Instant Genius - The miraculous healing ability of our brains

Episode Date: June 28, 2026

It was previously thought that once our brains suffer an injury due to stroke or trauma, the potential for recovery was severely limited. But recent developments in medicine have proven that this isn���t the case; our brains are, in fact, capable of miraculous acts of healing. This is thanks to a process known as neuroplasticity, a concept that’s changing the way that medical practitioners are helping patients suffering from brain injuries regain their health. In this episode, we’re joined by neurologist and author Orlando Swayne to talk about his latest book, How to Use a Fork – Stories of Mending the Broken Brain. He tells us what happens in our brains following injury, how learning new skills can change the structure of our brains, and how we can use this process to help people recover from strokes, aneurysms and other debilitating brain injuries. Learn more about your ad choices. Visit podcastchoices.com/adchoices

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in podcast form. Every Monday and Friday you'll hear world-leading scientists and experts talking about the most fascinating ideas in science and technology today. I'm Jason Goodyear, commissioning editor at BBC Science Focus. It was previously thought that once our brains suffer from an injury due to stroke or trauma, the potential for recovery was severely limited. But recent developments in medicine have proven that this isn't the case. Our brains are in fact capable of miraculous acts of healing. This is thanks to a process known as neuroplasticity, a concept that's changing the way

that medical practitioners are helping patients suffering from brain injuries to regain their health. In this episode, we're joined by neurologist and author Orlando Swain to talk about his latest book, How to Use a Fork, Stories of Mending the Broken Brain. He tells us what happens in our brains following injury, how learning new skills can change the structure of our brains. and how we can use this process to help people recover from strokes, aneurysms, and other

debilitating brain injuries. Welcome to the podcast. Thanks so much for joining us. Thanks for having me. So today we're talking all about your latest book, How to Use a Fork, Stories of Mending the Broken Brain. So the overriding idea of running through the book is that previously, even when you were studying yourself as a student, it was thought that once the brain suffered a significant injury from a stroke and aneurysm or physical trauma, etc. It was unable to recover.

But since then, we've discovered that this isn't the case at all. So over time, how has this thinking changed and, you know, what's enabled it? Well, previously, when people studied brains and brain injuries and strokes, they relied on looking down a standard microscope at the physical brain, an optical microscope. And at that level, all you really see after somebody has a stroke is some scale. scar tissue. If an area of the brain has effectively died, it's lost of its blood supply, it sort of turns to mush, really, you know, the beautiful crystalline structure of the brain sort of dissolves as the tissue doesn't have its blood supply anymore, and then gradually

over some weeks and months, some scar tissue forms around the edge, and that's kind of it. That's all you can see at a standard microscopy level, but it's only when you look much more closely with higher power microscopy or then with some of the more advanced neuro-science. techniques such as functional imaging and other other techniques to look at how the brain is working rather than the physical structure that you see change is occurring over a much longer time period. So with higher microscopy, in fact, these days you can look at an individual neuron in a brain and see the dendrites, the little branching parts of the neuron which connect to its neighbors and form the synapses. So you can see these physical little nobles under an electron microscope

and these come and go, they're not just static, they don't just sit there. They actually, there are dynamic presence that are forming more if the brain is active and forming less if it's inactive. And one of the things that was appreciated is that actually there's a lot of this dendritic branching and axonal sprouting, so that's the axons, the connecting cables of the brain, sprouting and forming new connections if you look at a very high power microscope. So I think part of the change is just the neuroscience. techniques really, be able to look in more detail what's going on in the brain.

I think the other changes is actually just clinical changes of people appreciating more that if you don't write patients off, if you do give them lots of therapy during that early stage, actually they do change. And even further down the line at a later stage, things can change. And that was just never really done before because it was always assumed that people were sort of written off in that situation. So I think it's both a combination of the science changing and getting better. but also the sort of clinical attitude gradually changing as well. Yeah, so throughout the book you detail a lot of different case studies

illustrating these processes. But first off, like sort of, as you mentioned there, underpinning the idea of the book is this concept of neuroplasticity. So I think a good place to kick off with is let's just get everyone clear exactly what we mean by that. Well, neuroplasticity is the brain's ability to change its function and its structure in response to the environment. So it's not just to, even though it looks like it just a solid lump, actually it's changing the whole time

and it changes in response to what it encounters. So in day-to-day life, that might be learning to do something you haven't done before. It might just be having a new experience. And at the level of the synapses, we know that in response to external changes, the brain is changing its connections the whole time. And that changes the way it functions. That's ultimately what neuroplasticity is. It's the brain's ability to mould itself in response to the world around it.

