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SEX AND REHAB – Tinder, escorts and an age-old taboo

The professionals helping to make sure sex is not forgotten in the drive to improve life quality after severe injury.

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Sex workers can play an important, if controversial, role in boosting confidence and quality of life for people with profound disabilities. Here pioneering sex therapist Tuppy Owens tells Andrew Mernin why it’s time to stop running away from the issue.

“Just because people are disabled, doesn’t mean they don’t have sexual urges,” says Tuppy Owens, who has spent decades helping people with disabilities enjoy sex and find love.

Owens is a sex therapist, campaigner, published author and former adult model. She is also founder of the TLC Trust, which helps disabled people to access sex workers safely.

Users visiting the site can browse a database of sex workers who have been vetted by TLC to check they can provide a safe and understanding experience for people with a range of disabilities; including those related to brain and spinal injury and neurological disease.

Tuppy Owens

TLC is closely linked to the Outsiders Club, also founded by Owens to help people with social and physical disabilities find partners, make friends and enjoy “peer support”.

After “helping a couple of disabled guys get laid” in 1978, she formulated plans for a club run by and for disabled people looking for friendship, romance and support.

The link between experiencing sex – via TLC – and finding love, possibly through the Outsiders Club, is absolutely intrinsic, believes Owens.

Crucially, sexual services can help to build the self-esteem and confidence needed to enter a loving, intimate relationship.

“If a disabled person feels nervous about starting a sexual relationship because they don’t really know what their bodies are capable of, they could go to a sex worker a couple of times so that they could be a better lover when they do find a partner.

“We don’t know how many sex workers are hired, how many disabled people use them or how they find them. Often their assistants or healthcare professionals will organise it for them because they are better [technically].

We vet both the sex workers and the people who want to join Outsiders to make sure the disabled people are safe.”

The legal aspect of helping disabled clients access sex workers is fraught with risks. At a very basic level, the individual must have capacity to make a choice about consenting to sex. But professionals looking to help clients visit a sex worker must of course consider a range of legal and other implications (as case manager John Walker explains below).

Owens’ mantra on the issue of legality is that: “It is illegal not to support disabled people to enjoy the same pleasures as others enjoy in the privacy of their own homes, under the Equality Act 2010 and the Human Rights Act 1998.

“This is great because when someone complains that they aren’t allowed to have sex, I can quote those laws and they have to go back to the person who won’t allow them to do it and say that’s illegal to stop them.”

TLC-vetted sex workers may visit the client’s house, offer services at their own accessible property or at a hotel.

In a residential care setting, Owens says, “there is usually someone running the home” that wouldn’t allow this sort of thing to happen on site.

“Care homes are becoming more interested but whether they would actually allow sex workers in the home is another thing.”

In terms of criminal law, the exchange of sexual services for money is legal in England, Wales and Scotland. A number of related activities are illegal, however, including soliciting in a public place, kerb crawling, owning or managing a brothel and pimping. Prostitution is illegal in Northern Ireland, meanwhile.

“People think sex work is still illegal in this country – even people who should know better,” says Owens.

Once the legal minefield is navigated, other challenges may arise, including the potential threat of emotional attachment issues.

Owens says: “If a person gets too keen on just one sex worker, we might suggest that they find another one because we don’t want them to fall in love. Obviously, a sex worker may have lots of other clients so there’s no point in getting too attached.”

Aside from mere pleasure, there are many other reasons why a person would choose to visit a sex worker. According to TLC, a common motivation for site visitors is to be taught what their bodies are capable of and how to please a potential partner.

Some users seek a “girlfriend or boyfriend” experience – pretending to be partners either in public in a non-sexual way or in the bedroom – or wish to lose their virginity. Others may be unable to achieve an orgasm alone, while acceptance is also an important factor.

TLC says: “Sexual expression may mean many things, and disabled people need to know that you will not be judged by your requests, however embarrassing you find them. People who provide sexual services have heard it all before, and are totally discreet.

“For many disabled people, just being in a warm set of arms, and having their bodies accepted, is incredibly powerful and helps to build your sexual confidence and walk tall ,or wheel tall, in the world

“Having your sexuality taken seriously without stigma or disapproval can be liberating and life-changing. For some, actually enjoying an orgasm at last can bring your life into balance.”

While male users may instigate the use of one of TLC’s vetted providers, women are advised to contact TLC first as it can be easy for them to “be lured by unprofessional guys”.

