," was awakened from sleep with a pang. Only twenty-nine and a half weeks pregnant, she was going into premature labor. Within seconds, her husband was on the phone to the ambulance. She tried to get down the stairs, but halfway down the baby's head came out. As she made it to the bottom, she delivered him herself. The entire labor lasted fifteen minutes. The baby was hypothermic—very cold, a blue-gray color—and too young to breathe properly by himself. She thought she would lose him. The ambulance got them to the hospital, where he was put on a ventilator machine to help him breathe. On his second day, his parents were told he wouldn't survive the night. They stood vigil by his incubator.

He did survive, but children born that prematurely are likely to have many complications. "Will," as I'll call him, had suffered oxygen deprivation, which can cause brain damage. Over 60 percent of the first two years of his life were spent in the hospital. At three months he had surgery for a hernia, then became unable to urinate, so he needed a second operation. He developed convulsions, requiring two admissions for suspected meningitis. He lost a kidney caused by infections. He suffered from pneumonia and swine flu. He was on antibiotics permanently (a burden on the gastrointestinal tract, because antibiotics kill the healthy organisms necessary for digestion). Instead of the blissful peace of the womb, and the gentle sleep and endless embraces of infancy, Will endured constant discomfort, invasions of his body, and brushes with death, while his parents watched helplessly.

Will became a fussy baby, waking every night around one in the morning, staying up for four to five hours a night, disconsolate. Liz and her husband, "Frederick," lived for two and a half years on two to three hours of sleep. Will didn't like food, or even textures in his mouth, or any kind of sticky substance on his hands. He flapped his arms, as do many children with developmental disorders. He spent most of his days under a table or a sofa, maneuvering himself to feel pressure on his middle. When he went to bed, he had the same peculiar longing for a heavy weight of blankets on him that Tomatis had had.

Will's language development was delayed. His first word was "Dada" at ten months, but he never used it to identify his father. He would repeat the word for five minutes at a time. At fifteen months, he had a handful of words but never used them for communication—he used them to make "noises." He seemed deaf, because he didn't respond to his name. He didn't crawl or walk. And yet his parents could see that despite his problems, given the slightest relief from his torment, he was an affectionate baby.

At fifteen months, Will's doctors said he should get the measles, mumps, and rubella vaccine (MMR); because his immune system was so weak if anyone was likely to get these illnesses, it would be him. Three weeks later he developed a fever of 105 and slipped into unconsciousness. The emergency room doctors suspected meningitis, and as they attempted to insert an intravenous needle, he became conscious. He struggled so hard, it took eight people thirty minutes to pin him down. Liz looked into his eyes as he was being pinned. To her they were saying "Why do you let them do this to me?"

After that he was terrified of needles and any kind of restraint.

At this point, he stopped speaking. From sixteen months on, Will didn't utter a single word. His personality changed—he withdrew. It was difficult to know which of the many stresses had caused his silence.

"At eighteen months," Liz says, "he wouldn't play with any toys. He was very autistic-like. He would turn a car over and spin the wheels—but would never play with it for its intended purpose. He was obsessive beyond comprehension, opening and closing every door for hours." He would run around furniture, as though he were trying to see the front, the side, and the back at the same time. He would put a piece of paper on the table, then run around the table. Out of his regular environment, at a mall, he would be unable to process all the new stimuli. At the park, he wouldn't go on the slide or the swing. All he did was run up and down along the fence railings.

He was unable to read his own bodily needs, didn't know if he was hungry or thirsty, never went to the cupboard to get food or tried to get a drink. He walked on tiptoes, an action seen in children with developmental problems—the persistence of a primitive "plantar" reflex. (The plantar reflex occurs when a physician strokes the bottom of the foot and the person's big toe turns up reflexively; it is present in young infants. It should disappear, but if it doesn't, that signals a brain problem.) He was so uncoordinated from low muscle tonus, he couldn't hold a crayon or a spoon.