Yeah, so I think, sort of sticking with that, a good example of this is how we learn things like motor skills, like complicated movements. So, for example, gymnasts or ballet dancers or musicians. You know, this is the process that helps us sort of master these skills. Is that right? Yes, that's exactly right. I mean, there are different kinds of learning, of course. And if you start thinking about what we're doing with movements, there are different kinds of movements.

So, for example, a golf swing is what we'd call a ballistic movement, where a ballistic means you're throwing something. So that's a kind of pre-rehearsed movement, which you're trying to hone, and then you're so preparing the motor programme, and then you execute it, and then you see, you know, how far your ball goes. And if it doesn't go very far, you know, presumably you slightly change the way you swing it. I don't play golf, just to be clear. But you make little changes to what you're going to do to your prepared movement,

and then you make the movement, and you get feedback from the result, and then you change it based on that. So that's a ballistic movement. So maybe throwing a dart might be another example of that. Whereas, you know, walking across a wobbly deck of a ship, you know, enduring a storm is a different kind of learning, you know. So maybe the first time you do that, you fall over, and then you keep doing it and you don't fall over.

That's a different sort of learning, because you're not preparing a movement there, making it, you're responding to changes and learning what that interaction between the environment and your movements is and honing it in that way. So, and there are lots of different kinds of me and maybe learning a piano piece, you know, so again, you've got another feature, haven't you? So you got the music on the melody, which you have on your brain, which you're feeding through to your hands. So there are lots kinds of motor learning or movement learning, but they all involve changes in the synapses because that is how we learn. So if you think of,

if you think of the brain as just being trillions of connections, an unimaginable number of connections. So I sometimes think of it as being like a dense forest that's impenetrable. But if you hack your way through enough times, you can form a sort of almost invisible path through it. And the more you use that path, the easier it gets to navigate. So I sometimes think of these connections or these pathways as being like a sort of path through a thick forest

that becomes easy to use the more you use it, if that makes sense. We think that the way we learn these movements involves strengthening pathways by repetitive use, and that involves changes in the synapse. So that's one example of what we call neuroplasticity. So let's have a look at a lot of things that you talk about in the book. It's focused on when things in the brain go wrong. So injuries of different kinds, such as we mentioned, strokes, aneurysms, even physical trauma. So unfortunately, I think a lot of people will have met someone or know someone who has a

stroke at some point in their life. And the first thing that probably a lot of people notice is that they'll lose some sort of mobility or control of over one side of their body, which seems to be a key feature of strokes. But before we get into that, what exactly happens in our brains when we have a stroke? A stroke is when a part of the brain suddenly loses its blood supply. And the most common reason for that is a blockage of an artery. So our arteries carry our oxenobes. generated blood to the brain as they do to all our tissues. And if one of them suddenly blocks for some reason, then the area it was going to serve loses this blood supply and stops working. And it stops working within a few minutes, you know, less than five minutes that will just stop working. So that's

the most common kind. It's a blockage of a blood vessel. So, and then there's a less common kind, which is when the blood vessel actually bursts and bleeds into the brain tissue itself. But it has the same effect of that bit of the brain, effectively no longer having a blood supply. So a stroke is just a sudden loss of blood supply and then the consequence of that is that whichever part of the brain has lost its plus supply stops working and therefore that function that it serves no longer happens. And very commonly, as you correctly say, that involves loss of movement down one side of your body. And that's really a feature of the way we're wired up, the way our brains control movement, you know, the left side of the brain controls the right side of the body and vice versa.