Owens says: “There tends to be more men looking for sex workers than women. With TLC I always tell women to ring me first so I can walk them through it. I want to be absolutely sure that they have a nice time – and that always works.”

An anonymous female user of services promoted on the site says: “Due to a combination of ill health and traumatic personal experiences, I had spent a long period of time avoiding physical contact and intimacy, but had reached a point where I felt confident enough to address the situation.

“I had many concerns, about safety especially, but I liked the way the website gave no- nonsense information and everything seemed very open…I was keen to work with ‘professionals’, as I thought that after all they knew what they were doing and also working with people with all kind of issues, disabilities and health issues meant they had experience of dealing with situations that might not be easy/ obvious for others to deal with.”

The woman was initially advised to meet a practitioner who offered a full body massage to help her to reconnect with herself physically; before considering taking the next step.

She says: “I was extremely nervous but the gentleman providing the service was kind, professional and at all times made it clear that I was able to stop anything that I did not like. In the end, everything went well and was far less difficult then I expected.

“Having taken this first step I then corresponded briefly with the second person I had been put in touch with and set up a booking. Again, the practitioner was lovely, caring, very open and had a great sense of humour and he made me feel safe at all time.

“Both experiences have been really helpful and, in some way, much less of a big deal than I thought they were going to be, in setting me back onto the path of being ‘physical’ again.”

Owens founded the TLC Trust in 2000 with the support of a disabled man who had reached his mid-40s without losing his virginity. Since then, scores of sex workers have been vetted and joined, with many happy customers along the way.

Among them was the young lady who wanted to buy herself a “birthday shag” for her 21st, and a man whose parents sought out a sex worker to help him have his first sexual experience at 38.

Owens would like to see disabled people’s desire to experience sex and love being taken more seriously by the professionals around them and society in general.

“Things haven’t really moved on in recent years, in fact I think they’ve gotten worse. Often people come to the Outsiders because they have been very lonely.

“Not only do they not have a good sex life, but they may have few friends, which is terrible. Even if they don’t end up finding a relationship they’ve been given the confidence to flirt and do other things that help to form relationships.”

Owens, who won a UNESCO award in 2015 for her innovative approach to sexual health and human rights, sees sexual services as empowering and positive to people with severe injuries – not shameful or something to be embarrassed about.

Could their costs therefore be factored into an individual’s care package? Owens would like to see this, although she is doubtful it will happen anytime soon.

“When you think about how much compensation a brain injured person requires, how much would they need to hire a sex worker [regularly] from when they were injured?

Obviously when they are younger, they would have a sex worker more often, maybe twice a month, then a bit less when they are 50 or so and less again when they are 80. It could be quite expensive overall.”

The prospect of sex workers becoming just another intervention on the rehab journey seems somewhat remote.

However, as Owens has long argued, sex is an integral part of the human experience and simply ignoring it under a cloud of taboo benefits no-one.


Sexual services and rehab – a case manager’s view

When a client asks to visit a sex worker, professionals must navigate a tricky terrain with no manual to guide the way, writes brain injury case manager John Walker.

The matter of clients using sex workers predisposes that they have the mental capacity to engage in that relationship. Having the capacity to have sex is a different question from having the capacity to utilise a sex worker however; and from a legal point of view, this is a foremost consideration.

Another consideration is the notion of the law of unforeseen consequences, in that embarking on the arrangement could result in all sorts of unexpected results.

It is therefore incumbent on a professional such as a case manager to risk assess the whole process as best they can.

There is also the potentially complex situation that surrounds the client’s family. The adult brain injured person rarely exists in isolation, but rather in the context of their family.

Understandably, families affected by severe injury tend to be more risk averse and protective, although sometimes, for example, parents who you may expect to be antagonistic towards the idea of sex workers, can actually be very liberal about it.

But overall, the case manager may be faced with very divergent views from the various people in the client’s life. Even after these challenges have been addressed, there are some relevant legal barriers that must be overcome before you consider putting a client in touch with a sex worker.

One part of the law determines how the process is driven along. Any practitioner in the area must be very clear that they are not, in any way, causing or inciting the process to take place.

Sections of the Sexual Offences Act 2003 ensure that the individual with whom the client would engage, for example, is not underage and is operating in the UK freely of their own volition.

Practitioners have to be very mindful of the legal context and make sure they are operating within criminal law. They must also navigate the fact that lots of bits of legislation can have contradictory effects in the UK.

Of course, as Tuppy Owens mentions in her interview, there are also relevant elements of the Equalities and Human Rights acts, which help to make a strong case for access to sexual services by disabled individuals.

