It was 6.30 on a Sunday evening, and Dr Bernard Brucker was examining the last patient of the day. The boy on a wheel chair was suffering from cerebral palsy. His parents -- on reading about the doctor's visit to Chennai -- had travelled from Mumbai. "We came here yesterday. We didn’t want to miss the appointment at any cost," said the father.

After the examination, an excited Dr Brucker took several photographs of the child and exclaimed, "This is an excellent prospect."

Then after the little boy had left, he added: "By next year, the boy would be walking without any support."

It took 30 years of research for Dr Bernard S Brucker to develop the Electromyographic Biofeedback method. And he was at the Apollo Asha Biofeedback Center in Chennai recently to examine patients from all over India.

An associate professor in the departments of orthopaedics and rehabilitation, psychiatry and behavioural sciences and radiology at the University of Miami School of Medicine, Florida -- Dr Brucker's research explores the possibility of replacing dead brain cells with alternate cells present inside the brain. The brain has over 1,000 trillion cells, of which the average person uses only 10 per cent.

The damage that occurs to brain cells and spinal cord cells due to stroke, injuries, cerebral palsy, etc renders the cells useless. These cells cannot be repaired, nor regenerated.

The Biofeedback treatment first evaluates the patient's condition. Computer-assisted surface EMG monitoring allows the patient and therapist to see whether there are chances of recovery. Electrodes are placed on paralysed muscles to detect electrical signals that come from the brain through the spinal cord to the muscle. These signals are amplified and fed into a customised PC for analysis, and displayed on a large monitor in front of the patient.

The patient is then able to see how brain cells are being used to produce electrical signals to various muscles. For example, signals for contraction of some muscles, and relaxation of the opposing muscles. The patient can immediately see how well he is doing by observing the trace displayed in real time on the monitor.

Thus, the patient learns new ways of controlling his body -- by bypassing the damaged areas of the brain and training alternate cells. When a patient finds that the nervous system is correctly reconnecting to the muscles, he is asked to repeat the process to cause the movement till he attains full control of the brain.

In an interview to Shobha Warrier, Dr Brucker explained that learning to use alternative cells was like learning to ride a bicycle, which one could never forget after mastering the technique.

You have worked with orthopaedics, psychiatry, behavioural sciences and radiology at the University of Miami School of Medicine, USA. Has your being part of all these departments helped you with developing the EMG Biofeedback method?

That's right. I am a psychologist by training, and my doctorate is in that. In 1969, my professional work was as a research scientist. My interest was in behavioural sciences, and that is why I am a psychologist. The work that I was involved with was specifically in understanding the structure of the brain.

We were doing many experiments and as our work proceeded, we began to get a better understanding of the process of learning. Through learning, we walk, ride a bicycle, speak various languages, etc etc. We wanted to bring the process of learning to the smallest possible level, that is, to the individual brain cell level.

We began to realise that many people who have a damage in the brain and spinal cord do have surviving cells even though their injuries are severe. We also found out that we can teach the surviving cells to take over the functions of the dead cells. And, we knew this would make a dramatic difference in their lives.

After how many years of research did you find out that alternate brain cells could take over the function of the dead cells?

I started the work in 1969, and in the seventies itself, we began to realise that this was possible. In 1981, I moved my laboratory to the University of Miami School of Medicine, and I have been there ever since. This is where we began to do the clinical work and look at people who had strokes and spinal cord injuries. We had to actually measure what's happening in the brain. In the seventies, we were measuring this in a crude way.

We needed microprocessor engineers to actually build computers that could measure what was happening in the brain, and establish the connection. So, with the help of computers, we tried to track what the brain was doing. Now that we have sophisticated microprocessors, we can actually measure how the brain tries to get the signal to a muscle.

What the person sees on the monitor is how the muscles respond to signals from the brain. Unlike other therapies, the focus is not on trying hard or repetition. The only way the patient can change the line of signals is (with a) better connection of the brain to the spinal cord. To get that, they hunt down their brain looking for alternate cells that have not been damaged and take over the function of the dead cells.

Has the intelligence of a person anything to do with his recovery?

No, not at all. People ask me this often. Actually intelligence has nothing to do with it. Learning to walk is pretty complex but everybody does learn. It really doesn't make any difference whether the person has less intelligence or is super intelligent.

