It is impossible to fully reverse stroke damage, current research shows the brain is capable of relearning even years after a stroke through Neuroplasticity.

Tips for Unlocking Neuroplasticity After Stroke Part 1

Almost 800,000 people suffer from a stroke in the United States each year,
making it the primary cause of disability among adults 1
[http://www.strokecenter.org/] Strokes often cause damage to areas of the brain
resulting in loss of movement, sensation or language skills. Although it is
impossible to fully reverse the damage, current research has shown that the
brain is capable of relearning lost skills even years after a stroke through a
process called Neuroplasticity.

The word Neuroplasticity is a fancy way of saying that the brain (neuro) can
change (plasticity). After a stroke, neuroplasticity can help the brain to work
around the damaged areas in order to regenerate, re-establish, and rearrange the
neural connections related to function.

With a little work and a lot of commitment, the amazing power of Neuroplasticity
can be activated at any time, even years after a stroke. In this series of blog
posts we will look at 10 tips for unlocking the power of retraining the brain
and body and neuroplasticity after stroke
[https://blog.neofect.com/tag/neuroplasticity/]. Check out the five tips below.
Make sure to check back in for tips 6-10 in the next installment!

1. Use it or Lose it
You may have heard the expression “use it or lose it”, meaning that if we don’t
use a muscle for a long time, it can atrophy (waste away). This principle
applies to the brain as well. When a stroke affects an area of the brain
controlling one arm many people compensate by relying on the unaffected or
“good” side for most tasks. This compensatory reliance on the unaffected hand
can lead to “learned non-use” of the affected side. The longer this disuse goes
on, the harder it can be for the brain to regain control of the affected arm.

Preventing learned non use involves working to incorporate the affected side
into your life as much as possible and as often as possible.

2. Use it and Improve it
The magic of neuroplasticity
[https://blog.neofect.com/5-ways-brain-games-for-stroke-rehabilitation-increase-brain-health/] 
is that the brain can remap itself. If an area controlling movement is damaged
it is possible for a neighboring area to rewire itself to control the movement
that was lost. This remapping won’t happen spontaneously, however. You have to
use it to improve it! The brain is made up of axons that send electrical signals
to each other to communicate. Every thought and action involves communication
between axons. When we repeat a movement or thought, axons from previously
unconnected areas of the brain can link up, creating a new network. This
connection formation principle is explained best with the phrase “what fires
together, wires together”, coined by neuropsychologist Donald Hebb in the 1940s.

3. Repetition Matters
Repetitive practice of desired movement patterns helps the brain become stronger
by rewiring and reinforcing newly formed neural pathways. But how much practice
is enough? Studies in humans and animals have shown that hundreds of repetitions
are required per day to elicit change(2). This much repetition can seem
daunting, but with the help of technology such as rehab based apps and stroke
rehab devices like the Neofect Smart Glove
[https://www.neofect.com/us/smart-glove] you will be surprised how easily you
can fit repetitive movement exercise into your daily routine.



4. Intensity Matters
Anyone that has learned to play the piano can tell you that you have to practice
every day to get better. The same is true of making changes in the brain after a
stroke. No matter how many repetitions you do in one sitting it takes more than
one day of practice to change your brain. So how quickly could you see progress?
Large studies of patients who were weeks to years past their stroke have
reported long-lasting functional improvements after completing 2–12 weeks of
intensive repetitive skilled motor practice programming (3).

5. Focus Matters
Think about learning a new route to work. Initially you will need to pay close
attention and use directions to get to where you are going. After repeating the
route daily it will become habitual and you may be able to complete the drive
without too much active thought. The same is true for relearning to use your
body after a stroke. In the beginning you will need to pay close attention to
your movements and use directions given by therapists. Once you have unlocked
neuroplastic change in your brain through practice and intensity you may be able
to complete activities with much less thought.

Here at NEOFECT [https://www.neofect.com/en/], we're committed to supporting you
in your stroke rehab [https://www.neofect.com/us/smart-glove] journey. If you
have had a stroke and are looking for an effective solution for your
rehabilitation needs, please look into NEOFECT's line of Smart Rehabilitation
Solutions.

To learn more, please call (866) 534-4989 or email contactus@neofect.com.

Nudo RJ, et al. Neural substrates for the effects of rehabilitative training on
motor recovery after ischemic infarct. Science, 1996;272(5269):1971-94.

Kimberley TJ, et al. Comparison of amounts and types of practice during
rehabilitation for traumatic brain injury and stroke. J. Rehabil Res Dev. 2010;
47(9):851-62. Rehabil Res Dev. 2010; 47(9):851-62.

