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 (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 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, 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 firstname.lastname@example.org. Here at Neofect, we are here to support you on this journey.
Nudo RJ. Adaptive plasticity in motor cortex: Implications for rehabilitation after brain injury. Journal of Rehabilitation Medicine, 2003; 41: 7-10.
De Sousa DG, et al. Interventions involving repetitive practice improve strength after stroke: a systematic review. Journal of Physiotherapy, 2018; 64(4): 210-221.
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.
Duncan P, et al. Randomized clinical trial of therapeutic exercise in subacute stroke. Stroke, 2003; 34: 2173-2180.
Dobkin, BH, and Dorsch, A. New Evidence for therapies in stroke rehabilitation. Current Atherosclerosis Reports, 2013; 15 (6): 331.
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.
- Natalie Miller, OTR/LNatalie is an occupational therapist and health writer based out of Richmond, VA. Natalie recently pivoted into the pediatric setting after spending eleven years working in adult neurorehabilitation.