But the way those tracts which come from the top of the brain, the cortex, down through the brain's stem and down into the spinal cord into our limbs, they're concentrated into these dense tracts called the corticospinal tract. And it's very common for a stroke to involve that cortic spinal tract on one side. So when that happens, the area that that tract is going to will just lose its control. So the effect of that is weakness on one side or hemiparesis, as we call it. Yeah. So once we've suffered from something like this, you know, we've removed the blockage, etc, if we can, using various medical devices. But following that, there's a period shortly after the stroke

called the plasticity window, which seems to be vitally important in recovery. So can you tell us about that, please? The plasticity window refers to the fact that for the first few months after an injury such as a stroke, the brain seems to be more amenable to this plasticity than it is normally. Now, most of this is taken from animal models of stroke, or animal data of one kind or another.

And in, for example, mouse or rat or even primates, it's very clear that the response of the brain shows to a stroke is greatly enhanced during that early period. And when I talk about the response it shows, what I mean is that, as I mentioned earlier, if you actually look in great detail of the neurons, you can see that the neurons, not the ones that have been damaged, of course,

but the ones around the edge of the damaged area, and even ones that are remotely connected to it, start sprouting and forming new connections more than they do normally. So that's what I mean, but that's what I'm referring to when I say the changes that you can see in the brain. You can actually physically see these changes forming in animal models. And that happens more during the early period after stroke, and people call that the plasticity window.

Now, the question is, does that apply to humans as well? It's much harder, obviously, as you can imagine, to study in humans, what happens physically in the brain after stroke, because you clearly can't cut people's heads open just to look. But there's other ways that we're looking at brain function, but it's difficult. But the impression seems to be that the same probably does hold true and people estimate something like a three-month period after a stroke

where there's this enhanced plasticity. Now, I think the phrase plasticity window is slightly flawed to the extent that a window is something you can shut, right? So, you know, and it's not like, and people sometimes do get hung up on this idea. And families who know a little bit about this have been reading around will come to you and say, but doctor, you know, they've got to have their rehab now because it's, you know, otherwise this plasticity window is going to close. And of course it doesn't work like that.

It doesn't just slam shut. You don't suddenly stop being able to have these changes. And actually, when you're deciding for a patient, what kind of input they might need it at any given time, it is a balance because while it's true that the brain has this capacity early on, it's also true that during the first weeks, patients after a stroke, they may be medically and well, they may be very fatigued, they may be knackered and just unable to do anything for a while. You know, it's a balance.

So it doesn't mean you need to force someone, you know, in the early days after stroke, to necessarily go through lots of therapy if they're unable to do it. So there is a sort of clinical balance to be struck. But broadly speaking, we think that this plasticity is more present in the early period. This episode is brought to you by Accenture. When your advertising operations fall out of sync, everything else follows.

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Learn more at Volvo. So we talked about the involvement of this process in learning. So say we've got a patient who has lost mobility in one or more of their limbs. So then they'll go through physical therapy of various kinds to help them regain as much movement as possible. So sort of too far, what does that involve? And, you know, what's happening in their brains to make it effective? Well, if you've had a stroke in your week down one side, the first week or two, the first couple of weeks, you may see some quite quick recovery in that early period. And it's quite common to see somebody's leg begin to move, for example, earlier than their arm.

And that's just a feature of the anatomy in the brain of the way we're wired up. Often the area of the controls the leg is less directly involved in the stroke than the area that controls the arm. But after you've had a stroke, the bit of the brain that's been affected is swollen and full of cytotoxic. chemicals which affect the way the brain around it works. So if you imagine when you twist an ankle and the ankle blows up and becomes enormously swollen and sort of tight and it's not dissimilar in the brain. So if you injure tissue, it swells up. And that's just as true in the brain as it is anywhere because fluid goes into parts that

it shouldn't be in and you get swelling as a result of that. So that impedes the function of the viable but not fatally injured, but sort of suffering. brain tissue around the edges. And then over the first couple of weeks, that swelling goes down, just like it does with an ankle. So as that swelling goes down and the kind of cytotoxic environment

of the brain around there begins to resolve, then those neurons that are affected but not fatally damaged begin to kind of wake up again. So you might see that just a simple, spontaneous recovery as the swelling goes down.

