Wednesday, September 4, 2013

Repetitive Practice Stroke

What is the key to recovery? