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註釋和參考文獻[1]

關於註釋的說明

在下面的參考文獻裡,讀者會看到針對有趣細節、特例、歷史掌故及學術問題的評論。評論以黑點(●)來表示。

題詞

1.“18世紀猶太哈西德教派諺語”:C.Stern,ed.,Gates of Repentance:The New Union Prayerbook for the Days of Awe(New York:Central Conference of American Rabbis,1978),p.3.

2.“人生苦短,藝術永恆”:由我的同事和朋友Waller R.Newell翻譯。

引論

1.“一如麥吉爾大學前醫學院長亞伯拉罕·福克斯(Abraham Fuks)所說,征服這個概念,為日常醫學實踐帶來了許多軍事性的比喻”:A.Fuks,“The Military Metaphors of Modern Medicine,”in Z.Li and T.L.Long,eds.,The Meaning Management Challenge(Oxford,UK:Inter-Disciplinary Press,2010),pp.57-68.

2.●“醫學是對抗疾病的‘戰鬥’”:17世紀中葉,人稱“英國的希波克拉底”的托馬斯·西德納姆(Thomas Sydenham),這樣描寫疾病:“我窮盡了瀉藥和涼爽藥,以及飲食手段來攻擊敵人”;“要跟一整隊危險的敵人抗爭,這場戰鬥,可不適合懶人”;“我不斷研究疾病,我瞭解它的特點,我滿懷自信地衝鋒向前消滅它。”The Works of Thomas Sydenham,trans.R.G.Latham(London:Sydenham Society,1848-50),1:267,1:33,2:43。

第1章 醫生得了病,又自己治好了

1.疼痛歷史上最重要的文章:R.Melzack and P.Wall,“Pain Mechanisms:A New Theory,”Science 150,no.3699(1965):971-79.

2.●德國生理學家曼弗雷德·齊默爾曼:出自1978年在蒙特利爾召開的第二次疼痛世界大會(Second World Congress on Pain)。M.Zimmermann and T.Herdegen,“Plasticity of the Nervous System at the Systemic,Cellular and Molecular Levels:A Mechanism of Chronic Pain and Hyperalgesia,”in G.Carli and M.Zimmermann,eds.,Towards the Neurobiology of Chronic Pain(Amsterdam:Elsevier,1996),pp.233-59,233.

3.《影響疼痛的主要因素》:“Central Influences on Pain,”in C.W.Slipman et al.,eds.,Interventional Spine:An Algorithmic Approach(Philadelphia:Saunders Elsevier,2008),pp.39-52.

4.“一旦設置到了慢性檔,疼痛就更加難以治療了”:同上,p.40.

5.期待又在我們感受到的疼痛水平中扮演了重要角色:G.L.Moseley,“A Pain Neuromatrix Approach to Patients with Chronic Pain,”Manual Therapy 8,no.3(2003):130-40;G.L.Moseley,“Reconceptualising Pain According to Modern Pain Science,”Physical Therapy Reviews 12(2007):169-78,172.

6.“中樞神經系統的輸出”:Moseley,“Reconceptualising Pain,”172.

7.“大腦……給予了反擊”:Moskowitz,“Central Influences,”p.44.

8.一項對慢性手部疼痛腫脹患者的巧妙研究:G.L.Moseley et al.,“Visual Distortion of a Limb Modulates the Pain and Swelling Evoked by Movement,”Current Biology 18,no.22(2008):R1047-48.

9.普雷斯頓:C.Preston and R.Newport,“Analgesic Effects of Multi-Sensory Illusions in Osteoarthritis,”Rheumatology(Oxford)50,no.12(2011):2314-15.

10.患者……安慰劑……大多心理不穩定……“缺少真實性”:A.K.Shapiro and E.Shapiro,The Powerful Placebo:From Ancient Priest to Modern Physician(Baltimore:Johns Hopkins University Press,1997),p.39.

11.●托爾·維奇:T.D.Wager et al.,“Placebo-Induced Changes in fMRI in the Anticipation and Experience of Pain,”Science 303(2004):1162-67;T.D.Wager et al.,“Placebo Effects in Human Opioid Activity During Pain,”Proceedings of the National Academy of Sciences 104,no.26(2007):11056-61;T.D.Wager,“The Neural Bases of Placebo Effects in Pain,”Current Directions in Psychological Science 14,no.4(2005):175-79.Tor Wager’s personal story is recounted in I.Kirsch,The Emperor’s New Drugs:Exploding the Antidepressant Myth(New York:Basic Books,2010).

12.如果響應非常迅速,是安慰劑反應:F.M.Quitkin et al.,“Heterogeneity of Clinical Response During Placebo Treatment,”American Journal of Psychiatry 148,no.2(1991):193-96.

13.安慰劑響應者更容易出現復發:F.M.Quitkin et al.,“Different Types of Placebo Response in Patients Receiving Antidepressants,”American Journal of Psychiatry 148,no.2(1991):197-203;F.M.Quitkin et al.,“Placebo Run-In Period in Studies of Depressive Disorders,”British Journal of Psychiatry 173(1998):242-48.

14.安慰劑效應能夠持續多個星期:T.J.Kaptchuk et al.,“Components of Placebo Effect:Randomized Controlled Trial in Patients with Irritable Bowel Syndrome,”British Medical Journal 336,no.7651(2008):999-1003.

15.蓋伊·蒙哥馬利:G.Montgomery and I.Kirsch,“Mechanisms of Placebo Pain Reduction:An Empirical Investigation,”Psychological Science 7,no.3(1996):174-76.

第2章 一個從帕金森綜合征症狀中“走”出來的人

1.膠質細胞……幫助……對大腦進行接線和重新接線:R.D.Fields,The Other Brain(New York:Simon&Schuster,2009),p.24.

2.弗蘭克·柯林斯和同事們發現了GDNF:L-F.H.Lin et al.,“GDNF:A Glial Line-Derived Neurotrophic Factor for Midbrain Dopaminergic Neurons,”Science 260,no.5111(1993):1130-32;Fields,Other Brain,p.180.

3.在實驗室用動物做的實驗……發現鍛煉可增加GDNF:M.J.Zigmond et al.,“Triggering Endogenous Neuroprotective Processes Through Exercise in Models of Dopamine Deficiency,”Parkinsonism and Related Disorders 15,supp.3(2009):S42-45.

4.●不吃藥的話,大多數人都會……喪失行走能力:W.Poewe,“The Natural History of Parkinson’s Disease,”Journal of Neurology 253,supp.7(2006):vii2-vii16.由於幾乎所有的病人都服藥,很難知道“不服藥”的帕金森綜合征會是什麼樣子。Poewe找到了對照藥物研究:一組病人服用藥物,另一組病人停藥,轉而服用安慰劑。他從患者衰退的速度推斷,沒有藥物,帕金森綜合征會在“不到10年內”導致嚴重殘疾。他發現,這一估算跟醫生們在19世紀及20世紀前半葉的記敘相符。

5.藥效會逐漸消退:E.R.Kandel et al.,eds.,Principles of Neural Science,4th ed.(New York:McGraw-Hill,2000),p.862.

6.患上癡呆症的風險比普通情況高6倍:Poewe,“Natural History of Parkinson’s.”

7.瑪格麗特·霍恩和馬爾文·亞爾:M.M.Hoehn and M.D.Yahr,“Parkinsonism:Onset,Progression and Mortality,”Neurology 17(1967):427-42.

8.●大腦黑質:黑質是所謂的基底節結構群的一部分,一般來說,基底節包括尾狀核、殼核、蒼白球、黑質和丘腦底核。基底節參與處理主動運動控制和日常行為及習慣。它可以起到制動作用,抑制機動性運動。當這個“制動器”釋放,運動系統就變得活躍。基底節活化還會帶來行為的切換。帕金森綜合征患者在嘗試切換到新活動時,往往會“凍結”。患病者有可能走路時看到人行道上有一條線或者小的障礙物,就“卡在了自己的道上”,無法邁過去,因為這需要改變步幅。

9.大腦的多巴胺,約80%都集中在……基底神經節:Kandel et al.,Principles of Neural Science,p.862.

10.藥物引起的運動障礙,是……不如人意的神經可塑性變化造成的結果:B.Picconi et al.,“Loss of Bidirectional Striatal Synaptic Plasticity in L-DOPA-Induced Dyskinesia,”Nature Neuroscience 6,no.5(2003):501-6。出現運動障礙的大鼠“突觸可塑性改變了形式”“紋狀體突觸產生異常信息存儲”,此外還有化學畸變。健康的大腦必須能夠同時加強、削弱自己的突觸。削弱可能需要遺忘,或刪除不再需要的連接,甚至允許該網絡做一些新的事情。有一種削弱類型叫作突觸去增益(synaptic depotentiation)。作者指出,“運動障礙的病例沒有表現出去增益能力。皮層紋狀體突觸喪失了這種雙向可塑性,或許會導致病理性地存儲不必要的運動信息,從而帶來異常運動模式的養成或表達。”(p.504)

11.還沒有找到治療方案能明顯放緩病情進展的:Poewe,“Natural History of Parkinson’s.”

12.電刺激可“卡住”異常啟動放電的回路:J.Bugaysen et al.,“The Impact of Stimulation Induced Short-Term Synaptic Plasticity on Firing Patterns in the Globus Pallidus of the Rat,”Frontiers in Systems Neuroscience 5(article 16)(2011):1-8.

13.亨廷頓病性癡呆……快走……發病時間明顯推遲:T.Y.C.Pang et al.,“Differential Effects of Voluntary Physical Exercise on Behavioral and BDNF Expression Deficits in Huntington’s Disease Transgenic Mice,”Neuroscience 141,no.2(2006):569-84.

14.佩珀自費出版了一本小書:J.Pepper,There Is Life After Being Diagnosed with Parkinson’s Disease(South Africa:John Pepper and Associates CC,2003).He later renamed the book Reverse Parkinson’s Disease(Pittsburgh:Rose Dog Books,2011).

15.四大症狀:幾乎所有的神經學教科書都會提到帕金森綜合征有四大症狀,但這四大到底包括哪些症狀,它們往往表述不一。或許,這只是出於愛湊“四大”的習慣表達方式而已,說清四大具體是什麼反而不重要了。此外,這還說明一點:分清哪些症狀屬於帕金森綜合征的核心症狀很困難。

16.“帕金森綜合征的特點”:I.Litvan,“Parkinsonian Features:When Are They Parkinson Disease,”Journal of the American Medical Association 280,no.19(1998):1654-55.