It is important to stress that the majority of brain injured adults who express an interest in visiting a sex worker never go on to do so.

From a rehab perspective, the issue may be approached as a problem-solving exercise. The client might tell you “I want this” but because of their brain injury may not be aware of the range of different factors in achieving it.

Working through the barriers to fulfilling this aim doesn’t mean the client will necessarily achieve it; but the process of pursuing it can serve as good cognitive, psychological and emotional practice that might better equip them to deal with life in the future.

At the same time, taking a client’s sexual requirements seriously is important and can positively influence their rehabilitation.

While most sex-related issues that occur after a brain injury are those that affect existing intimate relationships, some clients will indeed seek a sex worker visit. They may see the process as a stepping stone towards having the skills and confidence to pursue a loving relationship.

Sex is a very basic human need and without it people can become frustrated. After a
brain injury, what wasn’t necessarily a driver towards behavioural problems could become a contributing factor to the overall difficulties the client has.

Obviously, sex is also closely linked with self-esteem and self-worth. There is certainly anecdotal evidence that young men with brain injuries can benefit from a safe, carefully arranged sexual encounter.

For various reasons, including greater frequency of brain injury prevalence, this client group seems to be the most likely to seek sexual services after injury.

If clients have difficulties with inhibitory control caused by the brain injury, addressing their sexual frustrations could help to reduce possible behavioural problems in the community.

There are a number of different agencies who deploy sex workers with experience of working with clients with neurological impairment.

Clearly there is no prescribed method to helping clients narrow this field. Instead, the process involves conversations with agencies to work out whether there is someone with the adequate experience conveniently located for the client.

In the entire management of this tricky issue, case managers can find themselves operating from two very different positions. One is from the perspective of care and nurture and a commitment to introducing new experiences where possible.

The other is slightly opposing in nature, with a remit of control, risk management and consideration of the law. Always being aware of your position on this spectrum can help to manage the situation in the interest of the client’s wellbeing.

In summary, there is no guide book on this topic for brain injury professionals and each case must be considered in its own context. Based on my own experience I would strongly recommend discussing the issue as a multidisciplinary group – and definitely do not ignore any sexual concerns your client has, however awkward the topic may seem.

John Walker is a brain injury case manager who runs Education and Case Management Services with his wife Judith James.


From marital faux pas to dating game pitfalls

How occupational therapists play a key role in unlocking the power of sex in rehab.

Occupational therapy, as defined by the NHS, is supporting people whose health prevents them from doing the activities that matter to them.

When the slightest mention of the activity provokes mass embarrassment among clients and their families, however, the field becomes particularly challenging.

But such awkwardness must be overcome because sex really does matter and can have a huge influence on an individual’s life after brain injury.

So says Rachel Lees, a specialist occupational therapist (OT) at Neural Pathways, which provides therapy and rehab services for people with neurological conditions.

“It’s so important. Sex is a massive thing but as soon as you get to the topic, everyone panics and shys away from it. But it’s an important human need and part of helping people get back their quality of life.

“As OTs we look at everything holistically. We have a duty of care to support the client if they want to get into a new relationship or need help with an existing one as it’s such a huge part of anyone’s life.”

The impact of sex and intimate relationships on any individual extends far beyond the bedroom walls; for brain-injured adults in rehab, failing to meet these basic desires can be hugely disruptive to their recovery.

Lees says: “I had a client who was getting really down because he wanted companionship – a relationship and everything that comes along with that.

“It was impacting on his performance in other areas of his rehab. Because he was feeling low and had self-esteem issues, he was getting frustrated and agitated.

“Not having sexual and relationship needs met might increase frustration and anxiety and affect self-esteem. It really can affect everything.”

As well as helping clients address sexual and relationship needs, OTs in multidisciplinary teams are key in assessing whether they have capacity to consent to relationships.

Part of this involves considering how sex or a relationship would impact on the rest of
their rehab.

As an OT, Lees has never been involved in facilitating a brain-injured client’s visit to a sex worker or escort. She has, however, helped them to overcome the anxiety that might precede a planned sexual encounter.

A crucial part of her role is helping clients deal with behavioural changes that can affect relationships.

“After a brain injury, sexual and social disinhibitions rise quite commonly and people can become more inappropriate. They may have never said anything inappropriate before their injury but now they just can’t filter it out.”

This can cause obvious problems in marriages and other relationships that pre-dated the injury.

