Stroke survivors face a unique and difficult challenge: repairing and remodeling their bodies, minds, and lives. The process can often seem like mapping out a brand new course through totally uncharted waters.

Why Are Repetitive Motions Important After a Stroke?

In the beginning

Stroke survivors face a unique and difficult challenge: repairing and remodeling
their bodies, minds, and lives. The process can often seem like mapping out a
brand new course through totally uncharted waters. Survivors are charged with
figuring out how to do basic tasks like getting dressed, brushing teeth, and
using the restroom, while also focusing on standing up straight and not falling.
Often, all of these things must be done while using only one hand, because the
affected arm becomes weak and hard to control. Activities that once came
naturally and were programmed into habits are suddenly very challenging and
frustrating. The affected arm can become such a frustration that survivors may
start to only use their stronger arm to get things accomplished, even if that is
not normally their dominant arm.

There is good news, though!

Research has taught us a lot about how amazing our brains truly are. Now we know
that when we go through a neurological event (such as a stroke), we actually
have the ability to regrow and work around many of the connections in our brain.
We can actually repair and remodel our brains and bodies. We can remap our
brains to help us to function again. Another word for this is neuroplasticity
[https://www.neofect.com/us/blog/tips-for-unlocking-neuroplasticity-after-stroke-part-1] 
(1).



What does this mean for stroke recovery?

When a person suffers a stroke, he may notice that certain body parts are no
longer functioning correctly. Often the arm and leg on one side of the body
become weak or paralyzed. This is because the motor control center of the brain
has become “injured,” and with this injury, it now has difficulty sending out
strong signals to the arm and leg to tell them how to move. Essentially, the
brain needs help to get reorganized and get back to work controlling the rest of
the body.

When we talk about repairing and reorganizing our brains after a stroke, there
are two huge players in the game: time
[https://www.neofect.com/us/blog/how-to-quickly-recover-after-stroke] and brain
activity. Though we can’t control the time variable (exactly how long the
recovery process will take for each individual), we can definitely play a large
hand in the brain activity variable. The sooner we do this following a stroke,
the better, BUT, changes can still continue to take place months and even years
later. In fact, we now know that progressive motor practice is essential for
gains at any point after stroke onset (5). This is where high repetition comes
into play: our brains have an area where motor control, learning, and shaping
happens, and research shows that the more intensely and often we practice, the
more this part of the brain recovers, and the better we can get! (1). Tasks that
encourage repetitive practice using the arm can actually improve both strength
and activity (2).



What needs to happen next?

If the person is able to provide opportunities for the arm and leg to try to
move again, it is possible to reconnect some signals and also to form new
connections all around the injury to help the brain regain control. The key to
this is massed practice, or many, many, many repetitions. The more times the
body tries to move the arm or leg, the more opportunity for neuroplasticity. It
is noted that high numbers of repetitions are required to make an impactful and
lasting change in the brain (6). In other words, repeating a motion over and
over helps with learning and remembering that motion, because the signals from
our body parts become more connected to the brain.

Another important reason to repeatedly attempt to use the affected limb is to
prevent “learned nonuse.” When a person tends to use the stronger limb more
often because it’s easier and more efficient, the weaker limb starts to “forget”
what it is supposed to do, thereby becoming even weaker and less functional. In
fact, focusing on using only the non-affected side can actually hinder the brain
from recovering connections with the weak side (3). Instead, using the weaker
arm or leg many, many times can promote awareness of the limb, increased
strength, and overall functional use in the same ways - fixing old and making
new connections to the brain.



It has been shown that “high repetition” is most successful when hundreds of
repetitions of a particular movement happen during the day (6). Motor rehab
after a stroke helps promote reorganization of important areas of the brain that
control movements. Completing exercises set by your Occupational or Physical
Therapist help strengthen and retrain how your muscles work together to create
functional movements. Some types of activities and tools you may see during
therapy include Constraint Induced Movement Therapy (CIMT), Mirror Therapy,
neuromuscular electrical stimulation or Bioness, and massed task practice. All
of these have a component of high repetition to drive more significant change in
the brain and body. Engaging your affected arm in regular, routine
[https://www.neofect.com/us/blog/importance-of-setting-up-post-stroke-routine],
functional tasks is also very helpful -- the more that arm gets the opportunity
to do what it is meant to do, the greater the chance it has to recover.