17.得了帕金森綜合征的人分為兩類:同上。

18.●他花了3個月的時間讓左腳支撐自己的體重:那個時代的理療教材有時會提出,分析患者的步態很重要。但哪怕是當今最具前瞻性的教材,如《帕金森綜合征的神經康復》(Neurorehabilitation in Parkinson’s Disease),也並不指望理療能逆轉運動衰退。“在很大程度上,治療的目的是要幫助人們盡量長時間地維持當前運動能力,使之適應其功能水平不可避免的下降。”M.Trail et al.,Neurorehabilitation in Parkinson’s Disease:An Evidence-Based Treatment Model(Thorofare,NJ:Slack,2008),p.24.

19.基底神經節……把複雜的動作序列和想法編織到一起:L.F.Koziol and D.E.Budding,Subcortical Structures and Cognition:Implications for Neuropsychological Assessment(New York:Springer,2008),p.99.

20.如果基底神經節的多巴胺系統不再運作……人就難以……學習新的思考認知序列:O.Nagy et al.,“Dopaminergic Contribution to Cognitive Sequence Learning,”Journal of Neural Transmission 114,no.5(2007):607-12.

21.黑質……負責發起自動化的行為序列:Koziol and Budding,Subcortical Structures and Cognition,p.43.

22.患有帕金森綜合征的英國足球運動員:O.Sacks,Awakenings(New York:Vintage Books,1999;repr.of 1990 edition;originally published 1973),p.10.

23.“所有帕金森綜合征患者的核心問題是”:同上,p.345.

24.邁克爾·齊格蒙德博士小組……鍛煉……出現帕金森症狀的概率較小:Zigmond et al.,“Triggering Endogenous Neuroprotective Processes.”

25.精神病治療藥物。通常,患者不再服用這些藥物,帕金森症狀就逆轉了:“有研究報告指出,16%的案例進而確診了患有特發性帕金森綜合征。這些人很可能在未來進入帕金森綜合征的某個階段,但待議的藥物‘暴露’了潛在的多巴胺不足問題。”Drug-Induced Parkinsonism information sheet,Parkinson’s Disease Society of the United Kingdom,https://www.parkinsons.org.uk/sites/default/files/publications/download/english/fs38_druginducedparkinsonism.pdf.

26.絕大多數可逆:K.Ray Chaudhuri and J.Nott,“Drug-Induced Parkinsonism,”in K.D.Sethi,ed.,Drug-Induced Movement Disorders(New York:Marcel Dekker,2004),61-75.

27.多年來,醫生並不建議帕金森綜合征患者鍛煉:M.A.Hirsch and B.G.Farely,“Exercise and Neuroplasticity in Persons Living with Parkinson’s Disease,”European Journal of Physical and Rehabilitation Medicine 45,no.2(2009):215-29.

28.只有12%~15%的患者建議進行物理治療:同上,p219.

29.鍛煉甚至可能惡化:同上,p215-29.

30.攜帶人類ALS基因的雌性小鼠……惡化:N.C.Stam et al.,“Sex-specific Behavioural Effects of Environmental Enrichment in a Transgenic Mouse Model of Amyotrophic Lateral Sclerosis,”European Journal of Neuroscience 28,no.4(2008):717-23.

31.在起居室裡自由溜躂……更好地完成問題解決測試:D.O.Hebb,“The Effects of Early Experience on Problem Solving at Maturity,”American Psychologist 2(1947):306-7.

32.范·布拉格……轉輪:H.van Praag et al.,“Running Increases Cell Proliferation and Neurogenesis in the Adult Mouse Dentate Gyrus,”Nature Neuroscience 2,no.3(1999):266-70.

33.漢南和……德倫醫生……亨廷頓病性癡呆……延緩了疾病的初始發作:A.van Dellen et al.,“Delaying the Onset of Huntington’s in Mice,”Nature 404(2000):721-22.

34.轉輪……延緩……亨廷頓病性癡呆發作:T.Y.C.Pang et al.,“Differential Effects of Voluntary Physical Exercise on Behavioral and BDNF Expression Deficits in Huntington’s Disease Transgenic Mice,”Neuroscience 141,no.2(2006):569-84.

35.“特別擅長處理新穎信息”:E.Goldberg,The New Executive Brain(New York:Oxford University Press,2009),pp.254-55.

36.延緩帕金森綜合征、老年癡呆症、癲癇發病:J.Nithianantharajah and A.J.Hannan,“Enriched Environments,Experience-Dependent Plasticity and Disorders of the Nervous System,”Nature Review:Neuroscience 7,no.9(2006):697709;J.Nithianantharajah and A.J.Hannan,“The Neurobiology of Brain and Cognitive Reserve:Mental and Physical Activity as Modulators of Brain Disorders,”Progress in Neurobiology 89,no.4(2009):369-82。下面的基礎研究文章介紹了環境的豐富化怎樣延緩了亨廷頓病性癡呆的癡呆問題:J.Nithianantharajah et al.,“Gene-Environment Interactions Modulating Cognitive Function and Molecular Correlates of Synaptic Plasticity in Huntington’s Disease Transgenic Mice,”Neurobiology of Disease 29,no.3(2008):490-504.

37.跟百憂解一樣好的效果:T.Renoir et al.,“Treatment of Depressive-Like Behaviour in Huntington’s Disease Mice by Chronic Sertraline and Exercise,”British Journal of Pharmacology 165,no.5(2012):1375-89;J.J.Ratey and E.Hagerman,Spark:The Revolutionary New Science of Exercise and the Brain(New York:Little Brown,2008).

38.雷特氏綜合征:M.Kondo et al.,“Environmental Enrichment Ameliorates a Motor Coordination Deficit in a Mouse Model of Rett Syndrome—Mecp2 Gene Dosage Effects and BDNF Expression,”European Journal of Neuroscience 27,no.12(2008):3341-50.

39.類精神分裂症小鼠……其效果和抗精神病藥物治療的效果同樣明顯:C.E.McOmish et al.,“Phospholipase C-b1 Knockout Mice Exhibit Endophenotypes Modeling Schizophrenia Which Are Rescued by Environmental Enrichment and Clozapine Administration,”Molecular Psychiatry 13,no.7(2008):661-72.

40.對這些疾病帶遺傳易感性的小鼠……恰當的鍛煉和認知刺激……有助於補償:Nithianantharajah and Hannan,“Neurobiology of Brain and Cognitive Reserve.”

41.20世紀50年代……一些帕金森綜合征患者似乎得到了鍛煉的好處:D.S.Bilowit,“Establishing Physical Objectives in the Rehabilitation of Patients with Parkinson’s Disease(Gymnasium Activities),”Physical Therapy Review 36,no.3(1956):176-78.

42.●6-OHDA……可能會導致人類患上帕金森樣疾病:K.Jellinger et al.,“Chemical Evidence for 6-Hydroxydopamine to Be an Endogenous Toxic Factor in the Pathogenesis of Parkinson’s Disease,”Journal of Neural Transmission Supplement 46(1995):297-314。這些帕金森綜合征動物模型並不是該疾病的完美複製品,因為這些藥物是一次性地讓多巴胺損失,而帕金森綜合征是漸進的。6-OHDA類似大腦裡在神經元之間傳遞信號的化學物質。它氧化後會導致大腦細胞死亡,包括產生多巴胺的細胞。A.D.Smith and M.J.Zigmond,“Can the Brain Be Protected Through Exercise?Lessons from an Animal Model of Parkinsonism,”Experimental Neurology 184,no.1(2003):31-39.

43.●這些帕金森綜合征樣動物……完全恢復:J.L.Tillerson et al.,“Exercise Induces Behavioral Recovery and Attenuates Neurochemical Deficits in Rodent Models of Parkinson’s Disease,”Neuroscience 119,no.3(2003):899-911。這些動物每分鐘跑15米,約合每小時0.9千米。它們一天跑450米。每次跑步中間休息3小時。Sheila Mun-Bryce對帕金森綜合征和神經可塑性做了精彩總結,她這樣說:“在6-OHDA和MPTP兩個分組裡,治療方案裡包括了鍛煉的動物,行為都恢復了。相較而言,長久保持靜態,多巴胺耗盡的動物表現出了持久的行為缺陷。身體運動活躍的動物,只要每天鍛煉兩次,行為上就可長久不表現出缺陷。”S.Mun-Bryce,“Neuroplasticity:Implications for Parkinson’s Disease,”in Trail et al.,Neurorehabilitation in Parkinson’s Disease,p.46.

44.“增加跑步和環境的豐富性,能極大地減少多巴胺細胞損耗……”:Zigmond et al.,“Triggering Endogenous Neuroprotective Processes,”S42-45,S43.

45.鍛煉……神經生長因子……保護患有帕金森綜合征動物的大腦:同上。

46.人類的帕金森綜合征降低了黑質中GDNF的含量:N.B.Chauhan et al.,“Depletion of Glial Cell Line-Derived Neurotrophic Factor in Substantia Nigra Neurons of Parkinson’s Disease Brain,”Journal of Chemical Neuroanatomy 21,no.4(2001):277-88.

47.BDNF還可以保護神經元免受退化:H.S.Oliff et al.,“Exercise-Induced Regulation of Brain-Derived Neurotrophic Factor(BDNF)Transcripts in the Rat Hippocampus,”Molecular Brain Research 61,no.1-2(1998):147-53.

48.無法跑動的大鼠產生的BDNF較少:J.Widenfalk et al.,“Deprived of Habitual Running,Rats Downregulate BDNF and TrkB Messages in the Brain,”Neuroscience Research 34(1999):125-32.

49.自發在轉輪上鍛煉的小鼠,BDNF增加:Oliff et al.,“Exercise-Induced Regulation.”

50.BDNF還可以保護神經元:C.W.Cotman and N.C.Berchtold,“Exercise:A Behavioral Intervention to Enhance Brain Health and Plasticity,”Trends in Neurosciences 25,no.6(2002):295-301,296 box 1.

51.BDNF……神經元的生長也會隨著鍛煉而增加:L.Marais et al.,“Exercise Increases BDNF Levels in the Striatum and Decreases Depressive-Like Behavior in Chronically Stressed Rats,”Metabolic Brain Disease 24,no.4(2009):587-97.

52.鍛煉可增強動物的學習能力:S.Vaynman et al.,“Hippo-campal BDNF Mediates the Efficacy of Exercise on Synaptic Plasticity and Cognition,”European Journal of Neuroscience 20,no.10(2004):2580-90.

53.久坐的生活方式……是……顯著危險因素之一:S.Vaynman and F.Gomez-Pinilla,“License to Run:Exercise Impacts Functional Plasticity in the Intact and Injured Central Nervous System by Using Neurotrophins,”Neurorehabilitation and Neural Repair 19,no.4(2005):283-95,290.