So that's very different from what I'm talking about. That isn't neuroplasticity. That's just physical changes in the brain resolving. So we sometimes see, we often see a sort of curve of a few rapid changes in the first few weeks, and then it sort of slows down. And then you enter a much longer, a much slower phase of change, where it's probably

less to do with physical changes, such as swelling, et cetera, and more to do with these synaptic changes that we call plasticity. So that longer, slower phase is very different from the early phase because it depends on training and practice. So in the same way as if you're learning a new skill like a golf shot or a piano piece, it doesn't learn itself. You have to practice, otherwise these changes don't occur at the synaptic level. It's the same after a stroke, we believe, that actually the only way you get these slow changes over a longer period is to do that therapy and to do that repetitive practice. So that, and that's really one of the things that's very important when we consider how we treat patients because actually people's therapy input

drops off, you know, they may get some intense input early on, but then they'll be discharged home, and then they weren't see a therapist for months, potentially. So they lose that input. But actually what we realize is that the potential for change, even beyond that three-month period where the plasticity is enhanced, that potential is still there. And it's very important because people can continue to make significant gains with that input later on.

Another thing that you talk about, like sort of sticking with this hemisphere idea of the body, one extreme case is where a patient was unable to recognise one side of the body, even when shown their own arms, well, that's not mine. So that seems absolutely fascinating. How does that happen? Well, it's got a kind of fancy Greek name, Anasynosia, a lot of these medical terms are just Greek words stitched together, you know, it makes it sound very fancy, as if you know what you're talking about. But yeah, so it's got this long Greek name, but it really, that Greek name

just means not recognising yourself. So it doesn't explain what it is. is it just describes it. And probably it's a severe form of what we call neglect. So neglect is the deficit of attention. That's where you may be able to feel something from one half the body, you may be able to see something from one half of space, but you just can't really pay attention to it. You just ignore it. And that's because our brain works in very modular fashion. So there's different areas for different things. So one of the networks we have is an attention network, which directs what we're paying attention to at any time. And if that attention network gets damaged on one side, then our attention just becomes skewed over to the other side.

Even if the visual information or the sensory information is getting through to the relevant areas, you're just not able to attend to it. And the classic examples we see with hemispatial neglect are where somebody, for example, might eat one half of their plate of food or they might shave one half of their face. So that's a very common problem after stroke, actually, particularly with big strokes. And I think what you're describing is a very severe example of that, where they're so kind of divorced from that side of space that even their own body on that side just doesn't feel like theirs. And somehow the connection between a sensation, but also recognising it's part of your own body just doesn't work because your attention is just so pushed over to the other side. I think there's people who know a lot more about anastognosia than I do. and there's probably, you know, detail studies which I would have to go away and look up as to exactly how that works.

But that's my understanding is it's really an extreme form of inattention to one side. Yeah, so we've been talking about limb movement and limb mobility here. But another symptom that occurs quite commonly after a stroke or brain injury is the patient's loss of ability to speak, which I can imagine is just incredibly frustrating. So, you know, how does that happen? Is it simply down to where the stroke takes place? Is it a loss of muscle control within the sort of vocal apparatus? A bit of everything or something else?

Well, the reason I called the book How to Use a Fork is because there are many reasons why we may not be able to do something. So in the title, you know, why can't somebody use a fork? Is it because they can't feel it? Is it a hand weak? Are they got coordination issues? Are they neglecting that side? There's a long list of reasons why you can't do something.

So in the example you're giving, of communicating, there may be a number of reasons why somebody can't communicate. Now, the one we see very commonly is called aphasia, which is when you've had a stroke on the left, almost always the left side of the brain, because most people's language areas are on the left side of their brain. So that's when the actual language areas themselves have been damaged. So that's a very particular problem. That's very different as you can appreciate from having a problem moving your tongue or your lip. It's a fundamentally different issue. But really, aphasia, in my opinion, is the most devastating and the most frustrating of all stroke impairments that we see because there's

just nothing worse than not being able to communicate. It's just the most frustrating thing in the world. Somebody may have the concept of what they're trying to communicate. They can see the picture in their head. They know the thought they're trying to get across, but the connection from that concept to the word that represents it is damaged and they just can't access it. That's what we call aphasia. But it's not the only communication difficulty. There are lots, as I imply, there are lots of other reasons why communication may be difficult. But I think that's the most common kind and probably the most frustrating. Yeah, so what do we know about treatments or therapies

and what's going on with our brains that we can do to help these patients? Well, that's one of the things that has changed, really, is that what's become apparent is actually it's not that different from retraining a weak limb in some ways. So if you have somebody with a weak arm and maybe they have some movement, but it's only just beginning to emerge and the physio will repetitively practice it and they'll train it. And by doing that, they're not just, if I'm talking about the arm here for a moment, they're not just strengthening the muscles.