Unable to speak yet so often overwhelmed, he had a horrible way of discharging his emotions. When he went into a meltdown, he would bite his hand or arms, and because of his exceptionally low muscle tonus, could bend forward and bite his own stomach, drawing blood. Afterward "he became calmer, like it was a release," says Liz. "As we look back at videos of him, the hurt in his eyes is unbelievable."

The family was referred to a developmental specialist. "On the day that changed my life forever," Liz says, "I was told by a very experienced pediatrician that he had very severe cognitive impairment based on brain damage, and was the mental age of six months, though he was already two years two months. The consultant spent an hour with Will. She got out a tea set and asked him to make tea. All he did was stack the cups, and knock them down. She also did the U.K. autism test, and it didn't show signs of autism. And she said he was not going to get better, and that by the time he was thirteen, he would probably have the mental age of a two-year-old."

Liz questioned how the doctors could be so sure of Wills prognosis, earning a reputation as a "neurotic mother" with the staff of the National Health Service. She read fiendishly about premature babies and in January 2011 found descriptions of children who seemed like Will in a book by Sally Goddard Blythe, called Reflexes, Learning and Behavior. Liz sent a long description of Will to Goddard's Institute for Neuro-Physiological Psychology, and Peter Blythe, the neuropsychologist who had set up the institute, contacted Liz and asked her to bring films of Will since birth. Liz asked him if there was anyone in England who could help, "and he said, 'No. There's only one man who can help Will. And that man is in Toronto.'"

"We arrived in Canada. It was a heavy snow in March," says Liz. Will was nearly three and hadn't said a word for eighteen months. He couldn't sleep, walked on his tiptoes, was constantly frustrated, and in perpetual motion.

Paul Madaule examined Will and was confident his problems were chiefly neurological, mostly related to the vestibular or balance apparatus in the ear (introduced in Chapter 7) and how it related to the relevant brain areas that process balance.

Tomatis had emphasized that ears have two different functions. The cochlea, or "ear of hearing," as Tomatis called it, processes audible sound. It detects the sound spectrum from 20 to 20,000 Hz. The vestibular apparatus, or "ear of the body," as Tomatis called it, normally detects frequencies under 20 Hz. People experience the lower range of these vibrations, 16 Hz and slower, as "rhythmic" because they are slow enough for a listener to perceive the intervals between the individual waves. These frequencies often induce body movement.

Tomatis called the vestibular apparatus the "ear of the body" because the semicircular canals within it function as the body's compass, detecting its position in three-dimensional space and how gravity affects it. One canal detects movement in the horizontal plane, another in the vertical plane, and another when we are moving forward or backward. The canals contain little hairs in a fluid bath. When we move our heads, the fluid stirs the hairs, which send a signal to our brains telling us that we have increased our velocity in a particular direction. The signals from the vestibular apparatus travel along a nerve to a specialized clump of neurons in the brain stem, called the vestibular nuclei, which process the signals and send commands to the muscles to adjust themselves, to maintain balance. The "ear of the body" allows infants to switch from being mainly horizontal, crawling creatures with big heads to standing erect on narrow feet and walking without falling.

The specialists in England had assumed that the reason Will ran around furniture and other objects was that he couldn't see things in three dimensions, so he circled them to detect their depth. Paul had a different take. He thought Wills brain was "starved" for vestibular stimulation, because of a vestibular problem. By running around things, he was trying to stimulate his balance sense, which normally integrates input from the semicircular canals of the ear, the bottom of the feet, and the eyes, all of which give important sensory input about orientation in space.

Normally, when a child turns his head to look at something while walking, his vestibular sense tells him that he, and not what he is looking at, is moving. But when Will moved his head, he saw what he was looking at as moving, and it fascinated and energized him, so he could keep moving for hours without tiring. And because Will had a vestibular problem, he felt unstable in his own body and always felt as though he were in a rocking boat, always moving, and because his world was moving, he had to move with it.