54.●神經機能聯繫不能(diaschisis):“diaschisis”這個詞來自希臘語的“徹底斷開”,醫生們用來形容“徹底休克”,它是俄羅斯-瑞士裔神經病理學家Constantin von Monakow於1914年首次提出的。他認為,大腦損傷並不像大多數人認為的那樣僅限於局部。

55.受傷之後,大腦立刻出現“能源危機”:C.C.Giza and D.A.Hovda,“The Neurometabolic Cascade of Concussion,”Journal of Athletic Training 36,no.3(2001):228-35,232.

56.受傷的大腦特別脆弱,因為……能量太低:同上,232.

57.習得性廢用在帕金森綜合征中扮演了重要角色:J.L.Tillerson and G.W.Miller,“Forced Limb-Use and Recovery Following Brain Injury,”Neuroscientist 8,no.6(2002):574-85.

58.禁錮……運動帶來的好處完全喪失:J.L.Tillerson et al.,“Forced Limb-Use Effects on the Behavioral and Neurochemical Effects of 6-Hydroxydopamine,”Journal of Neuroscience 21,no.12(2001):4427-35.

59.●“身體活動減少不僅僅是帕金森綜合征的一種症狀,或許也強化了疾病的潛在退行”:J.L.Tillerson et al.,“Forced Nonuse in Unilateral Parkinsonian Rats Exacerbates Injury,”Journal of Neuroscience 22,no.15(2002):6790-99.Tillerson、Zigmond和Miller是這樣證明的:他們給大鼠的單個腦半球注射了低劑量的6-OHDA,讓動物的多巴胺損失20%,不足以使之產生症狀。接著,把一些動物未受影響的肢體固定住。7天後,取下固定模具,奇怪的事情發生了:注射了藥物損失了20%多巴胺的大腦半球,其多巴胺損失猛烈提升到了60%。簡單地說,短暫地剝奪行動能力,極大地加速了疾病發作的速度。多巴胺的產生是極富動態的。

60.從輪椅上一躍而起,去救溺水的人:Sacks,Awakenings,p.10.

61.在自行車上,他似乎完全正常:A.H.Snijders and B.R.Bloem,“Images in Clinical Medicine:Cycling for Freezing of Gait,”New England Journal of Medicine 1,no.362(2010):e46.For a film of the man riding,see doi:10.1056/NEJMicm0810287.

62.●針對平衡進行鍛煉:David Blatt醫生,現年54歲,來自俄勒岡州的科瓦利斯。他40多歲時被確診患上了帕金森綜合征,但只表現出了極少量的症狀,仍然是個職業級的滑雪高手。他認為,疾病發作如此緩慢,原因是他的鍛煉計劃專門挑戰平衡系統。他認為他的鍛煉計劃發揮了作用,觸發神經生長因子。他鍛煉單腿站立、彎腰,站在“博蘇球”(健身房裡用來鍛煉平衡感的一種不穩定的充氣軟球)上保持平衡、雜耍。D.Blatt,“Physician,Heal Thyself:A Corvallis Doctor with Parkinson’s Disease Finds Help in Exercise—for Himself and His Patients,”Corvallis Gazette Times,July 10,2010.

63.結果的價值越大,人們付出行動實現該結果的速度越快:R.Shadmerh and S.Mussa-Ivaldi,Biological Learning and Control:How the Brain Builds Representation,Predicts Events,and Makes Decisions(Cambridge,MA:MIT Press,2012),pp.291-93.

64.現帕金森綜合征患者能夠……做出機動性動作:P.Mazzoni et al.,“Why Don’t We Move Faster?Parkinson’s Disease,Movement Vigor,and Implicit Motivation,”Journal of Neuroscience 27,no.27(2007):7105-16,7115.

65.“機會成本”:Y.Niv and M.Rivlin-Etzion,“Parkinson’s Disease:Fighting the Will?”Journal of Neuroscience 27,no.44(2007):11777-79.

66.“運動系統有獨立的動機回路”:Mazzoni et al.,“Why Don’t We Move Faster?”7115.

67.借助有意識的行走技術規避前一回路:Y.Niv et al.,“A Normative Perspective on Motivation,”Trends in Cognitive Sciences 10,no.8(2006):375-81,377.Niv、Joel和Dayan指出,習慣性動作(如正常行走)是在紋狀體的外側部分以及依賴多巴胺的神經元裡處理的。非習慣性的、以目標為導向的動作,則由一套不同的回路處理,包括額葉和紋狀體的中間部分。我相信,約翰·佩珀在有意識行走技術(密切關注每一個動作及其目的)裡依賴的就是非習慣性、以目標為導向的運動。

68.●“慌張步態……是不由自主慌慌張張起來的”:Sacks,Awakenings,p.6.

69.●“這樣的人會陷入一種僵硬甚至凝固的生理機能衝突”:同上,pp.7-8。薩克斯指出,運動遲緩的病人在思考時,思路也很緩慢、凝滯,用術語來說,就是精神機能遲鈍(bradyphrenia,p.8)。然而,就算是這些遲鈍的患者,在外人眼裡顯得僵硬,卻並不是單純地被動;相反,薩克斯寫道,說他們“陷入困境”或許是更合適。“被動或遲鈍的外表是假象:這種受阻礙的運動不能,在任何意義上都不等同於空閒或寧靜狀態,(套用德昆西的說法)‘……並非遲鈍的產物,而是……來自勢均力敵,無限的活動,無限的膠著。’”薩克斯進而提出,威廉·詹姆斯說的“人類有兩種意志,一種是‘阻礙性’意志、一種是‘爆發性’意志”,就適用於帕金森綜合征的心理狀態:“前者統治時,就難於甚至不可能執行正常活動;而後者佔上風時,就擋不住不正常的行為。雖然詹姆斯用這些詞來形容意志的神經質反常,但同樣適用於我們所說意志的‘帕金森反常’情況(p.7n)。我想知道,約翰是不是比大多數帕金森綜合征患者更多地處在爆發性意志下,讓他得以採取行動,發明出步行技術。按照家人的說法,約翰一直是個非常活躍積極的人,所以,很難判斷,在這個患病多年的男人身上,他活躍的性質是否跟疾病相關。”

70.“將劇烈鍛煉放在帕金森綜合征治療的核心地位”:J.E.Ahlskog,“Does Vigorous Exercise Have a Neuroprotective Effect in Parkinson’s?”Neurology 77,no.3(2011):288-94.

71.低強度鍛煉,由患者自行選擇步速:L.M.Shulman et al.,“Randomized Clinical Trial of 3 Types of Physical Exercise for Patients with Parkinson Disease,”Journal of the American Medical Association:Neurology(formerly Archives of Neurology),70,no.2(2013):183-90.

72.額爾古納(Ergun Uc)……步行……讓患者的帕金森運動症狀得到改善:Ergun Y.Uc et al.,“Phase I/II Randomized Trial of Aerobic Exercise in Parkinson Disease in a Community Setting,”Neurology 83(2014):published online.

73.●埃爾伍德醫生……突破性的研究……老年癡呆症:P.Elwood et al.,“Healthy Lifestyles Reduce the Incidence of Chronic Disease and Dementia:Evidence from the Caerphilly Cohort Study,”PLoS ONE 8,no.12(2013).

74.●卡迪夫的研究……克服了此前11項研究存在的設計問題:其他研究發現,運動可以預防老年癡呆症,但這項研究是突破的原因在於,它克服了此前多項老年癡呆症研究中存在的一個問題。人在臨床上尚未表現出症狀很久之前,老年癡呆症就有可能在大腦裡啟動。如果一項研究指出,一個從不鍛煉、大量飲酒、不關注體重的人得了老年癡呆症,科學家們怎麼能夠確定是哪些“不良行為”導致癡呆症的呢?或許他早就有了低度的老年癡呆症,所以才做出了糟糕的選擇。在科學界,這就是所謂的反向因果關係問題。科學家們認為,不良行為導致疾病,但也有可能因果關係要反過來,很早就患上老年癡呆症的人(很早就被醫生們盯上了),也是那些不願意鍛煉或健康飲食的人。短期研究很容易犯這個錯誤,即研究只短暫跟蹤受試者,只截取受試者的簡短生活快照。在卡迪夫大學的研究公佈之前,11項研究中有10項指出,中年鍛煉與老年癡呆症風險降低相關,但均非長期研究。而卡迪夫研究跟蹤了患者30年,所有最終患上早期老年癡呆症的人都被排除在了數據分析之外。因此,卡迪夫的研究人員知道,如果一個人不鍛煉,不傚法其他健康行為,那不是因為他已經患上了老年癡呆症。

75.“只有百分比極低的人……攜帶了……阿爾海默病的遺傳模式”:T.Chow,The Memory Clinic(Toronto:Penguin,2013),p.69.

76.“和基因組成……互動”:同上,p.70.

77.“也不足以產生阿爾茨海默病”:同上,p.72.

78.2011年的另一項突破性研究:J.Ahlskog et al.,“Physical Exercise as a Preventive or Disease-Modifying Treatment of Dementia and Brain Aging,”Mayo Clinic Proceedings 86,no.9(2011):876-84.

79.海馬體明顯擴大:K.I.Erickson et al.,“Exercise Training Increases Size of Hippocampus and Improves Memory,”Proceedings of the National Academy of Sciences 108,no.7(2011):3017-22.

80.9年以後,海馬體都是增大:K.I.Erickson et al.,“Aerobic Fitness Is Associated with Hippocampal Volume in Elderly Humans,”Hippocampus 19(2009):1030-39.

81.70歲以上的人群,15%都患有這樣那樣的癡呆症:M.D.Hurd et al.,“Monetary Costs of Dementia in the United States,”New England Journal of Medicine 368,no.14(2013):1326-34.

82.“90+”……絕大多數都沒得老年癡呆症:M.M.Corrada et al.,“Prevalence of Dementia After Age 90:Results from the 90+Study,”Neurology 71,no.5(2008):337-43.

第3章 神經可塑性痊癒的階段

1.中風……仍然活著……表現出了萎縮或廢棄的跡象:L.V.Gauthier et al.,“Atrophy of Spared Gray Matter Tissue Predicts Poorer Motor Recovery and Rehabilitation Response in Chronic Stroke,”Stroke 43,no.2(2012):453-57.

2.卡爾·普裡布拉姆:K.H.Pribram,The Form Within:My Point of View(Westport,CT:Prospecta Press,2013).