It's not about building your muscles. It's about training the pathways and the brain to use them. So while that sort of makes sense, what's less obvious is that you can do the same for language. And I truly believe that you can and there's very good evidence that you can. So in the same way of strengthening an arm or training an arm, you can train the language network to begin to work better. And it's just the same is repetitive practice. And speech therapists, you know, that you'd have to ask a speech therapist,

the details of exactly what they do. But effectively, they're drilling the patient on linking concepts and words. And they're just doing it over and over again. They'll start with only a few, and then they'll build it up. Then they'll broaden it. Then they'll bring in more than one word into phrases. You know, so you're sort of reconstructing the ability to put words together into phrases through repetitive practice.

And I think previously it was just assumed that you couldn't really train that stuff, you know, just either happened or it didn't. But it's pretty clear now that you can because in the same way as studies that have looked to patients with weak arms and if you give them lots of therapy later on, they improve. Actually, the same is true of language, it seems. So people, they're phasia if you give them lots of input, even further down the line, they will improve. I mean, they may not go back to normal fully, but they will improve.

improve. And in patients with these sorts of problems, even a modest improvement can make a huge difference. You know, it doesn't, in some sense, it doesn't matter if they go back to 100%, but if they make a 20% improvement, that may be the difference between be able to interact with your children or not, you know, and that's, that's enormous, as you can imagine. Yeah. Another thing that you talk about with this sort of brain's ability to reorganise and reshape and relearn, I guess you'd say, is extreme cases. epilepsy, where patients, in fact, have entire chunks of their brain surgically removed, but are able to recover in some ways?

Yes, I mean, epilepsy surgery has evolved enormously over the years, as you can imagine, and is very different now. It's much, much, much more sophisticated than it used to be, obviously, given all the neuroscience techniques that we now have. But effectively, what you're talking about is that if an epileptic seizure is arising for one particular part of the brain. And an epileptic seizure, just to remind you, is when the electrical activity of the brain gets out of control and starts discharging repetitively in a hypersynchronous way. And if it stays in one part of the brain, you might just get jerking of an level limb or something

like that. If it spreads, then people lose consciousness and convulse. So it's very unpleasant. But in some patients, in lots of patients, it will arise from a particular area of the brain. And that may be an area where there's been a small scar from something when some patient was younger or something like that, or even just the way they developed. And if somebody has intractable epilepsy where no drugs will control it, despite many, many attempts, then sometimes the best solution is surgery is actually to remove that focus, that epileptogenic focus. Clearly, that's not done lightly. And this is not my field, clearly. But these days, as I said, people can locate the area much more closely and can be more specific about which area they're going to resect. But even so, in very extreme cases,

sometimes a surgeon will do a callosotomy. So that's when they actually divide the two halves of the brain from each other. That's cutting the corpus callosum, which is the bridge between the two halves of the two hemispheres, which prevents any seizures which start on one side of the brain from spreading to the other side of the brain. This isn't done much these days, but sometimes it is still. And I think one of the surprising things is that you would imagine that actually removing someone's connection between the two halves of their brain, which cause all sorts of terrible problems.

Interestingly, it doesn't seem to actually cause that much for a problem at all. It does cause some subtle changes, but it's less devastating than you might imagine. The other aspect to that is if the patient involved as a child, then it's a very different situation because the child's brain is, of course, developing all the way through their teens,

and even into their early 20s. So if somebody has an injury to their brain at a younger age, you see a very different situation from you do in an adult with a fully formed brain because actually the developing brain can then move some of the functions to other areas which are still growing. So I remember seeing an 18-year-old girl, I think I mentioned her in the book, who'd had an enormous stroke at the age of 11 where really one hemisphere had been almost entirely damaged. and that was on the left side where language resides.