One reason Will wanted heavy objects on him was that he could not tell where his body was in space, a consequence of his poor vestibular function. The balance system gives a person the sense of being grounded, rooted, and bounded, so necessary for having a settled, stable sense of self. Children born prematurely miss out on the allotted time nature usually provides for feeling enclosed in the protective comfort of the womb; they are born before their brain can filter out unnecessary sensations, so they feel assaulted by stimulation. Paul believed Will wanted pressure on his body as part of his attempt to integrate all his sensations and experiences as part of a single self—a way of "pulling himself

together." Nurses working with premature babies often swaddle them tightly in blankets, which settles them. Will was swaddling himself.

Will's nonverbal, two-way communication with others told Paul that he appreciated that other people had minds; that realization meant, by the common definition, that Will was not autistic. But Will had what Paul called "the peripheral symptoms of autism," such as tiptoe walking and hypersensitivities. Ten weeks of prematurity, followed by two brutally traumatic years, had led to what Paul called "missteps in development." And Will suffered from "the discomfort and fear which comes from being close to death, which adults can verbalize and kids cannot, but which I am sure has an impact on little kids." 

Paul's feeling was that the British diagnosis was true as far as it went—parts of Will's brain may have been "unrepairable"—but that diagnosis left out the possibility that Will may not have developed normally because he hadn't received the kind of stimulation he needed, at the time he needed it, to awaken normal development. Paul couldn't know which of Will's symptoms were based on brain cell death, and which on global developmental delays. But because he knew the brain is neuroplastic, his approach was "Let's stimulate Will's brain and see what happens."

The first fifteen days of Will's treatment were devoted to the passive phase. For ninety minutes, Will listened through headphones to Mozart, and to his mother's voice reading nursery rhymes, both filtered. After that, Paul played Will unfiltered Gregorian chants, sung by a choir of male voices. These Gregorian frequencies were to relax him, after intense sound stimulation. The rhythm of the chant matched the breathing and heartbeat of a calm, relaxed listener. To Liz, it seemed Will knew, almost immediately, that this process was helping him. Each morning he was more eager than the last to get out of his stroller, get up the steps, burst through the doors, and start.

Paul told Liz that Will might sleep a lot while listening to the music, and he did. Paul also predicted that near the end of the first week, Will would probably start sleeping better. On the sixth night, Will slept through the night for the first time in his life.

"It was absolutely unbelievable," says Liz, crying. "When someone says something like that is going to happen—and it will change your sons life—these are things you hold them to."

The first time Will listened to his mothers highly filtered voice—so filtered Liz couldn't recognize it—he started to look at her more and connected more deeply to her. He wanted more interaction and would sit close to her and try to join her in activities, or he would pull her toward him. His frustration and anger toward her eased. "It felt like he knew it was me," she says. Yet this was intriguing because he had, after all, heard her unfiltered voice all his life. Though children don't consciously identify their mother's voice with the whistling sound, Paul and his staff constantly see children who have shown no connection, or who show a limited or ambivalent one, spontaneously hug their mothers and for the very first time make eye contact and show signs of tenderness. Hyper children become calmer; goody-two-shoes children begin to act out in a healthy spirited way; and most become better listeners and talkers. Paul wrote, "It is as if the filtered sound of the mother's voice increases the child's desire to be born to a world where sound and language are a means of communication." Some autistic children start babbling, then for a few days scream high-pitched sounds, then begin to speak and make eye contact. Adults who do the training with the mother's voice may find they are less tense, sleep better, express more emotion (both pleasant and unpleasant), and become more energized.

Paul also made a prediction about Will's language. "He was very specific," says Liz. "He said, 'Expect to see language changes on day four.'" And on day four Will said his first word. He was on the floor, listening to filtered music, when he said "lion" while placing a picture of a lion into a jigsaw puzzle. It was the first word he had ever used in context. The next day, as he put the number eight into a puzzle, he said "eight." He added one new word a day, always while listening to the filtered music. On their last day in Toronto, Darlah Dunford, one of Will's therapists, put him on a swing and said, "Ready, steady, go!" and swung him several times. Then she said, "Ready, steady..." but didn't release the swing until he spoke the final word. He completed her sentence, saying "Go!" and she swung him.