3.大腦……沒有淋巴系統:R.D.Fields,The Other Brain(New York:Simon&Schuster,2009),p.42.

4.限制-誘導療法……觸發……神經刺激:L.V.Gauth-ier et al.,“Remodeling the Brain:Plastic Structural Brain Changes Produced by Different Motor Therapies After Stroke,”Stroke 39,no.5(2008):1520-25.

5.促進生長、節約能量:R.M.Sapolsky,Why Zebras Don’t Get Ulcers,3rd ed.(New York:St.Martin’s Griffin,2004),p.23.

6.關閉交感神經系統,似乎能改善……:turning off the sympathetic system appears to improve:M.E.Hasselmo et al.,“Noradrenergic Suppression of Synaptic Transmission May Influence Cortical Signal-to-Noise Ratio,”Journal of Neurophysiology 77,no.6(1997):3326-39.

7.在睡眠中,神經膠質會打開特殊通道:L.Xie et al.,“Sleep Drives Metabolite Clearance from the Adult Brain,”Science 342,no.6156(2013):373-77.

第4章 通過光對大腦重新接線

1.南丁格爾:F.Nightingale,Notes on Nursing:What It Is and Is Not(London:Harrison,1860).

2.弗朗西斯·克裡克……打開特定的神經元:F.H.Crick,“Thinking About the Brain,”Scientific American 241(1979):219-32.See also G.Stix,“A Light in the Brain,”Scientific American 302(2010):18-20.

3.●卡爾·戴瑟羅特……光遺傳學……對患者似乎並無益處:戴瑟羅特最近表示,他不主張“把光置入人體,進行直接的治療應用。”置入光纖涉及“放入外源蛋白,誰知道會引發什麼樣的免疫反應。較之它在基礎科學上的作用,治療作用微乎其微。”Presentation at Mount Sinai Hospital,Department of Psychiatry,University of Toronto,January 11,2013.

4.沃德負責的嬰兒漸漸好轉起來:R.H.Dobbs and R.J.Cremer,“Phototherapy,”Archives of Disease in Childhood 50,no.11(1975):833-36;R.J.Cremer et al.,“Influence of Light on the Hyperbilirubinaemia,”Lancet 1,no.7030(1958):1094-97.

5.羅馬人甚至制定了“光線權”的法律:R.Hobday,The Light Revolution:Health,Architecture and the Sun(Findhorn,Scotland:Findhorn Press,2006).

6.●光合作用:二氧化碳+水+光能,製造出:糖+氧氣。實際的方程是6CO2+6H2O+光能=C6H12O6+6O2。

7.古埃及……放置在陽光下以獲得醫治效果:H.Gyry,“Medicine in Ancient Egypt,”in H.Selin,ed.,Encyclopedia of the History of Science,Technology,and Medicine in Non-Western Cultures,2nd ed.(New York:Springer,2008),pp.1508-18,1513.

8.把……正在康復的患者放在陽光照射的房間裡:J.M.Walch et al.,“The Effect of Sunlight on Postoperative Analgesic Medication Use:A Prospective Study of Patients Undergoing Surgery,”Psychosomatic Medicine 67(2005):157-63.

9.阿里蒂亞斯……“……疾病是陰霾”:Aretaeus,“On the Therapeutics of Acute Diseases,”in F.Adams,ed.,The Extant Works of Aretaeus,the Cappadocian(London:Sydenham Society,1856),p.387.

10.還發現了其他感光細胞:D.M.Berson et al.,“Phototransduction by Retinal Ganglion Cells That Set the Circadian Clock,”Science 295,no.5557(2002):1070-73;S.Hattar et al.,“Melanopsin-Containing Retinal Ganglion Cells:Architecture,Projections,and Intrinsic Photosensitivity,”Science 295,no.5557(2002):1065-70.

11.視交叉上核又發送消息到我們的松果體:Y.Isobe and H.Nishino,“Signal Transmission from the Suprachiasmatic Nucleus to the Pineal Gland Via the Paraventricular Nucleus:Analysed from Arg-Vasopressin Peptide,rPer2 mRNA and AVP mRNA Changes and Pineal AA-NAT mRNA After the Melatonin Injection During Light and Dark Periods,”Brain Research 1013(2004):204-11.

12.生活在鹽沼裡的鹽桿菌:J.Spudich,“Color-Sensing in the Archaea:A Eukaryotic-Like Receptor Coupled to a Prokaryotic Transducer,”Journal of Bacteriology 175(1993):7755-61;J.M.Allman,Evolving Brains(New York:Scientific American Library,1999),p.7.

13.感光化學開關和放大器:K.Martinek and I.V.Ber-ezin,“Artificial Light-Sensitive Enzymatic Systems as Chemical Amplifiers of Weak Light Signals,”Photochemistry and Photobiology 29(1979):637-50.

14.艾爾伯特·聖喬其……電荷轉移,分子往往會改變顏色:A.Szent-Gyrgyi,Introduction to a Submolecular Biology(New York:Academic Press,1960),pp.54,80-81;A.Szent-Gyrgyi,Bioelectronics:A Study in Cellular Regulations,Defense,and Cancer(New York:Academic Press,1968),pp.19,26-27,43.

15.某個特定的波長有助於身體組織癒合:T.I.Karu,“Irradiation with He-Ne Laser Increases ATP Level in Cells Cultivated in Vitro,”Journal of Photochemistry and Photobiology B:Biology 27(1995):219-23,219.

16.1瓦的激光……是……1000倍以上:B.B.Laud,Lasers and Non-Linear Optics(New Delhi,India:Wiley Eastern,1991),p.4.

17.●傷勢極重,皮膚無法閉合:這些照片,不少可見於卡恩的三卷著作:F.Kahn,Low Intensity Laser Therapy in Clinical Practice,3 vols.(Toronto:Meditech International,2008).

18.●激光觸發了動物正常軟骨的再生長:M.D.C.Cressoni et al.,“Effect of GaAIAs Laser Irradiation on the Epiphyseal Cartilage of Rats,”Photomedicine and Laser Surgery 28,no.4(2010):527-32.Cressoni和同事指出,激光提高了軟骨的厚度和軟骨細胞(或軟骨生成細胞)的數量;Y.-S.Lin et al.,“Effects of Helium-Neon Laser on the Mucopolysaccharide Induction in Experimental Osteoarthritic Cartilage,”Osteoarthritis and Cartilage 14,no.4(2006):377-83.

19.低強度激光在治療人類骨關節炎上也表現出了效果:P.P.Alfredo et al.,“Efficacy of Low Level Laser Therapy Associated with Exercises in Knee Osteoarthritis:A Randomized Double-Blind Study,”Clinical Rehabilitation 26,no.6(2011):52333;A.Gur et al.,“Efficacy of Different Therapy Regimes of Low-Power Laser in Painful Osteoarthritis of the Knee:A Double-Blind and Randomized-Controlled Trial,”Lasers in Medicine and Surgery 33(2003):330-38.

20.納瑟爾……研究過激光治療中風:M.A.Naeser et al.,“Acupuncture in the Treatment of Paralysis in Chronic and Acute Stroke Patients—Improvement Correlated with Specific CT Scan Lesion Sites,”International Journal of Acupuncture and Electrotherapeutics Research 19(1994):227-49;M.A.Naeser et al.,“Acupuncture in the Treatment of Hand Paresis in Chronic and Acute Stroke Patients:Improvement Observed in All Cases,”Clinical Rehabilitation 8(1994):127-41;M.A.Naeser et al.,“Improved Cognitive Function After Transcranial,Light-Emitting Diode Treatments in Chronic,Traumatic Brain Injury:Two Case Reports,”Photomedicine and Laser Surgery 29,no.5(2010):351-58;M.A.Naeser and M.R.Hamblin,“Potential for Transcranial Laser or LED Therapy to Treat Stroke,Traumatic Brain Injury,and Neurodegenerative Disease,”Photomedicine and Laser Surgery 29,no.7(2011):443-46.

21.激光刺激……面部……穴位:M.A.Naeser et al.,“Laser Acupuncture in the Treatment of Paralysis in Stroke Patients:A CT Scan Lesions Site Study,”American Journal of Acupuncture 23,no.1(1995):13-28.

22.●發射的光的精確頻率……可以……控制:此情況對應的術語為“相干性”(coherence),意思是,激光器發出的光頻率是“輸入光信號的相干複製。”A.E.Siegman,Lasers(Mill Valley,CA:University Science Books,1986),p.4.

23.促進皮膚組織裡膠原纖維的生長:S.A.Carney et al.,“Effect of the Radiation on Skin Biochemistry,”British Journal of Industrial Medicine 25,no.3(1968):229-34.

24.●激光觸發ATP產生:能增加ATP的光,必須要有特定的波長。俄國科學家Tiina Karu指出,波長415、602、633和650納米的光能提升的ATP產生。然而,波長477、511和554納米的光就沒這樣的作用。Karu,“Irradiation with He-Ne Laser.”

25.●激光還可以提高氧氣的耗用:如果經過波長為365或436納米的光照射,細胞會消耗更多的氧。出處同上。

26.一道光的顏色是它包含了多少能量的量度:H.Chung et al.,“The Nuts and Bolts of Low-Level Laser(Light)Therapy,”Annals of Biomedical Engineering 40,no.2(2012):516-33.

27.激光在最需要的地方能發揮良好效果:J.Tafur and P.J.Mills,“Low-Intensity Light Therapy:Exploring the Role of Redox Mechanisms,”Photomedicine and Laser Surgery 26,no.4(2008):323-28,324.

28.●培養皿裡的人體細胞……合成更多的DNA:人類細胞響應波長為404、620、680、760和830納米的光合成DNA。酵母則響應波長404、570、620、680和760納米的光生長。T.I.Karu,“Photobiological Fundamentals of Low-Powered Laser Therapy,”IEEE Journal of Quantum Electronics QE-23,no.10(1987):1703-17.

29.陽光……釋放血清素:G.W.Lambert et al.,“Effect of Sunlight and Season on Serotonin Turnover in the Brain,”Lancet 360,no.9348(2002):1840-42.

30.“存在適用的最優劑量”:Chung et al.,“Nuts and Bolts of Low-Level Laser(Light)Therapy.”

31.低強度激光都有助於受損神經:S.Rochkind,“Photoengineering of Neural Tissue Repair Processes in Peripheral Nerves and the Spinal Cord:Research Development with Clinical Applications,”Photomedicine and Laser Surgery 24,no.2(2006):151-57.

