Disrupting the Habit
What is your habit? Maybe reaching for a cup of coffee in the morning, putting on a seatbelt when you get in a car or dropping your keys in a specific spot when you enter your home. We all have them and are capable of forming and breaking them too.
In the field of psychology, a habit is defined as an action that is triggered automatically responding to cues associated with their performance. Research supports that the repetition of a simple action in a consistent context leads to habit formation. They are also formed with a chemical reaction in the brain. A study published in a 2016 issue of Neuron and led by Christina Gremel of the University of San Diego, provides evidence that the neurochemical called endocannabinoids allow for habits to ‘take over’ in the orbitofrontal cortex of the brain, the decision-making area. Within the brain circuits, habits and goal-direct actions compete for control. The prominence of habits becomes cognitively efficient in the human brain. Basically, because we don’t have to ‘think’ about actions.
Upon arriving at home after the second surgery, I experienced this competition between habit and goal-directed action first hand. Sure, after this surgery, the restrictions for my upper body were relieved but the restrictions for my legs were imposed. This time I had one less incision; the first surgery left seven incisions while the second resulted in six. The healing process was very different. This was not based on anything external but what was implanted internally.
In the first surgery, we removed and replaced the IST-16. The seven resulting incisions where mainly connection points to the electrode lead wires. If the IST-16 moved slightly while the body was healing around the device, it should not alter the performance of the implanted receiver. Contrary to the first, the second surgery involved implanting cuff electrodes. These are small silicon spiral electrodes that are wrapped around a nerve and are strategically placed in the ideal spot in the body. During surgery, they dissected the nerve, installed the electrode and tested the performance before placing it into it’s new home. The cuff electrodes are designed to wrap twice around the nerve without sutures to stay at the “sweet spot” but they will unracel and come off the nerve if the lead wire gets pulled or tugged. If that electrode moves even a millimeter, the performance of the muscle contraction related to that electrode can change. The process of the body healing around the electrode by building tissue around a foreign object becomes critical. The process is otherwise referred to as the encapsulation process. With four new electrodes around my nerves and six new incisions on my skin, the healing process will dictate the functional results later.
Still, any actions I take can impact this process. This leads me to the breaking of old habits. When I was first injured, transferring to and from the wheelchair was a new skill to me. I had real difficulty moving my legs during the maneuver, particularly if I had to lift them. Keep in mind that your legs typically weigh about 20% of your total body weight. At the time, my mom made these velcro straps that I would put around my thigh with a loop that I could use to lift my legs during transfers. As time goes by the process became easier and I developed the habit of grabbing my legs under my knees during a wheelchair transfer. In other words, I hook my wrist under my knee and move my leg into place. This simple maneuver eventually became habit, an automatic action within a context of cues.
But that action had to change post surgery. After this surgery, each leg had an incision that is a couple of inches long at the back of the knee, almost looking like a knee replacement in reverse. The habit of transfers now had to change, immediately. If I grabbed under my knee during a transfer, it could potentially disturb the stitches in my skin and the cuff electrode around the nerve underneath it that controls the gastrocnemius muscle. My first night back at the hotel room, I had to think of every move in and out of the wheelchair. My first transfer took some time while trying to figure out another way to move my legs that weigh in at 25 pounds. I longed for those velcro straps from days gone by but finally settled on using knee-high socks to move my legs instead.
The sight was a little ridiculous on my flights home with pant legs rolled up, tall socks and showing off a few bandages. Each transfer was a thoughtful movement. The hard part is breaking the habit at home. Transfers in the early morning or when I’m running late are when the habitual behavior kicks in. The habits formed over the years had to be changed. As a long-time wheelchair user, transfers in and out of the chair become habitual. Particularly the ones that you do every day such as in and out of bed, to and from the car seat and so on. For now, each move has to be a goal-directed action rather than an unconscious response. In a few weeks, I’ll be back to my old habits.
Note: The statements and views posted here are of my own and do not reflect those of Case Western Reserve University, the Department of Veteran Affairs, Metro Health Medical Center or the National Institutes of Health along with their representives involved with this program. If you are interested in this clinical trial, please visit https://clinicaltrials.gov and search NCT00623389 or NCT01923662.
Reference: “Making health habitual: the psychology of ‘habit-formation’ and general practice.” Br J Gen Pract. 2012 Dec; 62(605): 664–666. PMCID: PMC3505409