Dobkin, Bruce H, et al. “New evidence for therapies in stroke rehabilitation.”
Current atherosclerosis reports vol. 15,6 (2013): 331.
doi:10.1007/s11883-013-0331-y

Lo AC, Guarino et al. Robot-assisted therapy for long-term upper-limb impairment
after stroke. N Engl J Med. 2010;362(19):1772–1783. [PMC free article] [PubMed]
[Google Scholar] *

Taub E., Uswatte G., Mark V. W., Morris D. M. (2006). The learned nonuse
phenomenon: implications for rehabilitation. Eura. Medicophys. 42, 241–256
[PubMed] [Google Scholar]

Sousa et al. (2018) Interventions involving repetitive practice improve strength
after stroke: a systematic review. Journal of Physiotherapy. 64, 4. [Science
Direct]

For more information on Neuroplasticity:
Brainworks - What is Neuroplasticity
[https://brainworksneurotherapy.com/what-neuroplasticity]
ScienceDirect - Neuroplasticity
[https://www.sciencedirect.com/topics/neuroscience/neuroplasticity]
Stroke-Rehab - Neuroplasticity
[https://www.stroke-rehab.com/neuroplasticity.html]

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.

Neuroplasticity

Learn about why a biofeedback device might be a better option than a robotic hand for rehabilitation after a stroke from a therapist's perspective.

Is Biofeedback or a Robotic Hand Better for Rehabilitation After Stroke

A Therapist's Perspective - Learn if Biofeedback or a Robotic Hand is better for rehabilitation after stroke.

WHAT HAPPENS TO THE BRAIN DURING A STROKE

A stroke is caused by either a blockage of a blood vessel or bleeding in or
around the brain, which results in a lack of oxygen to the brain and the death
of brain cells. The residual physical effects of the loss of brain cells will
depend on the area of the brain that was affected.

One of the functions of the brain is sending messages to our muscles to move in
a coordinated way to complete functional activities. More than half of stroke
survivors experience a lasting hemiparesis
[https://www.neofect.com/us/blog/hemiplegia-vs-hemiparesis] due to the damage to
the brain. [1] [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5688261/#B125] 
Hemiparesis is weakness on one side of the body, and depending on what brain
cells died will determine which pathways to specific muscles will be affected.
Stroke is the leading cause of long term disability in the United States. [2]
[https://www.ahajournals.org/doi/pdf/10.1161/CIR.0000000000000659]

HAND FUNCTION AND ROBOTICS


We often don’t appreciate the complexity of what the arm and hand are able to
do. It’s incredibly complicated. There are 20 joints in the hand alone, and the
joints of the arm are able to move in over 40 different directions. Add in the
degrees of freedom of each joint, the coordination required to grade movement,
the alignment of joints, and exertion of force and you’ve got a very complex
physical system you’re trying to repair after a stroke. That doesn’t even take
into account all the other requirements of a task, such as your visual
perception, your sensation, and your understanding of where your body is in
space. Spasticity
[https://www.neofect.com/us/blog/how-to-improve-spasticity-spinal-cord-injury] 
also develops in stroke, which makes movement of the joint even more difficult.

Robotics used in rehabilitation has made a lot of progress in the last 10 years,
primarily with devices to assist with walking. Upper extremity robotics in
stroke range from full assistance with movement to tracking active movement.
While they are both important, there seems to be a disconnect between designers
and clinicians in the purpose of the device.

Of course it would be awesome if you could put on a robotic glove and suddenly
you would be able to do all the things you were able to do before a stroke, but
it just doesn’t work like that. Even if they were to develop an exoskeleton that
could capture the motor movement parameters of the arm, it wouldn’t be able to
feel and capture the proprioceptive and visual feedback that the neurologically
intact arm provides.

But the brain is an amazing thing! Even though we can’t repair the damage to the
brain, the brain has the capacity to rewire itself. This is called 
neuroplasticity
[https://www.neofect.com/us/blog/using-brain-plasticity-to-supercharge-your-brain]
.

WHAT WE KNOW ABOUT REHABILITATION IN STROKE


There are several evidence-based rehabilitation strategies in stroke that tap
into neuroplasticity including repetitive task practice, constraint-induced and
modified constraint-induced movement therapy, virtual reality, mirror therapy
[https://www.neofect.com/us/blog/stroke-exercises-using-mirror-therapy-and-mirror-neurons]
, and strengthening and exercise. [3]
[https://www.ncbi.nlm.nih.gov/pubmed/25553742] Many of the techniques overlap in
their concepts, and while research is still determining the specifics of which
components of these interventions makes the biggest difference in hand use and
function, it’s clear that you have to put the work in to make neurological
changes.