32.顱神經也能痊癒:J.J.Anders et al.,“Phototherapy Promotes Regeneration and Functional Recovery of Injured Peripheral Nerve,”Neurological Research 26(2004):233-39.

33.激光照射大鼠大腦胚胎細胞,能讓它們重新萌發新連接:S.Rochkind,“Phototherapy in Peripheral Nerve Regeneration:From Basic Science to Clinical Study,”Neurosurgical Focus 26,no.2(2009):1-6.

34.激光……刺激人類神經祖細胞中ATP的產生:U.Oron et al.,“GaAs(808 nm)Laser Irradiation Enhances ATP Production in Human Neuronal Cells in Culture,”Photomedicine and Laser Surgery 25,no.3(2007):180-82.

35.奧隆……在大腦受過外傷(重物砸中其頭部)的小鼠身上測試了相同的激光:A.Oron et al.,“Low-Level Laser Therapy Applied Transcranially to Mice Following Traumatic Brain Injury Significantly Reduces Long-Term Neurological Deficits,”Journal of Neurotrauma 24(2007):651-56.

36.中過風的大鼠:A.Oron et al.,“Low-Level Laser Therapy Applied Transcranially to Rats After Induction of Stroke Significantly Reduces Long-Term Neurological Deficits,”Stroke 37(2006):2620-24.

37.減少……瘢痕形成:U.Oron et al.,“Low Energy Laser Irradiation Reduces Formation of Scar Tissue Following Myocardial Infarction in Rats and Dogs,”Circulation 103(2001):296-301.

38.血液低強度激光照射法:E.N.Meshalkin and V.S.Ser-gievskii,Primenenie pryamogo lazernogo izlucheniya v eksperimental’noi i klin-icheskoi meditsine(Application of Direct Laser Radiation in Experimental and Clinical Medicine)(Novosibirsk:Nauka,1981).

39.一項光的研究,已證實了這種認知上的益處:D.W.Barrett and F.Gonzalez-Lima,“Transcranial Infrared Laser Stimulation Produces Beneficial Cognitive and Emotional Effects in Humans,”Neuroscience 230(2014):13-23.

40.利用光降低了上述蛋白質的水平……阿爾茨海默病:S.Purushothuman et al.,“Photobiomodulation with Near Infrared Light Mitigates Alzheimer’s Disease-Related Pathology in Cerebral Cortex—Evidence from Two Transgenic Mouse Models,”Alzheimer’s Research and Therapy 6,no.1(2014):1-13.

41.視網膜損傷:B.T.Ivansic and T.Ivandic,“Low-Level Laser Therapy Improves Vision in a Patient with Retinitis Pigmentosa,”Photomedicine and Laser Surgery 32,no.3(2014):1-4.

42.光療……改善了阿爾茨海默病患者神經元之間受損的連接:C.Meng,et al.,“Low-Level Laser Therapy Rescues Dendrite Atrophy via Upregulating BDNF Expression:Implications for Alzheimer’s Disease,”Journal of Neuroscience 33,no.33(2013):13505-17.

第5章 莫捨·費登奎斯:物理學家、黑帶和治療師

1.●1940年6月,一名年輕的猶太人……逃脫:我對費登奎斯個人歷史的主要信息來源是跟他親密朋友亞拉伯罕·貝尼爾(現年90多歲)、他的學生和追隨者阿娜特·貝尼爾、馬裡恩·哈里斯、大衛·澤馬赫-貝辛等人的採訪和談話。Garet Newell的“A Biographical Moshe Feldenkrais”,Feldenkrais Journal,no.7(Winter 1992)也有幫助。Mark Reese精彩但有失過分簡短的“A Biography of Moshe Feldenkrais”擴充成了費登奎斯重要傳記Moshe Feldenkrais:A Life in Movement(San Rafael,CA:Feldenkrais Press,2014)。費登奎斯在行李箱裡偷運機密的故事,也收錄在這本書裡。此外還有費登奎斯自述的建立;他在The Elusive Obvious一書中的自傳性介紹;他所著的柔道書籍,尤其是Higher Judo:Groundwork;他和Karl Pribram的談話錄音;Carl Ginsburg的“Berstein and Feldenkrais:The Fathers of Movement Science”,Feldenkrais Journal,no.12(1997-98);以及Dennis Leri,“Feldenkrais and Judo,”Newsletter of the Feldenkrais Guild,In Touch,2004。對費登奎斯理論的總體介紹,我最喜歡的是Embodied Wisdom:The Collected Papers of Moshe Feldenkrais,ed.E.Beringer(Berkeley,CA:North Atlantic Books,2010)。

2.行李箱裡裝著法國科學界的機密和資料:M.Reese,Moshe Feldenkrais:A Life in Movement.See Chapter 3.

3.“手術有可能不成功嗎”:M.Feldenkrais,“Image,Movement,and Actor:Restoration of Potentiality:A Discussion of the Feldenkrais Method and Acting,Self-Expression and the Theater”(1966),in Feldenkrais,Embodied Wisdom,pp.93-111,95.

4.“我覺得自己都快瘋了”:M.Feldenkrais,The Elusive Obvious,or Basic Feldenkrais(Capitola,CA:Meta Publications,1981),p.45.

5.“身體所有部件之間的微妙潛意識連接”:M.Reese,“Moshe Feldenkrais’s Work with Movement:A Parallel Approach to Milton Erickson’s Hypnotherapy,”in Jeffrey K.Zeig,ed.,Ericksonian Psychotherapy,vol.1,Structures(New York:Brunner/Mazel,1985),p.415.

6.“身體的任何部分,運動時都不可能不受其他部分的影響”:M.Feldenkrais,Body and Mature Behavior:A Study of Anxiety,Sex,Gravitation and Learning(1949;reprinted Berkeley,CA:Frog Ltd.,2005),p.76.

7.“我更著迷於觀察怎麼做一個動作”:Feldenkrais,Elusive Obvious,p.90.167“I believe...that the unity of mind and body”:M.Feldenkrais,“Mind and Body”(1964),in Embodied Wisdom,p.28.

8.“生活分為軀體和精神兩套的概念……已經過時了”:Feldenkrais,Body and Mature Behavior,p.191.

9.“他本來可以得諾貝爾物理學獎”:Anat Baniel,interview by author.

10.“最漫長的學徒期”:Feldenkrais,Elusive Obvious,p.246.

11.“智人”:同上,p.63.

12.“精神……開始對大腦功能進行編程”:同上,p.26.

13.“神經基質……自我組織”:同上

14.“我的基本觀點是”:Feldenkrais,Embodied Wisdom,p.94.

15.當動物……執行任務,卻沒有給予關注的時候:N.Doidge,The Brain That Changes Itself(New York:Viking,2007),pp.68,337.

16.“如果我舉著一根鐵棍”:M.Feldenkrais,Awareness Through Movement:Health Exercises for Personal Growth(1972;reprinted New York:HarperCollins,1990),p.59.

17.非常細微地抬頭或低頭:Feldenkrais,Embodied Wisdom,p.7.

18.“想法和動作之間的延遲”:Feldenkrais,Awareness Through Movement,p.45.

19.“別太較真,別太躍躍欲試”:Feldenkrais,Elusive Obvious,p.94.

20.“你們不要判斷怎麼去做動作”:Reese,“Feldenkrais’s Work with Movement,”p.418.

21.埃斯特·瑟倫:E.Thelen and L.B.Smith,A Dynamic Systems Approach to the Development of Cognition and Action(Cambridge,MA:MIT Press,1994).

22.“完全拜倒”:Esther Thelen,“A Dynamic Systems Approach and the Feldenkrais Method,”2012.

23.傑出的柔道大師……組織得“更妥帖”:M.Feldenkrais,Higher Judo:Groundwork(1952;reprinted Berkeley,CA:Blue Snake Books,2010),pp.32-36.

24.“身為教師,我可以加快你們的學習進度”:M.Feldenkrais,Body Awareness as Healing Therapy:The Case of Nora(Berkeley,CA:Somatic Resources and Frog,1977),p.xiv.

25.“這不是一個關於消除錯誤的問題”:M.Feldenkrais and H.von Foer-ster,“A Conversation,”Feldenkrais Journal 8(1993):17-30,18.

26.“我沒有一套能適用所有人的現成固定技術”:Feldenkrais,Body Awareness as Healing Therapy,p.9.

27.“一個技能,無法像從前那樣執行”:同上,p.71.

28.“我對自己很惱火”:同上,p.30.

29.“我大喜過望”:同上,p.31.

30.“這是兩具身體的共生體”:同上,p.45.

31.“一個新的集合”:Feldenkrais,Elusive Obvious,pp.3-4.

32.就像是跳舞:同上,p.9.

33.“恢復不是一個正確的詞語”:Feldenkrais,Body Awareness as Healing Therapy,p.48.

34.“‘進步’……漸進改良”:同上,p.37.

35.“費登奎斯從對習慣的認識出發”:C.Ginsburg,introductory comments to M.Feldenkrais,The Master Moves(Cupertino,CA:Meta Publications,1984),p.7.

36.“打開膝蓋容易得多了吧”:A.Rosenfeld,“Teaching the Body How to Program the Brain Is Moshe’s‘Miracle,’”Smithsonian 1,no.10(1981):52-58,54.

37.動中覺知課程也可以拉長肌肉:J.Stephens et al.,“Lengthening the Hamstring Muscles Without Stretching Using‘Awareness Through Movement,’”Physical Therapy 86(2006):1641-50.

38.包含了大腦近80%的神經元:S.Herculano-Houzel,“Coordinated Scaling of Cortical and Cerebellar Numbers of Neurons,”Frontiers in Neuroanatomy 4,no.12(2010):1-8,5.

39.持久性的缺陷,而且小腦據信可塑性有限:L.F.Koziol and D.E.Budding,Subcortical Structures and Cognition(New York:Springer,2009);D.Riva and C.Giorgi,“The Contribution of the Cerebellum to Mental and Social Functions in Developmental Age,”Fiziologiia Cheloveka 26,no.1(2000):27-31.

40.“孩子們從經驗裡學習”:A.Baniel,Kids Beyond Limits:The Anat Baniel Method for Awakening the Brain and Transforming the Life of Your Child with Special Needs(New York:Perigee,2012),p.25.

41.拋投技術看起來“簡直就像是假的”:Feldenkrais,Embodied Wisdom,p.154.

42.“在柔道裡……不能改變……很糟糕”:Feldenkrais,Higher Judo,p.94.

43.“應該始終記住,‘固定’……不是事情的實際狀態”:同上,p.55.