But she'd actually continued to develop and seven years later when I saw her, she was fully conversant, you know, normal language. Not totally normal movement on that side. You'd notice she wasn't walking quite normally if you saw her in the street, but remarkably different from what would happen in a grown adult who had the same stroke.

And that's because, you know, as I said, the brain is still developing at that stage. It's a very different sort of plasticity at that point. It's developmental plasticity. if that makes sense. Yeah, so as we've sort of established there, the brain does have amazing ability to recover from an injury.

But let's look into the future then. So obviously we're talking about all the sort of therapies and surgeries and things that have progressed in leaps and bounds over the last several decades or so. But how about looking into the future? As you mentioned there, so the younger brain, when it's developing, seems to be more plastic, if I can say that.

is there any sort of techniques or medicines or drugs we could use to sort of kickstart that process even in adults, you know, is that something that we can look forward to in the future? Well, the idea of sort of reopening this plasticity window, if you want to call it that, or enhancing or bringing about that sort of childhood capacity is in some ways the holy grail of people who are looking to help patients recover from brain injury. And at animal model level, there have been experience where you can dramatically enhance the plasticity available to an adult brain just by manipulating neurotransmitters and switching off particular inhibitory circuits. So you do that in an animal model, you get very excited.

So, well, we can do this for humans. But of course, it doesn't always work the same. And there are many instances in neuroscience where things which look like they're going to be game changes in animals, models don't. translate to humans. So we're not there yet. But in theory, it might be, it might be possible to further enhance the available plasticity in the, in the adult brain after a stroke. The other way that people have tried to do that and still try to do that is with non-invasive brain stimulation. I spent some years looking at this as part of my PhD thesis. So this is when you do what's called transcranial magnetic stimulation. And you can stimulate the brain from outside using a large

magnet effectively, which gives pulses, which go through the skull and have an effect on the lining of the brain, the cortex. Sounds very kind of rocky horror show and Frankenstein, and it is a bit, actually, if you see someone doing it, it does look a bit like that. But what became parents about 20-old years ago is that if you stimulate the brain in that way, in particular patterns or particular sequences, you could enhance either upwards or doubt. You could either turn up or turn down the activity in the area you're stimulating. So you could facilitate the activity in that brain or you could inhibit it. And that would last for, you know, maybe minutes to even a couple of hours in some cases. So people got very excited by them and say, well, we can we, we can turn areas of the

brain up or down at our will. Can we, is this going to help with stroke recovery? Is this going to unleash some of this plasticity in some way? And there's a theoretical way in which that might occur and there are studies which have shown that non-invasive brain stimulation does seem to help recovery in some patients but the problem is it's it doesn't apply to everyone and I think when people do these studies they tend to study patients with lots of different kinds of stroke and each individual brain is probably recovering in a different way so once you so if you apply it to whole you know to hundreds of people often that any effect you might see in a few of them might cancel out so actually it's not

something I recommend and people do come and ask you know what about non-invasive brain stimulation I've read this paper you know trans cranial monastic stimulation and I've done to various reviews and things of of the literature over the years and my personal conclusion is I wouldn't recommend it at the moment because I don't think we really understand how it works it seems to do different things in different people and it's not a sort of panacea I would say in my opinion at the moment but that might be because we just haven't learned enough yet about how it works or or I mean

or we can't choose the patients well enough that it works for. So that might change in the future. But at the moment, I think I don't routinely recommend it. Thank you for listening to this episode of Instant Genius. Brought you from the team behind BBC Science Focus. That was Orlando Swain. To discover more about the topics we've just discussed, check out this book, How to Use a Fork, Stories of Mending the Broken Brain.

If you liked what you just heard, then please do consider subscribe to Instant Genius on your preferred podcast platform. If you'd like to see our guests and hosts in person, then why not check out our YouTube channel at ScienceFocus. The current issue of BBC ScienceFocus magazine is out now. Pick up a copy wherever you buy your favourite magazines or download us on your app store of choice. You can also find us on Apple News or online at sciencefocus.com.