“Their partner could be embarrassed by their behaviour. For example, I had a client who was out with his wife and paid attention to, and made a comment about, another woman’s breasts. So it can be a bit embarrassing.”

Similar challenges occur when single clients attempt to navigate the dating game in an age of Tinder and other instantly accessible apps.

“They may need support workers to act as the filter they no longer have or be that person looking over their shoulder who says: ‘Do you think that’s an appropriate thing to say? How can we make it more appropriate?’”

While sex and relationships influence an individual’s overall wellbeing, they can also be a useful area in which to hone problem- solving skills.

Even the mere process of going on a date can involve numerous tasks that may be highly challenging for a person with cognitive difficulties. Overcoming them with the help of the OT can be an important part of rehab.

“A lot of clients don’t have the skills to use computers because of their cognitive impairments. They go online and struggle to write information about themselves – so they struggle in terms of putting a dating profile together and we can work on their computer skills.

“Then, if they are going out for a date, do they need support to attend it? How do they budget for the date? What would they wear? There is a whole list of things we could get involved in as an OT as part of their rehab programme. We often look at pros and cons of different options and then seek a solution to each problem.”

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Taking time to look back – so the way ahead is clearer

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Reflective practice within healthcare settings is widely talked about, but not always so easy to implement in the workplace. NR Times speaks to one neurological centre about how it benefits patients and staff there.

Reflective practice and discussion in healthcare settings is a professional requirement for nurses, as laid out by the Royal College of Nursing revalidation requirements as part of their continuous professional development.

It allows professionals to take time to pause and reflect, communicate and plan, which undoubtedly leads to better outcomes for patients and staff.

But in reality, reflective practice can often be left to the bottom of the pile, underneath many of the competing responsibilities facing staff who are often pressed for time.

It could be argued that this is also why reflective practice is so important – healthcare staff are facing so many pressures that it actually makes less sense to neglect the important work of individual and team reflection.

The Royal College of Nursing defines reflective practice as: A conscious effort to think about an activity or incident that allows us to consider what was positive or challenging and if appropriate
plan how it might be enhanced, improved or done differently in the future.

Staff at Elysium St Neots Neurological Centre in Cambridgeshire started doing regular, weekly reflective practices when its new hospital director, Fiona Box, came into the role a few months ago.

The nurses and healthcare assistants from a ward are invited into the meetings and in their absence the therapy staff monitor patients and provide activities.

“We thought it would be helpful for team members to give them the opportunity to think, learn, and to hear their opinions,” says charge nurse Jemima Vincent.

“If we have an incident with a patient, we discuss it in the session” she says.

Sessions are led by the management team, with added input from psychology teams on each ward.

They will talk through any strengths, weaknesses and opportunities, and work through an analysis to learn from the incident and create an action plan.

They talk about the worst-case scenario in relation to an individual situation and discuss how staff would manage that, so they’re better prepared in the event of it happening.

While they focus on one patient at a time, issues arise during conversations that bring in their wider experiences.

In an article* published in the Nursing Times in 2019, Andrea Sutcliffe, chief executive of the Nursing and Midwifery Council said: “In these challenging times for health and social care, it’s so important that collectively we do all we can to support our health and care professionals, and their employers, in devoting time to individual, reflective, personal and honest thinking.”

Fiona has received encouraging feedback from staff, who say the meetings help the staff feel much more involved in a patient’s care and allow the team to increase their knowledge and understanding resulting in a more consistent way of working.

“Healthcare workers often don’t fully understand patients’ diagnoses or why they’re reacting in a certain way, for example,” Jemima says.

“They know a patient presents with certain behaviours and may be taking medicine to help them cope but they’re not aware why the patient is showing signs of aggression and the best response to deescalate the situation,” she says.

“It’s a learning opportunity for staff, because reflective practice means that they can understand a patient’s diagnosis and why they behave how they do,” Jemima says.

“Reflective practice answers their ‘why’ questions, and gives them a more open mind.”

Jemima also benefits from the meetings; it’s a way for her to get to know staff better, especially when it comes to learning opportunities.

“I’m able to understand what level of support each member of the team requires, including training needs and if they need more knowledge on a specific topic.”

In her final year as a mental health nurse student on extended clinical placement at Elysium St. Neots, Jo took part in a reflective practice session.

She had just finished her dissertation, in which she looked at how settings can increase the opportunities and variety of reflective practices within hospital settings.

The aim of Jo’s session was to reflect on the recent deterioration in a patient’s mental state and the resulting impact on their well-being to ensure staff had a consistent approach to support the patient.

