Some clinicians think that neuroplasticity means little in the every day life of someone who suffers from brain damage. These neuroplastic naysayers believe that change in the brain is not worth a hill of beans if there’s no “functional change”. I rather disagree. I think that “function” is a manifestation of what insurance companies think will get patients out the door as quickly and inexpensively as possible. Consider ambulation. Insurers believe that someone walking, no matter how ugly the gait, no matter the orthopedic risk, no matter the bracing or assistive device, is better than not walking.
So what happens? Therapists slap on AFO’s and call it toast. Everybody’s happy, right? The only problem is that a more natural, neuroplastic recovery of dorsiflexion is now made impossible by a rigid orthosis that disallows the very movement that stroke survivors are trying to recover! Penny wise but pound foolish, insurance companies impede the very process of recovery. Neuroplastic change is the only true substrate of recovery from brain damage. Everything else from bracing to stretching are local Band-Aids ameliorating symptom rather than cause.