Barnes-Jewish Hospital | Washington University Physicians
essays on life, health and medicine



My story is about neuroplasticity and mayonnaise. I spent the greater part of my 20s living in Dublin, where I was working on a doctoral thesis in history and where mayonnaise comes in glass jars. While growing up, I had lived in just one St. Louis house. In Dublin, I was on the move, quite literally, living in three different apartments and one guest bedroom over four years, thanks to Dublin’s turbulent rental market. For the most part, I did my moving on my back and on my own.

neuroplasticity and mayonnaise jar

Unfortunately, that hands-on approach didn’t do much to affect my muscle memory, and for the first two weeks after I moved into flat number three, I would catch myself en route to my previous digs after a long day in the rare book rooms at school. On one such occasion, made it all the way to my previous mailbox before realizing I was following an old path toward home. So by the time mayonnaise entered my story, I had a sense of how long it takes me to form new habits.

One night, as I was walking home, laden with a bag of groceries, disaster struck. I tripped, dropping the groceries and shattering a glass mayonnaise jar. I landed palm-first in the wreckage. Broken glass sliced through nerve branches across the base of my right hand. Fortunately, my parents, still living in St. Louis, knew about the near-miraculous hand and arm nerve grafts performed at Barnes-Jewish Hospital by Washington University plastic surgeon Susan Mackinnon, MD, and her team. After a short stay in St. James’s Hospital in Dublin, I flew home to Dr. Mackinnon and repair.

But having nerves transplanted in my hand was only the first step in my recovery. Next came intensive rehabilitation and, more significantly, brain retraining. The physical and occupational therapists working at the Washington University Occupational Therapy – Milliken Hand Rehabilitation Center started me on a course of work called graded motor imagery (GMI) that exercises the brain in different ways. First, I worked on identifying left and right images of my hands. Then came visualization exercises and, finally, the mirror box, which works this way: I put my injured right hand inside the box, behind a mirror, and attempt to use that hand in specific ways. I then watch the reflection of my uninjured left hand as it imitates those motions. During rehabilitation, I also used more traditional therapy, particularly working on grip strength, but the majority of my post-surgery recovery has been a matter of retraining my brain. Thanks to its incredible capacity to adapt, an ability called neuroplasticity, I have even managed to curb some of my nerve pain.

I still use my mirror box, three years after surgery. Slowly, but steadily, my brain has started to make sense of and use the new sensory and neuromuscular pathways Dr. MacKinnon’s nerve transplantation gave me. Thanks to GMI, and the neuroplasticity that it builds on, I continue to heal, perhaps suddenly discovering I can feel a part of my palm I couldn’t before or that I can stretch my fingers a little farther. And that’s unquestionably worth 20 minutes of GMI rehabilitation each day.

Today, when I return to my current St. Louis apartment after work, I can even open a mayonnaise jar.

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