The hospital’s director Fiona asked the team about the patient’s care plan, diagnoses and needs and wishes.

Where staff were unsure of the answers to questions, Jo says Fiona gave them answers and encouraged the team to share their knowledge of the patient, problem solve and come up with an agreed plan to move forward with.

Jo found the session helpful and was impressed with how the healthcare assistants were so involved in the discussions about all aspects of the patient’s care, including the more clinical elements.

Healthcare assistants told her they found the session helpful too and that it made them feel like they had a better understanding of the patient’s changing mental state, behaviours and needs.

Jo says having the opportunity to reflect on practice is a crucial skill for all healthcare workers to help them learn from their experiences and increase self-awareness, which, in turn, can improve individual professional standards, strengthen teams and enhance patient-centred care and clinical outcomes.

For referrals to Elysium St Neots Neurological Centre or other Elysium centres visit: www.elysiumhealthcare.co.uk/neurological

Reference source: https://www.nursingtimes.net/news/ professional-regulation/nmc-highlights-importance-of-nurses- reflection-on-practice-18-06-2019/

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Robots and resilience at Askham Rehab

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NR Times reports on a new rehabilitation approach taking place in Cambridgeshire.

Despite a year of relentless change and upheaval for all involved in neuro-rehab, one provider in Cambridgeshire has been able to keep its ongoing development on track.

Askham Rehab, part of the Askham Village Community, is a recently-launched specialist rehabilitation service incorporating the latest in rehab robotics and sensor assisted technology.

While the firm has invested in state-of-the-art technology to do the heavy lifting, however, its rehab services remain person-centred, as director Aliyyah-Begum Nasser explains.

“We’re a specialist rehab centre in essence, and so, although the robotic technology helps us to get the most out of our patients and staff, we are very much family-focused.

The equipment is obviously fantastic but we know from experience that a person’s mindset, and their ability to sustain whatever improvements they make, comes down to the people who are supporting them – their family members.

“We’ve been on some real journeys with many of our family members who just didn’t understand the impact of a brain injury in terms of how it can impact behaviour or what it can do for cognition.

“Once they understand that, suddenly they become a lot more compassionate, and a lot more supportive; they become part of the recovery process, rather than being a frustrated observer.”

With recognition of the family’s paramount importance to recovery, Askham Rehab does everything within its power to harness this force – including by enabling families to stay together in specially-designed apartments on site.

Aliyyah-Begum says: “The flats are fully adapted, with cantilever cupboards, height-adjustable sinks in the bathroom and full wet room with turning spaces.

“We have the patients themselves participating in rehab, specifically to their programme, but relatives are also there from the beginning, seeing the improvement and being part of our process from the outset.

“We think of the centre as more of a rehab environment; it’s not a just care home with therapy as an added extra.

“So from the minute our patients wake up to the minute they go to bed, everything is based around their recovery goals, and everyone is working together towards achieving them.”

And robotics are an important tool in pursuing these goals through patient exercise. They help therapists to achieve the repetitions and intensity needed to progress their clients, as Aliyyah-Begum explains.

“The point of the robotics is that they respond to the patient. For example, if you set the machine on a left lower limb, but it senses that there is more pressure being exerted through the right limb than the left, it will automatically respond to make sure the patient is moving the correct part of their body.”

The centre’s head of rehab and nursing, Priscilla Masvipurwa, says: “This is a real a game changer in our approach to rehabilitation.

“Robotics help to bridge the gap, increasing the frequency and repetitiveness of treatment, something that’s an essential part of the process.

“We anticipate that this will enable us to support our patients in reaching their goals in a more efficient and sustainable way.

“The centre has so far invested in four items from robotic rehabilitation firm Tyromotion, but is looking to add more over time, as the benefit to both staff and patients becomes ever more evident.

Aliyyah-Begum says: “It’s really important to the team at the centre that the robotics aren’t just seen as an add on.

“There is a lot of nervousness about robots replacing therapists, but our service is still very much therapy-led.

“What this means in practice is that, where a resident would previously have had maybe an hour of therapy time in an afternoon, now you have an hour of therapy time, and then you can carry on exercising if you want to, or carry on playing games with other residents.

“For example, one of our machines, the Myro, enables patients to play games like bat and ball, or perform virtual tasks like sweeping leaves.

“However, because it is all sensor-assisted, if it senses that the patient needs to work a certain hand, it will alter what it is asking them to do accordingly, while they won’t even necessarily feel they’re having therapy – it’s all part of the game, and part of their socialising with other residents.”