The commonality for all of the above interventions is frequent repetitions of
movement. We don’t know the magic number of repetitions, but it has to be enough
to create a signal from the brain to the muscle. Imagine you’re trying to build
a road from point A to point B through a pile of dirt with just a truck. The
first time you drive the truck over it’s going to be slow and kind of a bumpy
ride, but then you do it again and again. Each time your truck goes over the
path, it creates a smoother road and gets easier. This is how you train your
brain to send messages to the muscles. Your brain sends a signal to the muscle
to move. The more you do it, the easier it gets. It can be a foreign feeling to
try to isolate a muscle movement because for everyday tasks we use a combination
of muscles and joints to complete the requirements of the task. Creating those
neural pathways to the muscles is the first step of being able to use the
muscles of arm together.

You could sit there and move your hand and arm 200 times everyday for each
motion, but in practical application of rehab this just doesn’t happen. We also
know that initiating movement for a purpose is more likely to develop
neuroplasticity than straight repetitions alone. [3]
[https://www.ncbi.nlm.nih.gov/pubmed/25553742]

The Neofect Smart Glove [https://www.neofect.com/us/smart-glove] is a 
biofeedback
[https://www.neofect.com/us/blog/how-can-biofeedback-jumpstart-your-stroke-rehab-program] 
device that targets movements that are typically impaired for people with
stroke.





It’s training your brain to create those pathways to your muscles, and it does
it in a way that’s motivating and tracks your progress. A typical session will
have you complete 200-300 repetitions. It doesn’t move your hand for you, you
have to do the work. If you have visible movement of your wrist, forearm, and/or
fingers, there is a message that’s trying to get from the brain to the muscle.
The algorithm can create that “just right challenge” to push you just a little
further to really dig into making that path. A robotic hand that moves for you
and doesn’t make you work for it, isn’t sending the truck down the road.

CONTINUING THE REHABILITATION JOURNEY


Repetitive movements are only one piece of the puzzle when it comes to stroke
rehabilitation. Your brain can create pathways to the muscles, but all
functional activities require a variety of muscles and joint movements. You also
have to practice the functional task you want to achieve over and over again
until your brain can learn to do it without thinking about it. It’s not just
about improving your movement, it’s about being able to do the things that give
you quality of life. You don’t have to have full range of motion of each joint
and muscle to be able to do your favorite things, there are a lot of different
ways to accomplish a task.

Depression and a decrease in social activity are common in people with stroke
and impact their quality of life [4]
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3018998/]. Discover the activities
that make you happy and give you life. As we age we all have to re-evaluate
what’s important to us and grieve the things that are harder than they used to
be. But that doesn’t mean we can’t find new versions and new things that make us
happy. Regardless of the function of your hand, you can live a beautiful,
fulfilling life.

Here at Neofect [https://www.neofect.com/us/], we're committed to supporting you
in your rehabilitation journey. If you have had a stroke and are looking for an
effective solution for your rehabilitation needs, please look into NEOFECT's
line of Smart Rehabilitation Solutions [https://www.neofect.com/en/pt-solution/]
.

To learn more, please call (866) 534-4989 or email contactus@neofect.com.

References

 1. Yue Z, Zhang X, Wang J. (2017) Hand Rehabilitation Robotics on Poststroke
    Motor Recovery [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5688261/#B125].
    Behavioral Neurology
 2. Benjamin, E. J. et al. (2019) Heart Disease and Stroke Statistics—2019
    Update: A Report From the American Heart Association
    [https://www.ahajournals.org/doi/pdf/10.1161/CIR.0000000000000659].
    Circulation
 3. Nilsen, D. M., Gillen, G., Geller, D., Hreha, K., Osei, E., & Saleem, G. T.
    (2015). Effectiveness of interventions to improve occupational performance
    of people with motor impairments after stroke: An evidence-based review
    [https://www.ncbi.nlm.nih.gov/pubmed/25553742]. The American Journal of
    Occupational Therapy, 69(1), 1-5A.
 4. Opara, J. A., & Jaracz, K. (2010). Quality of life of post-stroke patients
    and their caregivers.
    [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3018998/] Journal of medicine
    and life, 3(3), 216–220.

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
[https://www.neofect.com/us/] is solely at your own risk.

Robotic Hand

Is Biofeedback or a Robotic Hand Better for Rehabilitation After Stroke: a Therapist's Perspective

A Therapist's Perspective - Learn if Biofeedback or a Robotic Hand is better for Rehabilitation After Stroke