Think of it, a lot of this research was done on animals! You will not say that mice are as intelligent as humans. Working with animals has helped us work with human beings without being restricted by language. Even those who are badly impaired can respond to our instructions.

When did you start working with human beings? How successful was your first attempt?

We have been working with human beings from 1969, not because we were doing clinical treatment but because we were doing research with human subjects. Of course, we were doing animal research too simultaneously.

We were working with people who had had strokes. We were trying to restore at least one function, for example, the movement of the arm. When we succeeded in some cases, we could see that they were using their arm after a gap of five years or so. That was very, very exciting!

It took us ten years or so to get a really significant total outcome because in the initial years, it was more of clinical work like understanding the functioning of the brain and developing the microprocessor.

You said you have treated 8000 patients from 1981 onwards and the success rate of the biofeedback treatment is 98 per cent.

Yes, we have treated 8000 cases but that is in the laboratory in Miami alone! We have similar laboratories in other places too: five in America, three in Brazil, three in Israel, now one in India and soon, there is going to be one in Germany.

Not always can you get tremendous results because of structural damages (to the brain). Many who have not stood or walked for 10, 12 or 14 years have stood and walked, and it was so exciting to see them walk. In some other cases, the damage of the spinal cord is so severe that they will not make tremendous progress but they do make some progress, for sure.

Some may get trunk powers. We freed some who couldn't do anything without the respirator. We made some people who have not walked for years, walk with braces. Some, who couldn't stand, stood up… So, the success is of different degrees but it made a big difference to their quality of life.

You said you analyse a patient before you start the treatment. Just now, you said, the little boy who is suffering from cerebral palsy is an excellent prospect. Why do you say he is an excellent prospect? How different is one cerebral palsy patient from another?

We do the initial assessment to find out how far the patient can get better. We find out the nature of the paralysis, get some idea about his medical history, etc. But the most important factor is whether we can determine the measurement of the surviving cells in the brain, and their response. So, we measure the signals from the brain to the spinal cord to the muscle.

The patient is looking at the monitor and he sees changes in the signals when he tries to do something even if it looks like there is no movement. Once the patient sees that, we do the learning procedures called Operant Condition Procedures where we reinforce the brain every time he makes a response closer to what we want. This procedure is like learning to ride a bicycle. This is also like playing a video game. This is a learning procedure.

Once he learns, it is there forever. That is why I said this boy is an excellent patient. The way he responded in the assessment and learning procedures is excellent.

How much improvement can we expect in this boy? Will he be able to walk?

I will answer it this way: in the first 45 minutes of assessment itself, we will know how well he responds to the learning procedures. Lesson number one, not all people can respond and even among those who respond, some will get great function and some will get little more function. This is what we do while we evaluate and tell what to expect.

This is a very young boy who has tremendous potential in many muscles.

He has his head control affected, his trunk control affected and every muscle of his body affected, and that is going to take a long time. We can only work on one muscle at a time. Probably, after 10 or 15 treatments, we will have head control and free sitting trunk control. In three months or four months time, he will have a free sitting balance. We expect after another 10 sessions, probably a free stand which may happen before the end of the year. And he may be able to walk after another 15 sessions. That is, by next year, we should have him walking without anybody holding on to him.

How does the medical fraternity look at the biofeedback method?

What is happening is this: to those in the clinical field, the belief is that once the brain is damaged, there is no hope. So, it is hard for some to accept what is not there in the textbook. Actually, what we say is, there are alternate cells to take care of the function that was earlier done by another cell. Yes, we know that a brain cell can never be replaced.

Academic physicians do understand what we are talking about. But it is hard for clinical folks to accept how a paralysed patient can get better. They have been telling patients, 'Look, we don't want to give you false hopes. We can't say whether you will walk again.'

So, the controversial issue is whether people with disabilities can get long-term recovery or not, when the textbooks say they don’t. What we say is, they do recover.

How long do you think it will take for the whole world to accept your therapy?

It is changing already. The changes won't be dramatic. We are getting more and more calls from physicians all over the world and more and more patients are coming to us.

Now we are here in India. I must say I have found greater acceptance here. There is a difference in the culture. Here, people have a better understanding of the power of the brain and there is a much more holistic approach to medicine here unlike in the West.

Photographs: Sreeram Selvaraj. Design: Dominic Xavier

The Rediff Interviews