After fifteen days, Will had ten words, was using them in context, was sleeping through the night, and was playing appropriately with toys for the first time. He was no longer always moving. And he stopped biting his stomach and drawing blood.

THE  UNBORN  CHILD  AND  THE  MOTHER'S  VOICE

The mother's voice plays a special role in the treatment of premature children—it is one of the strangest aspects of Pauls technique, but it seemed even stranger when Tomatis first developed it. It is now established that a fetus can recognize its mother s voice, but when Tomatis first proclaimed that the maturing fetus—curled up in the womb, oddly enough, in the shape of an ear—could hear sounds and recognize the mother's voice, medical schools were teaching that fetuses, and even newborns, were not capable of awareness. The argument—routinely made as recently as the 1980s—was that the infant's nervous system was not sufficiently complete. The unborn child was a witless tadpole.

In the early 1980s, scientists (and especially the Toronto psychiatrist Thomas Verny) gathered studies proving that the fetus has experiences in the womb. Until then, only some mothers (who believed it made sense to sing to their fetuses) and a few psychoanalysts (including D. W. Winnicott) argued that the unborn child perceived and had feelings. Freud and Otto Rank, who believed that birth could be traumatic, agreed with these ideas. Tomatis read about the unborn child's alertness in the work of the neonatal neurologist Andre Thomas, who demonstrated that newborns, surrounded by conversing adults, turn only to their mother's voice. Tomatis wrote that this action must indicate recognition of "the only voice of which he or she was aware while still in the fetal stage."

"My own experience as a premature baby often stirred up and guided my libido sciendi" or desire to know, wrote Tomatis. In the 1950s, eager to better understand the origins of listening, he wondered what it would be like for an infant to hear the mother's voice in utero— from within her body. To find out, he built an artificial womb and filled it with fluid, designed to replicate the sounds of the intrauterine environment. He equipped the "womb" with waterproof microphones, and from inside it he played sound recordings from the bellies of pregnant women. As he listened, he heard deeply soothing sounds: from the intestines, the brooklike gurgling of fluids; the rhythm of the mother's breathing, ebbing and flowing like the surf; her heartbeat; and in the distant background, the faint sounds of her voice. He saw premature birth as emotional trauma that the infant experienced, in part, because of the sudden loss of all these sounds. He suggested that the mother's voice be piped into incubators to soothe premature infants, a practice that was taken up in parts of Europe. And to help people who had had auditory problems since infancy, he began to use the mother's voice in the Electronic Ear, filtered so it sounded as it did in the womb.

By 1964, scientists had demonstrated that the eardrum and the inner bones of the ear are already adult size halfway through pregnancy; that the acoustic nerve is mature by then and can conduct signals; and that the temporal lobe, which processes sound, is also largely functioning. Eventually 3-D ultrasounds and methods of monitoring the fetal heart and brain waves showed that fetuses respond to voices. Recent studies confirm that the fetus can differentiate its mother's voice from other voices. Barbara Kisilevsky and her colleagues, working with sixty pregnant mothers (on average 38.2 weeks pregnant), played a recording of each mother's voice, ten centimeters above her abdomen; they found that the heart rate of the fetus increased, but not when they played strangers' voices. Recent studies have replicated Andre Thomas's findings that newborns prefer their mother's voice to that of strangers and prefer stories that were read to them by their mothers in the last six weeks of pregnancy to new stories. Immediately after birth, newborns can distinguish the "mother tongue"—the language the mother spoke while they were in the womb—from another language, and newborns have neural networks sensitive to native speech before birth.

Tomatis believed that all unborn children, during the four and a half months that their ears are functioning within the womb, grow "attached" to the sole voice they hear murmuring a language they do not understand. Some argued, "But isn't the contact between child and mother primarily a physical one?" to which he answered, "Language, too, possesses a physical dimension. By causing vibrations in the surrounding air, language becomes a sort of invisible arm by which we 'touch' the person listening to us in every sense of the term."