Recovery Mode: ON!

It can certainly be challenging to carry over such a demanding high repetition
exercise program at home. It may be hard to find time in an already busy
schedule, or it may be hard to find motivation when your therapist is no longer
present to cheer you on. One of the best things you or your loved one can try to
do is to figure out what types of activities and strategies are the most
motivating and engaging, because that will help to stick to the plan and see
real results. In fact, the brain needs to be motivated, engaged in learning, and
paying good attention to the task in order to make real change happen (5).



Use of the NEOFECT Smart Glove and/or Smart Board can be added to your
repertoire to help keep you motivated and excited to work on these repetitions -
when you’re having fun, seeing visual responses to the movements you make, and
tracking your own progress, you may be more likely to stick with it, and enjoy
the process! While you are searching for more options for you or your loved one
to add to your stroke recovery toolkit, don’t forget to check out NEOFECT Home
Rehab Solutions, clinically proven to improve hand and arm function at home. To
learn more, call 888-623-8947 or email info@neofect.com. Here at Neofect, we are
here to support you on this journey.

References

 1. Nudo RJ. Adaptive plasticity in motor cortex: Implications for
    rehabilitation after brain injury. Journal of Rehabilitation Medicine, 2003;
    41: 7-10.
    
    
 2. De Sousa DG, et al. Interventions involving repetitive practice improve
    strength after stroke: a systematic review. Journal of Physiotherapy, 2018;
    64(4): 210-221.
    
    
 3. Allred, RP, et al. Use it and/or lose it -- Experience effects on brain
    remodeling across time after stroke. Frontiers in Human Neuroscience, 2014;
    8: Article ID 379.
    
    
 4. Duncan P, et al. Randomized clinical trial of therapeutic exercise in
    subacute stroke. Stroke, 2003; 34: 2173-2180.
    
    
 5. Dobkin, BH, and Dorsch, A. New Evidence for therapies in stroke
    rehabilitation. Current Atherosclerosis Reports, 2013; 15 (6): 331.
    
    
 6. Kimberley, TJ, et al. Comparison of amounts and types of practice during
    rehabilitation for traumatic brain injury and stroke. Journal of
    Rehabilitation Research and Development, 2010; 47 (9): 851-862.
    
    

All content provided on this blog is for informational purposes only and is not
intended to be a substitute for professional medical advice, diagnosis, or
treatment. Always seek the advice of your physician or other qualified health
provider with any questions you may have regarding a medical condition. If you
think you may have a medical emergency, call your doctor or 911 immediately.
Reliance on any information provided by the NEOFECT website is solely at your
own risk.

Stroke Recovery

Cerebral palsy is defined as non-progressive lesions or damages in the brain at or before birth, leading to impairments in movement and posture.

Movement and Strength of Children with Cerebral Palsy

Movement and Strength of Children with Cerebral Palsy
Cerebral palsy is defined as non-progressive lesions or damage in the brain at
or before birth, leading to impairments in movement and posture.

These impairments vary from person to person, but the majority of children with
cerebral palsy experience differences in muscle strength which can lead to many
functional challenges throughout their lives.





As discussed in the article above, strength training in children with cerebral
palsy has been shown to be beneficial particularly in improving their motor
activity. It can be confusing for caregivers to objectively determine what type
and frequency of strength training activity would be helpful. Evaluations such
as the Pediatric Functional Muscle Test can be useful for clinicians and
therapists for in-the-moment information, but provides limited information and
applications for continued training.

It is important to know the basic principles of strength training with children
with cerebral palsy before starting any program.



Strength training for children with cerebral palsy
 1. Repetition!
    Children with cerebral palsy often have difficulty activating certain muscle
    groups. In order to effectively strengthen these muscle groups, training
    should focus on repetition of postures or activities that encourage movement
    in these areas.
    
