Monday, May 10, 2010


I get so many questions about stroke recovery from survivors and caregivers and therapists. Many of the questions are sad. Survivors and their loved-ones often contact me when they don't have any resources providing direction towards further recovery.

I could probably write a book of questions and answers I get.

Instead, I wrote an article.



Dean said...

Peter, thanks for your postings on this subject. My latest Qs are:
Do connections from the sensory cortex cross the central sulcus to the motor cortex to make their way to the sensory nerve endings? This is because my MRI scan shows no damage to the sensory cortex but my sensations are not that good. And my two favorite questions that i have posted on numerous forums. Can neurons handle two separate tasks? Can the spot for toe control also handle finger control?

If not then how is it decided which parts of brain function are thrown away to neuroplastically recover the dead areas? If I lost toe movement to my hand that would be ok but I don't want to lose cognitive ability. This makes the assumption that 100% of my brain is in use. Though an alluring idea, the "10 percent myth" is so wrong it is almost laughable, says neurologist Barry Gordon at Johns Hopkins School of Medicine in Baltimore.
I think way too much about stroke recovery. My questions are endless so these are just the latest. I did like the latest research on bat saliva, it can join rat poison in our arsenal.

Dean said...

One more. Didn't realize bat saliva was that long ago.
Can any scan tell the penumbra of the stroke? This is to determine which therapies might be applicable when they require some movement in order to participate. I like the Catch-22 part of this. You don't have enough movement to use this therapy but aren't given help in getting to that minimal movement. I already know about passive therapy, imagery, thermal stimulation.

Peter G Levine said...


They do cross the central sulcus and here's the weird part: if the sensory cortex dedicated to movement grows, the motor area grows as well—and visa versa. That's not to say the two always communicate directly. Impulses tend to get bounced around in the brain, so many areas are engaged. But, yeah, the sensory and motor communicate. A lot.

Can neurons handle two separate tasks? I think so. A single neuron could have multiple relationships with adjacent neurons, and so be used for a variety of tasks. After all, a neuron can have up to (theoretically) 100k synaptic connections. Still, I think most neurons are pretty engaged in a specific task or a group of related tasks.

"How is it decided which parts of brain function are thrown away to neuroplastically recover the dead areas?" Yeah, so good question. The brain is funny. Its capacity grows according to the stresses put on it. So, if a stroke survivor wanted more brain power dedicated to the fingers, they would have to give up something, this is true. But the change in ability from the “lender” area because of the "borrowed" neurons could not even be measured. A good example is fMRIs that our lab has done of people who have the “bad” hand “borrow” neurons from, get this, the good hand. Does the good hand get worse, or loose coordination? Not that we’ve seen. And if it has, its effect would be negligible. Plus, the whole area that’s being borrowed from can make their synapses more “bushy” (have more synaptic connections), so it’s far from a zero sum game. Learning, like motor learning after stroke, increases the overall capacity of the brain.

As always Dean, thanks!

vickyh said...

Hi Peter I just wanted to tell you how much I enjoyed reading your blog and article. My aunt has been struggling for years to come to terms with having a stroke, the recovery seems to be neverending at times. I am proud to say that the company I work for work with The Stroke Association by holding an annual BMI4Life campaign and I wondered if you would be interested to read the article

Peter G Levine said...

Hey Vicky,

Good message there, thanks. There is a new book that is called "Stroke Diaries: A Guide for Survivors and their Families" that has a lot about prevention.

Prevention. So much better than than a stroke!

Stefosaurus said...

Hi Peter,

I just stumbled on your blog and must say that it's incredibly interesting and a good source for someone whose grandfather has recently suffered his second stroke. He was unfortunately at the grocery store this last time and had to be rushed by EMS to the hospital. He is luckily out of the hospital now but still (very slowly) recovering...

In an effort to find a way to help him though (because the medics didn't know he had a severe allergy to latex), I hopped onto my mac and started looking up info about what could potentially help people like my grandpa who suffer in these emergency situations. I stumbled upon a site called that offers a HIPAA-compliant web service that you can register your allergies and emergency contacts on a little card you keep behind your wallet. I've already signed both of my grandparents up for them, but I thought that you might care to know about it too, being a credible source in the medical community.

Anyway, thanks for your postings and I will continue to visit your blog as my family and I fight our way through this ordeal. Thanks again!

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