Paul puts it this way: "We don't relate to people directly; we relate through our voice. It is a medium. The brain is a tool user, and the voice is a tool." The unborn child in the womb hears many lower-frequency sounds (like the heartbeat and breathing), and then the mother's voice, which has low but also higher frequencies of speech, occasionally breaks through.

Paul continues, "We can imagine the unborn child making a first attempt to 'connect' with the more agreeable sound of the voice of her mother. But unlike a radio, the voice is not always 'on' and the fetus cannot control it. She has to wait until it comes on to enjoy it. Thus the first motivation to reach out is born. This is followed by the first gratification— the pleasure of hearing this sound again. This initial silent 'dialogue'gives birth to listening. Many mothers sense and respond to their unborn child's silent quest for dialogue. They sing the same songs over and over again The unborn child does not understand the meaning

of the messages sent by the mother's voice. What he 'understands' is the emotional charge of those messages."

BACK  TO  WILL

Will responded profoundly to the listening therapy: he slept better, spoke, formed closer emotional connections, and was able to regulate his emotions. At that point he had finished his fifteen-day passive phase. Paul said that Will would need six weeks for his brain to consolidate his gains. His development would continue, but as he started to communicate for the first time, he would also develop new frustrations. Paradoxically, this change would be a sign of progress.

When the family returned to Britain, Will continued to develop. He got up to twenty-two words, his sleep was now "fantastic," his appetite improved, and many of his unusual symptoms vanished. He was no longer squashing himself underneath weights, running around tables, looking at objects from different angles, or opening and closing doors. Toys he had never played with were now being used appropriately.

Six weeks later, in May 2011, they returned to Toronto for a second fifteen-day visit, to begin the active phase. Will listened to filtered music again, but also to his own filtered voice while he spoke or sang. Over the fifteen days his vocabulary grew, he was able to communicate better, and he became calmer. Because he could communicate his emotions and thoughts, he didn't rage or bite himself when frustrated, and Liz could now reason with him. He progressed to role-playing and pretend play, and his imagination flourished. Sound stimulation had so awakened his brain that he developed a sense of smell for the first time.

But as Paul had predicted, he was often frustrated. Two to three days into his second treatment phase, having begun communicating, he suddenly expressed intense annoyance and threw tantrums whenever his parents couldn't immediately understand him. Having tasted communication, he wanted as much as possible. Then after a month, his frustration diminished as quickly as it had begun.

"Paul said he would be speaking in sentences by Christmas," says Frederick, "and literally a week before Christmas, he did."

Paul had developed a portable Electronic Ear, called the LiFT (for Listening Fitness Trainer), and he gave Liz one to take home to England. Paul kept in touch by Skype, modifying Will's program as needed. In late 2012 speech and language therapists in England declared Will's language, speech, and comprehension to be age appropriate for a four-year-old. 

In eighteen months, with Paul's help, he had moved through more than four years of language development, because in fact, at four, he read and comprehended at a six-year-old's level. Frederick marveled the day Will read the word scientist, thinking, "Two years ago he couldn't speak!" In September the pediatric consultant in the U.K. apologized, saying that she had "got it totally wrong," and she admitted that Will's progress completely blew her away and that she would now direct other children like Will to listening therapy.

The pediatric consultant's original assessment—that Will would not progress—no doubt had its source in the doctrine of the unchanging brain as she had been taught it and as it was still being applied to premature infants. While many premature lives are saved, the long-term statistics are that between 25 and 50 percent of such infants (who have not had listening therapy) have cognitive and learning disabilities, attention problems, social interaction difficulties—and often cerebral palsy. The view of mainstream physicians has been that such catastrophic deficits must be caused by brain cell death.