44.●費登奎斯病得很重,行將離世,亞拉伯罕·貝尼爾:費登奎斯的臨終故事,是亞拉伯罕·貝尼爾在一次私人溝通中所講。

第6章 一位盲人學會了看

1.●眼睛靜止,卻動個不停:M.Andreas Laurentius,A Discourse of the Preservation of the Sight:Of Melancholike Diseases;of Rheumes,and of Old Age,trans.R.Surphlet,Shakespeare Association Facsimiles no.15(1599;London:Humphrey Milford/Oxford University Press,1938).Laurentius was physician to France’s Henri IV.

2.許多常見眼科問題:W.H.Bates,The Bates Method for Better Eyesight Without Glasses(New York:Henry Holt,1981);T.R.Quackenbush,ed.,Better Eyesight:The Complete Magazines of William H.Bates(Berkeley,CA:North Atlantic Books,2001);L.Angart.Improve Your Eyesight Naturally(Carmarthen,Wales,and Bethel,CT:Crown House Publishing,2012);A.Huxley,The Art of Seeing(Toronto:Macmillan of Canada,1943).

3.●切除了晶狀體……仍然能夠調整焦點:W.H.Bates,Perfect Sight Without Glasses(New York:Press of Thos B.Brooks,1920).有關這一爭議的更詳盡討論,參見T.R.Quackenbush,Relearning to See(Berkeley,CA:North Atlantic Books,1997),pp.50-56.

4.●查爾斯·達爾文的父親羅伯特發現……眼睛……運動:R.W.Darwin and E.Darwin,“New Experiments on the Ocular Spectra of Light and Colours,”Philosophical Transactions of the Royal Society 76(January 1786):313-48.For an excellent review of the history of microsaccades,see M.Rolfs,“Microsaccades:Small Steps on a Long Way,”Vision Research 49,no.20(2009):2415-41,2416.

5.微掃視受到……抑制:J.K.Stevens et al.,“Paralysis of the Awake Human:Visual Perceptions,”Vision Research 16,no.1(1976):93-98.

6.視網膜……信息……開始衰減:S.Martinez-Conde et al.,“Microsaccades:A Neurophysiological Analysis,”Trends in Neurosciences 32,no.9(2009):463-75.

7.大約70%的亞洲人現在都是近視:K.Rose et al.,“The Increasing Prevalence of Myopia:Implications for Australia,”Clinical and Experimental Ophthalmology 29,no.3(2001):116-20.

8.重度近視……可能導致……:T.L.Young,“The Molecular Genetics of Human Myopia:An Update,”Optometry and Vision Science 86,no.1(2009):E8-22.

9.動物不再使用某一身體部位時:N.Doidge,The Brain That Changes Itself(New York:Viking,2007),pp.58-59.

10.當人們閉上眼睛,可視化地想像一個簡單物體:同上,pp.203,268.

11.金斯伯格……一共上了7次課:D.Webber,“What Does It Mean to See Clearly:The Inside View,”Feldenkrais Journal no.23(2009):23.

12.減少車禍:K.K.Ball et al.,“Cognitive Training Decreases Motor Vehicle Collision Involvement of Older Drivers,”Journal of the American Geriatrics Society 58,no.11(2010):2107-13;J.D.Edwards et al.,“Cognitive Speed of Processing Training Delays Driving Cessation,”Journals of Gerontology,Series A,Biological Sciences and Medical Sciences 64,no.12(2009):1262-67.

13.以計算機為基礎的練習能重新拓展視野:I.Mueller et al.,“Recovery of Visual Field Defects:A Large Clinical Observational Study Using Vision Restoration Therapy,”Restorative Neurology and Neuroscience 25(2007):563-72;J.G.Romano et al.,“Visual Field Changes After a Rehabilitation Intervention:Vision Restoration Therapy,”Journal of the Neurological Sciences 273(2008):70-74.

14.蘇珊·巴裡……《目光修復》:S.R.Barry,Fixing My Gaze:A Scientist’s Journey into Seeing in Three Dimensions(New York:Basic Books,2009).See also O.Sacks,“Stereo Sue,”New Yorker,June 19,2006;O.Sacks,The Mind’s Eye(New York:Alfred A.Knopf,2010).

15.視網膜……發送名為Otx2的蛋白質:S.Sugiyama et al.,“Experience-Dependent Transfer of Otx2 Homeoprotein into the Visual Cortex Activates Postnatal Plasticity,”Cell 134(2008):508-20.

16.“眼睛告訴大腦什麼時候轉入可塑狀態”:T.Hensch,“Interview:Trigger for Brain Plasticity Identified:Signal Comes,Surprisingly,from Outside the Brain,”Children’s Hospital Boston news release,August 7,2008;reposted in ScienceDaily,August 9,2008.

第7章 重置大腦的設備

1.●一種啟動模式,非常類似……觸摸:目前,他們把114個電極劃分成16個區域,每個區域由3×3個電極構成。啟動一開始,每個區域的左上角就激活,接著電波傳到右側。

2.但為什麼是刺激舌頭呢:J.C.Wildenberg et al.,“Sustained Cortical and Subcortical Neuromodulation Induced by Electrical Tongue Stimulation,”Brain Imaging and Behavior 4(2010):199-211;Y.Danilov et al.,“New Approach to Neurorehabilitation:Cranial Nerve Noninvasive Neuromodulation(CN-NINM)Technology,”Proceedings of SPIE 9112(2014):91120L-1-91120L-10.

3.●舌尖上有15000~50000條神經纖維:舌頭上分佈著若干條神經。按尤里的說法,每一條舌神經(舌頭的左右兩側各有一條)有10000~33000條觸覺纖維(總計20000~66000條纖維)。大部分都集中在舌尖。另一條神經,鼓索(面神經的一條分支)處理味覺和痛覺。它有3000~5000條纖維(兩側共計6000~10000條纖維)。因此,兩側都算的話,舌頭上總計有26000~76000條神經。“腦橋”只刺激舌頭前面6平方厘米的區域,而非所有的纖維。尤里估計,該設備刺激的纖維數量在15000~50000條。相比而言,聽覺神經具有30000纖維。A.T.Rasmussen,“Studies of the Eighth Cranial Nerve of Man,”Laryngoscope 50(1940):67-83.

4.●舌神經:是三叉神經的一條分支。

5.兩條關鍵的經脈:B.Frantzis,Opening the Energy Gates of Your Body:Qigong for Lifelong Health(Berkeley,CA:North Atlantic Books,2006),p.100.

6.用這些舌頭上的穴位……:J.G.Sun et al.,“Randomized Control Trial of Tongue Acupuncture Versus Sham Acupuncture in Improving Functional Outcome in Cerebral Palsy,”Journal of Neurology,Neurosurgery and Psychiatry 75,no.7(2004):1054-57;V.C.N.Wong et al.,“Pilot Study of Positron Emission Tomography(PET)Brain Glucose Metabolism to Assess the Efficacy of Tongue and Body Acupuncture in Cerebral Palsy,”Journal of Child Neurology 21,no.6(2006):455-61;V.C.N.Wong et al.,“Pilot Study of Efficacy of Tongue and Body Acupuncture in Children with Visual Impairment,”Journal of Child Neurology 21,no.6(2006):455-61.

7.為脊髓受傷……的截癱患者設計避孕套:F.Borisoff et al.,“The Development of a Sensory Substitution System for the Sexual Rehabilitation of Men with Chronic Spinal Cord Injury,”Journal of Sexual Medicine 7,no.11(2010):3647-58.

8.●某些波浪模式讓人入睡:電波可以由電極陣列定時啟動的方式來產生。比如說他們在設備上安裝150根電極。把電極分成6組,每組25個,排成5×5的陣列,並且每一個電極都設定好啟動時間。這樣一來,中間的25個電極可以先啟動,接著周圍的電極再啟動,總之,讓波從中心電極往外擴展。也可以讓外面的電極陣列先啟動,接著再向內來到中心的電極。

9.●謝麗爾·切爾茨是他們的第一個病人:Y.P.Danilov et al.,“Efficacy of Electrotactile Vestibular Substitution in Patients with Peripheral and Central Vestibular Loss,”Journal of Vestibular Research 17(2007):119-30;B.S.Robinson et al.,“Use of an Electrotactile Vestibular Substitution System to Facilitate Balance and Gait of an Inpidual with Gentamicin-Induced Bilateral Vestibular Hypo-function and Bilateral Transtibial Amputation,”Journal of Neurologic Physical Therapy 33,no.3(2009):150-59;Y.Danilov and M.Tyler,“Brainport:An Alternative Input to the Brain,”Journal of Integrative Neuroscience 4,no.4(2005):537-50.For the vision device,see,P.Bach-y-Rita et al.,“Vision Substitution by Tactile Image Projection,”Nature 221,no.5184(1969):963-64.

10.《能否用2%殘存的神經組織恢復功能》:P.Bach-y-Rita,“Is It Possible to Restore Function with Two-Percent Surviving Neural Tissue?”Journal of Integrative Neuroscience 3,no.1(2004):3-6.

11.●俄羅斯睡眠機能治癒失眠症一樣:對失眠問題,俄羅斯普遍使用電療睡眠機來代替安眠藥。在俄羅斯,尤里的朋友及同事Valery P.Lebedev是睡眠機學領域的先驅人物。機器使用5~25赫茲的頻率來誘發睡意,還用75~78赫茲的峰值頻率來誘導麻醉。Lebedev的作品是俄語所寫。見V.P.Lebedev,Transcranial Electrical Stimulation,Experimental and Clinical Research:A Collection of Articles(St.Petersburg:Russian Academy,Pavlov Institute of Physiology,2005),vol.2。北美市場也有大量的經顱微電流刺激療法設備,比如Fisher Wallace stimulator,是脫胎於俄羅斯技術而來。CES設備即將獲FDA批准用於失眠、抑鬱和焦慮問題。

12.大多數確診為輕度腦外傷的人,3個月內就能恢復:M.A.McCrea,Mild Traumatic Brain Injury and Post-Concussion Syndrome:The New Evidence Base of Diagnosis and Treatment(New York:Oxford University Press,2008),p.ix.

13.創傷性腦損傷是年輕人殘疾和死亡的首要原因:同上,p.3.

14.●反覆腦震盪會讓早發性阿爾茨海默病……的發生率提高19倍:A.Schwartz,“Dementia Risk Seen in Players in N.F.L.Study,”New York Times,September 29,2009;K.M.Guskiewicz et al.,“Association Between Recurrent Concussion and Late-Life Cognitive Impairment in Retired Professional Football Players,”Neurosurgery 57,no.4(2005):719-26.For a picture of these brains,see“Images of Brain Injuries in Athletes,”New York Times,December 3,2012.

