Saturday, October 6, 2018

How vulnerable brains find workarounds is this scientist's passion

Photo and interview by Louise Kinross

Dr. Tomáš Paus is fascinated by brains—not individual brains, but the study of hundreds of thousands of them. As a neuroscientist, he studies how our genes, and our physical and social environments growing up, influence our brains. Why do some children’s brains find workarounds to compensate for early adversity—such as premature birth—while others don’t? And in children with brain-based disabilities like cerebral palsy or autism, is there a way to build resilience that can aid brain function as the child grows?

Tomáš is the new director of Population Neuroscience and Developmental Imaging at the Bloorview Research Institute. His research program will rely on an accessible and child-friendly MRI coming to the hospital in 2019. Tomas did six years of medicine and a PhD in physiology in the Czech Republic, where he grew up, before moving to Montreal for a post-doc fellowship in cognitive neuroscience. We talked about his move into the world of children’s rehab.

BLOOM: First of all, what is developmental neuroimaging?

Tomáš Paus:
 It’s imaging the brain, from conception onwards, and there are no strict boundaries on what we call development. Some people are talking about development when the brain is in the womb, others say the first three years of life are most important. Others say development is certainly happening in adolescence. In the context of Holland Bloorview, we’re talking about the first two decades of life.

BLOOM: You've come from Baycrest Centre. What research were you doing there?

Tomáš Paus:
 I worked on adolescence, mostly by studying children from mainstream high schools, some of whom experienced early adversity—for example, whose mothers smoked during pregnancy.

Many people have experienced an early adversity, and their brains overcame it in some way. Is it because they had ‘good’ genes or a good supporting environment at home, or a socially supportive environment in their community?

What is it that will maintain someone in a healthy trajectory of brain development despite experiencing adversity? If we can learn what this resilience is, perhaps we can supplement it to people who don’t have it naturally.

BLOOM: Which population will you work with here?

Tomáš Paus: 
We don’t know yet. We’re not going to focus on a specific diagnosis or disability, but a type of adversity that may result in many different outcomes. For example, very preterm birth—if you’re born at least two months before term—puts you in a more vulnerable position.

We know that some children handle it well, while some children develop immediate disabilities such as cerebral palsy, and some may have a higher likelihood of developing autism. Some children may be fine all the way into their teens, and then be at higher risk of developing depression, bipolar disorder or psychosis. Other children may be fine on those lines, but have learning disabilities.

One idea is to develop a large cohort of 10,000 kids, between the ages of five and 14, that we would follow for 10 years. A group of them would have been born very pre-term, another group less pre-term, and another group at term.

BLOOM: Has this been done before?

Tomáš Paus:
 I’m not aware of any large, population-based study of children who were exposed to early adversity and may have a variety of outcomes that range from healthy brain development to having autism or cerebral palsy.

BLOOM: Why is there a need for such a study? 

Tomáš Paus: Some
 kids—no matter what you do at the time of an event like hypoxia of the brain—will have damage. Now we need to work out what we can do, at any time of their life, to help the brain achieve its potential. When the brain has to find a detour, some brains find the detour more easily than others. What does it depend on?

Does it depend only on the biology of the brain and the genes of the individual? Probably not. Does it depend on the family and what they’re doing and how they’re doing it? Most likely. Does it depend on the peers that the kid is encountering through childhood and adolescence, or not encountering, if there is social isolation? Most likely.

But we don’t know how it works, and I want to know how it works, because then we may be able to use this knowledge and provide a supplement. Perhaps it’s an app for parents, or a school policy that will improve integration, or a particular type of support at a particular time in the child’s life. It may be a technology that helps kids with disabilities to function better.

BLOOM: Isn’t there a danger in implying that resilience is largely up to the individual, or family? I’m thinking of some doctors who pushed back against the idea that burnout could be solved solely through building their resilience, rather than changing the system. 

Tomáš Paus: 
Very good point. That’s why we need to emphasize that the sources of resilience are at multiple levels. Some of them may be at the level of the individual. Others may be at the level of the household, and others are at the level of the community and education system. And even at the level of the individual or the family, you don’t want to have solutions that require their effort.

I know I’m lazy when it comes to exercise. So the only way I can build it into my schedule is if I do it automatically. So every day I walk from Lawrence subway station here and back, and that gives me my 12,000 steps a day. So the solutions for resilience have to be really smart, and nudge or guide you in a way. It can’t be that something beeps at you and says ‘Please do this.’

There's a book called Nudge that talks about how we can help people make better health choices by nudging them in the right direction. For example, in a subway, when you have a set of stairs and an escalator, how do you nudge people to take the stairs? You paint piano keys on those stairs and, somehow, subconsciously, people find it interesting to be walking up piano keys and it works.

BLOOM: You’re not suggesting that through resilience we would somehow remove a disability are you?

Tomáš Paus: No, we will not be able to remove the disability, absolutely not. But we may be able to find workarounds for living with disability. For example, take the work Tom Chau is doing here with external devices that help kids with disabilities to function better. We may be able to learn how those devices interact with the brain, and affect the brain, over months and years. We may be able to suggest how to tinker with a device to increase its usefulness.

BLOOM: Many people look at something like autism or intellectual disability now as a difference that has value, not just as a deficit. Will your work just measure kids’ brain function in conventional ways?

Tomáš Paus: 
There are current population studies with strong imaging components that are focused on the general population. They’re focusing on normal kids. We’re moving in the opposite direction.

We're opening the range of variability, and the range of possible outcomes, and there will be no judgment. I was just interviewed on CTV News and the reporter asked: ‘Will you be studying atypical brains?’ I said I don’t know what is atypical or typical. I don’t want to make any judgment about what’s normal or not normal. It’s the diversity that will tell me how it all works.

BLOOM: What’s the greatest challenge of this work?

Tomáš Paus:
 The first is we need people to get excited about it, because it requires a commitment of 10 years. This would not be a study where you show up once.

We would bring the kids back every two years to do scans and answer questionnaires. We’re thinking about innovative ways to collect information on the behaviour of the kids and families by having them wear technology. So perhaps, with their permission, they would wear a smartphone that would collect information.

BLOOM: Why were you so interested in the brain in the first place?

Tomáš Paus:
 Who wouldn’t be? It came to me through psychology and psychiatry. I was interested in people’s behaviour. As a teen I read a lot of novels about people’s behaviour. I grew up in a small town not far from where Sigmund Freud was born and lived for a few years. But I think it was the human behaviour through novels that really got me going.

There was a large psychiatric hospital next door to where I grew up, and I would pass it every day. My teacher of biology in high school saw my interest, and encouraged me to go and talk to a new senior physician at that hospital. The physician said he’d just read about how Vitamin C can be good for attention, and asked me if I’d like to do a study on it. My father worked for a pharmaceutical company and helped me to set up the placebo pills. And my mother helped me with typing things up.

BLOOM: You mentioned that your wife, Zdenka Pausova, is also a researcher.

Tomáš Paus: 
Yes, she works at SickKids. Her primary interest is in cardio metabolic health. She’s an expert in genetics, but now she’s looking at the relationships between cardio metabolic health and obesity and brain health in teenagers and adults. She has a big National Institutes of Health grant to look at the relationship between inflammation induced by obesity and how it can potentially induce inflammation of the brain.

BLOOM: What are your first impressions of Holland Bloorview?

Tomáš Paus: 
It’s a very cheerful environment, and I keep running into people in the hallways and talking about things that interest me and interest them, so it’s very interactive. There are little barriers between the hospital and the research institute, which is impressive. It’s amazing how strong that integration is.

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