But a 2013 study by Justin Dean and Stephen Back shows that when fetal lambs in the womb sustain even a catastrophe as deadly as lack of oxygen to the brain, it does not necessarily kill all brain cells, though it may decrease the number of neuronal branches and synaptic connections between the neurons. These oxygen-deprived fetuses have a smaller brain volume than normal, but it is not caused by an overall loss of neurons. Rather, the smaller brain volume is caused by the lack of connections between the neurons. The neurons have fewer dendritic branches to receive signals from other neurons, and the branches they have are shorter, and there are fewer synapses between neurons. The neurons hadn't matured properly. Dean and his colleagues concluded, "Our findings question current assumptions that the cognitive and learning disabilities in preterm survivors arise principally from irreversible brain injury resulting from neuronal degeneration."

Prematurity, even without oxygen deprivation, contributes to fewer connections between neurons because a rapid increase in the branching of fetal neurons normally occurs in the last third of pregnancy—the period when most premature babies are extruded from the womb. The problem is that mainstream physicians have no training in using mental activity or sensory stimulation to "hook up" disconnected neurons and help them mature, training that would take advantage of the fact that "neurons that fire together wire together." It took experts like Alfred Tomatis and Paul Madaule to devise ways of stimulating neurons to fire and wire to connect, because everyday experience—of which Will had plenty—is insufficient to do so. Before he could make use of everyday experience to mature, he had to pass through the steps I have described: in the first few days he required appropriate neurostimulation, which turned on the parts of his brain that neuromodulate arousal. He got the neurostimulation and began to sleep properly. This state of neurorelax-ation allowed him to accumulate energy so that he was soon able to make huge leaps in language development and sensory discrimination, a sign of neurodifferentiation.

It's June 2013, and Will is back at the Listening Centre for his third visit. We are in the sensory room, filled with swings, hammocks, and toys with different textures. Will is listening to filtered music with the headphones wrapped around his thick blond hair. He has cherubic cheeks and is a charming, disarming chatterbox.

"Hallo!" he says immediately to me with great warmth, making good eye contact. Darlah stands over a mirror on the floor, holding a tube of lotion, and asks Will, "How many squirts do we do?"

"Seven!" he answers joyfully. "Can I skate on it?"

"Yes," says Darlah, helping him pull off his socks and putting seven squirts on the mirror. Will stands on the slippery surface and moves his feet around on it. He falls, emits peals of laughter, and plays with the lotion, which is all over him. This is the boy who couldn't tolerate gooey or sticky textures. He gets up and runs in place.

Will is learning to integrate sensory input, motor movement, balance, and coordination. That he had had problems integrating sensory input could be seen in his hypersensitivities to sound and tactile sensations, his need for constant movement, and his lack of coordination.

When Paul works with children who can't speak or who have immature or delayed speech, he often finds that moving them on a swing while they are wearing the Electronic Ear stimulates their speech, showing the interplay of the vestibular apparatus and the cochlea. Movement naturally induces speech, he has observed, and mothers, by bouncing their tots on their laps, are stimulating their children's vestibular system, preparing the way for speech.

Tomatis emphasized that we have two ways of picking up sound. First, air conducts sound waves through the ear canal to the cochlea; this is called air conduction. Second, sound waves vibrate directly against the bones of the skull, which conduct sound to the cochlea and the vestibular apparatus. This is called bone conduction. Tomatis found that he could best influence the vestibular apparatus through bone conduction because it conducts lower frequencies especially well. So he attached a small vibrating device to the headphones of the Electronic Ear, to sit directly against the skull. Wills headphones were thus equipped with a bone conduction vibrator. Its impact on his vestibular system brought about a radical decrease in his need to "move around" when he looked at objects because he was no longer starved of vestibular stimulation. The stimulation to his poorly functioning vestibular apparatus (which had left him feeling he was always moving) fixed it and left him feeling more at home in his body, less clumsy, and more grounded.

The Listening Centre used objective measures to monitor Wills vestibular functioning. When a person with a healthy vestibular apparatus is seated in a rotating chair and is then spun rapidly and stopped suddenly, his eyes will quickly jerk, many times, in the direction opposite to his spinning. This normal reflex, called postrotary nystagmus, is a sign that the vestibular apparatus is detecting body movement and sending signals to the eyes to readjust where they look. But many developmental delayed children, and children on the autistic spectrum, don't have postrotary nystagmus. When Darlah first spun Will and stopped him, his eyes stayed still. But a couple of days ago, when Darlah spun Will, he said, "I feel funny," and his eyes showed nystagmus for the first time—a sign his vestibular apparatus was kicking in. When she got him to explain what "feeling funny" meant, it turned out he was dizzy, a new experience for him.