Askham Rehab forms part of the Askham Village Community, on the edge of Doddington village, in Cambridgeshire.

It provides specialist care for people of all ages, offering day visits, respite care and continuing long-term support, both on-site or at home.

The site consists of five homes, three of which are specialist neurological facilities. In total, the neuro-rehab team can look after up to 52 patients at any one time, with 120 staff made up of rehab professionals and specialists.

The team comprises carers nurses, physiotherapists, occupational therapists, speech and language therapists and psychologists.

Aliyyah- Begum believes that the introduction of the robotic rehab services, combined with the patient-led therapy the group has been offering for 30 years, can only enhance the centre’s outcomes.

She adds: “We know that there is an increasing number of care homes that offer specialist therapy, but the difference with Askham Rehab is that we have embedded it into the whole culture of our setting – and the outcomes really speak for themselves.

“We often discharge people earlier than planned, and that’s a testament to the fact that the patients are really working hard with the team throughout their stay with us to achieve their goals – and that is the key.”

For more information about Askham Rehab, visit www.askhamrehab.com

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Astrocytes identified as master ‘conductors’ of the brain

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In the orchestra of the brain, the firing of each neuron is controlled by two notes – excitatory and inhibitory – that come from two distinct forms of a cellular structure called synapses.

Synapses are essentially the connections between neurons, transmitting information from one cell to the other. The synaptic harmonies come together to create the most exquisite music–at least most of the time.

When the music becomes discordant and a person is diagnosed with a brain disease, scientists typically look to the synapses between neurons to determine what went wrong. But a new study from Duke University neuroscientists suggests that it would be more useful to look at the white-gloved conductor of the orchestra – the astrocyte.

Astrocytes are star-shaped cells that form the glue-like framework of the brain. They are one kind of cell called glia, which is Greek for “glue.” Previously found to be involved in controlling excitatory synapses, a team of Duke scientists also found that astrocytes are involved in regulating inhibitory synapses by binding to neurons through an adhesion molecule called NrCAM. The astrocytes reach out thin, fine tentacles to the inhibitory synapse, and when they touch, the adhesion is formed by NrCAM. Their findings were published in Nature on November 11.

“We really discovered that the astrocytes are the conductors that orchestrate the notes that make up the music of the brain,” said Scott Soderling, PhD, chair of the Department of Cell Biology in the School of Medicine and senior author on the paper.

Excitatory synapses — the brain’s accelerator — and inhibitory synapses — the brain’s brakes — were previously thought to be the most important instruments in the brain. Too much excitation can lead to epilepsy, too much inhibition can lead to schizophrenia, and an imbalance either way can lead to autism.

However, this study shows that astrocytes are running the show in overall brain function, and could be important targets for brain therapies, said co-senior author Cagla Eroglu, PhD, associate professor of cell biology and neurobiology in the School of Medicine. Eroglu is a world expert in astrocytes and her lab discovered how astrocytes send their tentacles and connect to synapses in 2017.

“A lot of the time, studies that investigate molecular aspects of brain development and disease study gene function or molecular function in neurons, or they only consider neurons to be the primary cells that are affected,” said Eroglu. “However, here we were able to show that by simply changing the interaction between astrocytes and neurons — specifically by manipulating the astrocytes — we were able to dramatically alter the wiring of the neurons as well.”

Soderling and Eroglu collaborate often scientifically, and they hashed out the plan for the project over coffee and pastries. The plan was to apply a proteomic method developed in Soderling’s lab that was further developed by his postdoctoral associate Tetsuya Takano, who is the paper’s lead author.

Takano designed a new method that allowed scientists to use a virus to insert an enzyme into the brain of a mouse that labeled the proteins connecting astrocytes and neurons. Once tagged with this label, the scientists could pluck the tagged proteins from the brain tissue and use Duke’s mass spectrometry facility to identify the adhesion molecule NrCAM.

Then, Takano teamed up with Katie Baldwin, a postdoctoral associate in Eroglu’s lab, to run assays to determine how the adhesion molecule NrCAM plays a role in the connection between astrocyte and inhibitory synapses. Together the labs discovered NrCAM was a missing link that controlled how astrocytes influence inhibitory synapses, demonstrating they influence all of the ‘notes’ of the brain.

“We were very lucky that we had really cooperative team members,” said Eroglu. “They worked very hard and they were open to crazy ideas. I would call this a crazy idea.”

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