15.恢復以後,又隨著時間的推移不斷惡化,這有可能是大腦的退行性過程所致:C.Till et al.,“Postrecovery Cognitive Decline in Adults with Traumatic Brain Injury,”Archives of Physical Medicine and Rehabilitation 89,no.12,supp.(2008):S25-34.

16.●他們……用功能性磁共振成像機觀察她的大腦活動:J.C.Wildenberg et al.,“High-Resolution fMRI Detects Neuromodulation of Inpidual Brainstem Nuclei by Electrical Tongue Stimulation in Balance-Impaired Inpiduals,”NeuroImage 56,no.4(2011):2129-37.

17.中間神經元……信號……到來時機最優:G.Buzáki,Rhythms of the Brain(New York:Oxford University Press,2006),p.77.

18.●單個的光受體並未進化得可以處理這麼大的波動範圍,但……中間神經元的幫助,光受體可以適應它:按照尤里的說法,視覺神經科學家把我們處理的光範圍看成11個對數單位的區域。但每一個光受體只處理兩個對數單位的對數範圍。中間神經元讓我們檢測全範圍(11個對數單位)的信號,因為有一組內穩態中間神經元可以以一種極富動態的方式激發或抑制與自己相連的神經元,使得視覺網絡的範圍達到最優,適應平均視覺環境。參見J.Walraven et al.,“The Control of Visual Sensitivity:Receptoral and Postreceptoral Processes,”in L.Spillman and J.S.Werner,eds.,Visual Perception:The Neurophysiological Foundations(Toronto:Academic Press,1977),pp.81-82,88-90;O.Marin,“Interneuron Dysfunction in Psychiatric Disorders,”Nature Reviews Neuroscience 13(2012):107-20;A.Maffei and A.Fontanini,“Network Homeostasis:A Matter of Coordination,”Current Opinion in Neurobiology 19,no.2(2009):168-73.

19.●中間神經元還能幫忙讓信號更銳利清晰:它們靠的是抑制信號,使之在網絡中不至擴散得太過廣泛。通過一個稱為側抑制(lateral inhibition)的過程,它們不讓信號變得太過瀰散,或是對附近的神經元造成不當影響,干擾其信號。中間神經元也可通過反饋,在發送信號後關閉神經元,使之不再轟炸所連接的其他神經元。(若非如此,我們看到的圖像、聽到的聲音就會持續太長時間,甚至超出其實際時長。)尤里說,這一功能,就類似大腦在尖峰序列的末端打上句號。

20.著名小說家諾曼·梅勒……“人存在的每一刻,不是有所成長……”:N.Mailer,Advertisements for Myself(New York:Berkley,1959),p.355.

21.公佈了對多發性硬化症的試驗性研究:M.Tyler et al.,“Non-invasive Neuromodulation to Improve Gait in Chronic Multiple Sclerosis:A Randomized Double Blind Controlled Pilot Trial,”Journal of Neuroengineering and Rehabilitation 11(2014):79.

22.●該神經炎反射的細節:神經炎反射是醫學博士、神經外科醫生兼科學家Kevin Tracey,以及Ulf Andersson醫學博士最近發現的。他們用電刺激迷走神經,迅速治癒了一個因類風濕關節炎致殘的人。患者住在波斯尼亞的莫斯塔爾,手部、腕部、肘部和腿部多年來都有著難忍的疼痛。一枚小型心臟起搏器類的設備通過外科手術植入他的身體,像“腦橋”那樣,為迷走神經注入尖峰。起搏器的一條電極直接順著導線插入迷走神經。研究團隊打開電刺激,患者在臨床上得到了緩解。該設備能夠完成常規藥物(抑制免疫系統,而且全都有著巨大的副作用)做不到的事情。

迷走神經之所以叫做“迷走”,因為它像流浪漢一樣大範圍、散漫地遍佈全身,從腦幹延伸到胸部再進入腹部。它調節許多身體功能,包括消化、心臟速率和膀胱控制等。它的左側分支接收來自主要器官的感覺,也將信號從大腦分配到主要器官。它還調節最近發現的神經炎反射。

炎症觸發產生“細胞因子”,幫助人們抵禦感染;但如果炎症轉為慢性,這些細胞因子就會變得對組織有毒害作用。風濕性關節炎和多發性硬化症一樣,是自身免疫性疾病,即人的免疫系統產生炎症,把人體細胞視為外來入侵者進行攻擊。細胞因子積聚在軟骨和關節,引起疼痛和組織破壞。

Kevin J.Tracey、Mauricio Rosas-Ballina和同事們描述了神經炎反射(及其神經與免疫成分)怎樣寄居在迷走神經當中。這一反射裡的輸入信號察知炎症水平,如果炎症水平過高,可以將其關閉。機制如下:迷走神經將信號發送到T細胞(漂浮在血液裡的免疫系統細胞),讓神經遞質乙酰膽鹼(常用於向大腦發送信號的化學物質)停止刺激炎症的細胞因子的產生。

大腦通過這一神經炎反射影響免疫系統,這個發現有著重要的意義,因為諸如多發性硬化症、創傷性腦外傷、癡呆症、自閉症、抑鬱症等多種腦部疾病,以及部分學習障礙(還有炎性腸病、多種類型的心臟疾病、動脈粥樣硬化、癌症、糖尿病,以及所有的自身免疫疾病)都有著巨大的炎症元素。遺憾的是,我們用來抑制炎症和免疫系統的藥物,有可能很危險,甚至導致死亡,而且經常沒有作用。

“腦橋”從舌頭上傳送刺激,進入腦幹裡名為孤束核(也就是迷走神經傳入輸入的區域)的細胞群中。有許多跡象表明,“腦橋”有助於迷走神經調節身體。例如,如果患者的血壓過低,“腦橋”能將之升至正常。如果血壓過高,它能自己降到正常(以求實現內穩態)。一名男子說,每當他使用“腦橋”,就能感覺自己的腸道開始運動,這是設備開始調節消化系統(有可能是通過迷走神經進行調節)的跡象。多發性硬化症患者有時發現,使用“腦橋”能改善自己的膀胱控制。

發現神經炎反射是一項重大突破。種種身心訓練,如冥想、催眠、氣功和瑜伽式呼吸,從神經可塑性上利用思想來訓練神經炎反射,治療某些類型的炎症疾病。參見M.Rosas-Ballina and K.J.Tracey,“The Neurology of the Immune System:Neural Reflexes Regulate Immunity,”Neuron 64(2009):28-32;U.Andersson and K.J.Tracey,“A New Approach to Rheumatoid Arthritis:Treating Inflammation with Computerized Nerve Stimulation,”Cerebrum,Dana Foundation,March 21,2012,www.dana.org/news/cerebrum/detail.aspx?id=36272.

第8章 聲音的橋樑

1.柏拉圖:Plato,The Republic,trans.Benjamin Jowett(New York:C.Scribner’s Sons,1871),bk.3,401d.

2.“我有一種不可動搖的直覺”:A.A.Tomatis,The Conscious Ear:My Life of Transformation Through Listening(Barrytown,NY:Station Hill Press,1991),p.2.

3.“我的出生”:同上,pp.1-2.

4.“擠壓機”:T.Grandin,“Calming Effects of Deep Touch Pressure in Patients with Autistic Disorder,College Students,and Animals,”Journal of Child and Adolescent Psychopharmacology 2,no.1(1992):63-72;J.Anderson,“Sensory Intervention with the Preterm Infant in the Neonatal Intensive Care Unit,”American Journal of Occupational Therapy 40,no.1(1986):9-26;T.M.Field et al.,“Tactile-Kinesthetic Stimulation Effects on Preterm Neonates,”Pediatrics 77,no.5(1986):654-58;S.A.Leib et al.,“Effects of Early Intervention and Stimulation on the Preterm Infant,”Pediatrics 66,no.1(1980):83-89.

5.“從來不容易”:Tomatis,Conscious Ear,p.4.

6.“我已經謹慎地反覆想過了”:同上,p.12.

7.●只能聽到自己新的演唱範圍:托馬迪斯後來證實這個假設,卡魯索有三個朋友告訴他,說因為卡魯索的右耳遭到手術傷害,他們跟卡魯索一起時,總是走在他左邊。托馬迪斯分析了另一位傑出歌劇演唱家貝尼亞米諾·吉裡(Beniamino Gigli),發現他的發聲範圍也有相同的限制。

8.“這就像是……卡魯索得益……”:Tomatis,Conscious Ear,p.53.

9.●“耳朵……只是大腦皮層的外部屬性”:A.A.Tomatis,“Music,and Its Neuro-Psycho-Physiological Effects.Appendix:‘The Three Integrators,’”translated by Terri Brown,presentation to the thirteenth Conference of the International Society for Music Education,London,Ontario,August 17,1978.The“three integrators”theory appeared in A.A.Tomatis,La Nuit Uterine(Paris:Stock,1981),pp.108-34.

10.“所有人,無一例外地,感到幸福感增加了”:Tomatis,Conscious Ear,p.55.

11.像火車頭咆哮而過的那樣尖叫的孩子:K.Barthel,“The Neurobiology of Sound and Its Effect on Arousal and Regulation,”presentation to the Integrated Listening Systems conference,Denver,CO,September 21,2011,p.9.

12.中耳這些收聽對話所用的肌肉,由大腦調節:S.W.Porges,The Polyva-gal Theory:Neurophysiological Foundations of Emotions,Attachment,Communication,Self-Regulation(New York:W.W.Norton,2011),p.220.

13.聽覺皮層對這些頻率的映射區域就會在數分鐘內膨脹:J.Fritz et al.,“Rapid Task-Related Plasticity of Spectrotemporal Receptive Fields in Primary Auditory Cortex,”Nature Neuroscience 6,no.11(2003):1216-23;J.C.Middlebrooks,“The Acquisitive Auditory Cortex,”Nature Neuroscience 6,no.11(2003):1122-23.

14.●它們要先從他的左耳前往大腦右半球:右側聽覺通路較短的原因之一與喉返神經(削弱喉部力量,監控右耳)相關。左側的喉返神經比右側更長,因為我們的心臟在身體左側,所以左喉返神經必須繞過連接心臟的大血管。P.Madaule,When Listening Comes Alive:A Guide to Effective Learning and Communication(Norval,ON:Moulin,1994),p.42.

15.●延遲長達0.4秒:Tomatis,Conscious Ear,pp.50-51.

16.右耳……聽到更高的語言頻率:同上,p.52.