Just before Will's latest visit, he had to have his adenoids removed. Since every operation triggers the unresolved traumas of his previous surgeries. Will regressed a bit in his skills and behavior. "Yesterday," says Liz, "he tripped and fell and said to me, 'Why did you let me trip?'"

"If anything goes wrong, he blames his mom. He doesn't blame me," says Frederick, puzzled.

"I hear that all the time," says Paul. "From the standpoint of the suffering child, Mom is the cause of all his pain. The one who gave me life, gives me all the problems of life. And that makes mothers feel very guilty—inappropriately so. We do everything we can to remove that with counseling, but another way to settle that child down is to use her voice, the mother's voice, which can be very soothing in this situation." To help out, Paul played Will the recording of Liz's voice, and it calmed him quickly. Such is the rectifying power of the filtered voice, sounding just as it did in the sanctuary of the womb, before his life's troubles began.

Two days later its Wills fifth birthday at the Listening Centre. Will is not simply talking—his vocabulary is downright sophisticated. When Darlah brings in two bags of birthday presents—toys he's grown to love in the sensory room—he says, "I wasn't expecting that!" and gives Paul a big hug. Then he takes a drink from the water fountain and goes to throw out his cup. Seeing two wastebaskets side by side, he reads a sign over one out loud, "'Recycling drinking cups go here.'"

The cake comes out, and he smiles and yells, "Hip, hip, hooray! A big hooray!" in his little-boy English accent, and he dances. "Its a white cake!" he exclaims, and blows out the candles. "Are we going to share it?" he asks Liz, subtly instructing her to begin cutting the cake.

Liz says, "Last night he said to me, 'Mom, will I be bigger in the morning?' And I said, 'Well, you'll have to look in the mirror.' And he did, and said, 'Look, my neck's longer!'" He's a happy boy—he jokes— and though Liz, Frederick, Paul, and I have talked about his eventually needing to work through the terrible traumas of the first few years of his life—episodes he never brings up—for now, as long as no one tries to restrict him physically, he displays the most pleasant, outgoing, endearing of temperaments, overflowing with affection.

Will goes to a regular public school now.

Paul, feeling so happy for Will, leans over to me and says, "I agree that neuroplasticity is the ability of the brain to change at any time and any age. But when you have the opportunity to use it early—as we got to do with Will—there is so much more you can do. Had we waited another ten years, he would have been so damaged by then. We could have helped him, but we would have had a child who had years of struggle, was completely lost in his senses, was unable to put a sentence together, unable to express his feelings and needs, and all those experiences would have accumulated, leaving him locked within himself."

Liz, Frederick, Will, and his baby sister return to England tonight. Wills extended family back home is incredulous. "They can't comprehend," says Liz, "that Will listened to filtered Mozart, Gregorian chant, and his mother's voice, and it changed his life. It's surreal."

Frederick pipes in, "It was like a miracle for us. But it's all true. All the specialists and consultants—all but Peter Blythe—said he was braindamaged and would be an eighteen-month-old forever. And most people would accept that. But she"—he points a trembling finger at Liz, holding their one-year-old daughter—"wouldn't believe it."

I look over at Liz, bouncing her healthy baby girl on her lap. Liz has blond hair and earnest eyes; she is wearing stylishly torn jeans and looks for just this moment like an ordinary mother, at her son's happy but otherwise unremarkable fifth birthday.

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WOW  IF  ALL  THAT  JUST  DOESN'T  BLOW  YOU  AWAY……. OH  THE  BRAIN,  WONDERFULLY  MADE….. AND  HOW  IT  CAN  HEAL  ITSELF  WITH  THE  RIGHT  STIMULI  -  TRULY  REMARKABLE  -  Keith Hunt