    
 2. Find the right tools!
    In order for a training program to be effective the child needs to be able
    to understand and engage in the instructed movements.
    
    
 3. Positioning!
    Engaging in the activity with good posture will enhance the effectiveness of
    the training
    
    
 4. Adaptation!
    Make sure the training activity is an appropriate amount of challenge for
    the child's abilities. Remove too-complex elements or add challenge to
    too-easy elements to ensure they stay motivated.
    
    
 5. Engagement!
    Training that is relevant to the child's interests will have better
    long-term effects. Ensure they have a say in their program, either catering
    a routine to include relevant personal touches or letting the child pick the
    day's activity are surefire strategies.
    
    





Goals of strength training for CP
Not only can strength training activities for children with cerebral palsy
strengthen muscle groups, these effects can translate into improved function in
daily life. Stronger and more coordinated muscles may lend to greater
independence in self-care skills and feelings of capability and self-confidence.

The benefits of strengthening for pediatric CP are clear. Look to your
rehabilitation team for additional tips to get started on an effective exercise
program.



Dodd KJ, Taylor NF, Damiano DL. A systematic review of the effectiveness of
strength-training programs for people with cerebral palsy. Arch Phys Med
Rehabil. 2002;83(8):1157-1164. doi:10.1053/apmr.2002.34286

Cerebral Palsy Rehab

Consider functional things that you can do with your affected side. Get out of the habit of moving your affected side with your "good" or non-affected side.

4 Tips for Combating Hemiplegia Using the Power of the Brain

With repetition as one of the main keys to improving movement, it’s important to 
consider creative ways to incorporate repetition into your daily rehabilitation
routine. Using virtual reality rehab devices such as the Neofect Smart Glove
[https://www.neofect.com/us/smart-glove] and Neofect Smart Board
[https://www.neofect.com/us/smart-board] can increase repetition 10x (250-300
repetitions) in the same amount of time as an outpatient therapy session (32
repetitions).



Here are four other ways that you can work on incorporating more repetition into
your daily rehabilitation routine:
 1. Consider functional things that you can do with your affected side. Even if
    it seems insignificant, something like using your affected side to turn on
    and off a light switch or open the fridge every time you do it, reinforces
    voluntary repetition. This idea of “forced-use” helps to reorganize the
    brain and recreate pathways to improve motor control. Additional repetition
    of functional movement can be added to your routine at home by using the
    Neofect Smart Glove or Smart Board. Virtual reality solutions like the 
    Neofect Smart Rehab devices [https://www.neofect.com/us] can encourage 10x
    more repetitions than traditional therapy sessions alone.
    
    
 2. Get out of the habit of moving your affected side with your “good” or
    non-affected side. For repositioning needs, try to move the side affected by
    the stroke on its own first before jumping in to “help”. It’s really easy to
    fall into “learned non-use” where your brain starts to forget about your
    affected side based on avoiding it as part of your daily routine. Force it
    to do as much active work as you can on a daily basis.
    
    



 3. Visualization has been proven to be an effective technique for motor
    improvement, even if you don’t have the functional movement to do the task
    itself. Visualization has long been used by high level athletes as a tactic
    for working toward maximizing their performance. For individuals that have
    had strokes, visualization of a particular activity such as raising the arm
    or leg, sends blood flow to the area of the brain responsible for that
    motion, activating that area.
    
    
 4. Mirror box therapy can also be effective in using the mirror neurons of the
    brain to trick the brain into thinking that the affected side is moving in a
    normal manner. In a review of studies on mirror therapy compared to other
    interventions, mirror therapy was shown to have a significant effect on
    motor function as well as pain and visual neglect.
    
    


*Neofect Home Inquiry:
-www.neofect.com [https://www.neofect.com/us]
-Phone: (888) 623-8984 [tel:+18886238984]

Lang, Catherine E et al. “Observation of amounts of movement practice provided
during stroke rehabilitation.” Archives of physical medicine and rehabilitation
vol. 90,10 (2009): 1692-8. doi:10.1016/j.apmr.2009.04.005