17.“所有事情……似乎都容易得驚人,就連英語也不例外”:Madaule,When Listening Comes Alive,p.11.

18.“這就好像,經過濾的母親的聲音”:同上,p.73.

19.D.W.溫尼科特:D.W.Winnicott,“Birth Memories,Birth Trauma and Anxiety”(1949),in Through Paediatrics to Psycho-Analysis:Collected Papers(New York:Basic Books,1975),pp.174-93.

20.“尚在胎兒階段就察覺到的唯一聲音”:Tomatis,Conscious Ear,p.127.

21.“我作為早產兒的親身經歷”:同上。

22.●耳內骨骼就長到了成年大小:這一點在1670年就為人所知了。G.B.Elliott and K.A.Elliott,“Some Pathological,Radiological and Clinical Implications of the Precocious Development of the Human Ear,”Laryngoscope 74(1964):1160-71.

23.播放每一位准媽媽的聲音錄音:B.S.Kisilevsky et al.,“Effects of Experience on Fetal Voice Recognition,”Psychological Science 14,no.3(2003):220-24.

24.新生嬰兒更喜歡媽媽的聲音:A.J.DeCasper et al.,“Of Human Bonding:Newborns Prefer Their Mothers’Voices,”Science 208,no.4448(1980):1174-76.

25.更喜歡妊娠最後6周聽到的母親所講的故事:A.J.DeCasper and M.J.Spence,“Prenatal Maternal Speech Influences Newborns’Perception of Speech Sounds,”Infant Behavior and Development 9,no.2(1986):133-50.

26.●新生兒立刻能分辨出“母語”:Moon、Lagercrantz和Kuhl是新生兒語言及可塑性專家,他們指出,在子宮內接觸一種語言,會影響人對這種語言的感知能力。C.Moon et al.,“Language Experienced in Utero Affects Vowel Perception After Birth:A Two-Country Study,”Acta Paediatrica 102,no.2(2012):156-60.

27.新生兒在出生之前,就具備了對母語敏感的神經網絡:B.S.Kisilevsky et al.,“Fetal Sensitivity to Properties of Maternal Speech and Language,”Infant Behavior and Development 32,no.1(2009):59-71.

28.“語言,也具備一種身體上的維度”:Tomatis,Conscious Ear,p.137.

29.“我們可以想像,未出生的孩子”:Madaule,When Listening Comes Alive,pp.82-83.

30.待產羔羊……致命的大腦缺氧……不一定會殺死所有大腦細胞……減少神經元分支的數量,以及神經元之間突觸連接的數量:J.M.Dean et al.,“Prenatal Cerebral Ischemia Disrupts MRI-Defined Cortical Microstructure Through Disturbances in Neuronal Arborization,”Science Translational Medicine 5,no.168(2013):1-11(168ra7).

31.“我們的發現結果對這一假設提出了懷疑”:同上。

32.●旋轉後眼震:有關這一現象,參見“when the rotation is suddenly stopped,nystagmus[occurs]in the opposite direction,”see A.Fisher et al.,Sensory Integration:Theory and Practice(Philadelphia:F.A.Davis,1991),p.81.

33.隨著皮層的演進、體積的增加,皮層下結構也大為發展,進行了修正:S.Herculano-Houzel,“Coordinated Scaling of Cortical and Cerebellar Numbers of Neurons,”Frontiers in Neuroanatomy 4,no.12(2010):1-8.

34.●他易怒,難以管教,一動怒就無法安撫:你可以到下面聆聽中心的網站上見識喬丹的脾氣,還有正在幫助https://listeningcentre.com/,點擊頁面最底下的鏈接,見視頻The Child That You Do Have。

35.對傳入的感覺過度敏感,尤其是聲音:E.Gomes et al.,“Auditory Hypersensitivity in Autistic Spectrum Disorder,”Pro Fono 20,no.4(2008):279-84.

36.“幾十年來,大多數醫生都告訴家長,自閉症……基因出了問題”:M.Herbert and K.Weintraub,The Autism Revolution(New York:Ballantine Books,2012),p.5.See also M.R.Herbert,“Translational Implications of a Whole-Body Approach to Brain Health in Autism:How Transduction Between Metabolism and Electrophysiology Points to Mechanisms for Neuroplasticity,”in V.W.Hu,ed.,Frontiers in Autism Research:New Horizons for Diagnosis and Treatment(Hackensack,NJ:World Scientific,2014).

37.●“數百個基因”:M.Herbert,“Autism Revolution,”presentation at Autism Research Institute Conference,Fall 2012,with slides.See also Herbert and Weintraub,Autism Revolution,p.31.

38.許多自閉症兒童都有免疫系統異常:P.Goines and J.Van de Water,“The Immune System’s Role in the Biology of Autism,”Current Opinion in Neurology 23,no.2(2010):111-17,115.

39.●他們的胃腸道感染……患病率很高:H.M.R.T.Parracho et al.,“Differences Between the Gut Microflora of Children with Autistic Spectrum Disorders and That of Healthy Children,”Journal of Medical Microbiology 54,no.10(2005):987-91.Seventy percent of autistic children have a history of GI symptoms,twice the rate of children with normal development.M.Valicenti-McDermott et al.,“Frequency of Gastrointestinal Symptoms in Children with Autistic Spectrum Disorders and Association with Family History of Autoimmune Disease,”Developmental and Behavioral Pediatrics 27,no.2(2006):S128-136.

40.●臍帶血裡平均有200種主要的有毒化學物質:很多關心自閉兒童的人都報告說,將有毒化學物質的接觸控制在最低限度後,孩子的情況有了改善。Herbert and Weintraub,Autism Revolution,pp.35,42,125.每年數千種人工化學物質進入環境,大部分的長期健康影響未作檢測。人們公認毒素對免疫系統有負面影響。參見P.Grandjean et al.,“Serum Vaccine Antibody Concentrations in Children Exposed to Perfluorinated Compounds,”Journal of the American Medical Association 307,no.4(2012):391-97.See also S.Goodman,“Tests Find More Than 200 Chemicals in Newborn Umbilical Cord Blood,”Scientific American(2009).

41.炎症在“小腦上尤其驚人”:D.L.Vargas et al.,“Neurological Activation and Neuroinflammation in the Brain of Patients with Autism,”Annals of Neurology 57,no.1(2005):67-81,77.

42.來自母親的抗體:The studies are reviewed in Goines and Van de Water,“Immune System’s Role.”

43.母親……23%攜帶這類抗體……:D.Braunschweig et al.,“Autismipecific Maternal Autoantibodies Recognize Critical Proteins in Developing Brain,”Translational Psychiatry 3(2013):e277,doi:10.1038/tp.2013.50.

44.猴子……顯示出與自閉症兒童類似的症狀:M.D.Bauman et al.,“Maternal Antibodies from Mothers of Children with Autism Alter Brain Growth and Social Behavior Development in the Rhesus Monkey,”Translational Psychiatry 3(2013):e278,doi:10.1038/tp.2013/47.

45.抗體水平也很高:A.Enstrom et al.,“Increased IgG4 Levels in Children with Autism Disorder,”Brain,Behavior,and Immunity 23,no.3(2009):389-95.

46.●是否會觸發一小部分孩子中的待議炎症,目前尚存爭議:我們經常在媒體上聽到,所有的醫學專家都認為接種疫苗無風險,是安全的,不可能傷害孩子。但主流醫學的觀點反倒更加微妙。美國疾病控制中心發佈過一份34頁的《接種疫苗禁忌症及注意事項》(Guide to Vaccine Contraindications and Precautions)。禁忌症是一個醫學術語,指的是不應使用某一治療干預手段、或對其加以調整的情形,比如有些人對疫苗(或其中的某種成分)有著明顯反應,甚或威脅生命;也有人有著異常的免疫系統,感染過某種疾病;也有人之前有過不良反應,等等。一般的醫療共識是,疫苗有時對某些人有害,出於這個原因,有些疫苗已經撤出市場。對自閉症患者的關鍵問題,有些潛在患有自閉症的孩子,是否屬於疫苗的禁忌或注意範圍?這些孩子是否得到了專門的研究?赫伯特在《自閉症革命》中描述了這些孩子有些什麼外貌特點。一些專家說,這一群體尚未與疫苗接種聯繫起來進行過研究。加州大學戴維斯分校MIND研究所(世界頂尖的自閉症及炎症研究機構)主任David Amaral醫生在PBS最近的一次特別節目中說到有自閉症風險的孩子,“對這些孩子來說,接種疫苗或許是將之推至自閉症邊緣的環境因素。我認為最最重要的是,要努力弄清這一小群孩子身上到底有什麼弱點,使某種疫苗對他們這麼危險。”新出現的個性化疫苗學(vaccinomics)旨在為人的基因譜和個人病史設計個性化的疫苗,它承認我們當前使用的統一規格疫苗不夠完美,對某些人來說,某些現行疫苗可能無效,對另一些人來說,某些疫苗甚至有害。參見M.W.Moyer,“Vaccinomics:Scientists Are Devising Your Personal Vaccine,”in Scientific American(June 24,2010),https://www.scien tificamerican.com/article/vaccinomics-personal-vaccine/。本章討論的喬丹·羅森和“蒂莫西”,都是在18個月時接種疫苗後的一個星期內,就患上了自閉症。

47.慢性炎症擾亂神經回路的建立:R.H.Lee et al.,“Neurodevelopmental Effects of Chronic Exposure to Elevated Levels of Pro-Inflammatory Cytokines in a Developing Visual System,”Neural Development 5,no.2(2010):1-18.

48.“連接不足”:M.A.Just et al.,“Cortical Activation and Synchronization During Sentence Comprehension in High-Functioning Autism:Evidence of Underconnectivity,”Brain:A Journal of Neurology 127,no.8(2004):1811-21.

49.大腦正前方的神經元……連接很糟糕:S.E.Schipul et al.,“Inter-regional Brain Communication and Its Disturbance in Autism,”Frontiers in Systems Neuroscience 5,no.10(2011),doi:10.3389/fnsys.2011.00010.

50.其他腦區則表現出“連接過度”:R.Coben and T.E.Myers,“Connectivity Theory of Autism:Use of Connectivity Measures in Assessing and Treating Autistic Disorders,”Journal of Neurotherapy 12,no.2(2008):161-79.

51.艾布拉姆斯……在自閉症兒童身上……聽覺皮層區域,跟大腦的皮層下獎勵中心連接不足:D.A.Abrams et al.,“Underconnectivity Between Voice-Selective Cortex and Reward Circuitry in Children with Autism,”Proceedings of the National Academy of Sciences 110,no.29(2013):12060-65.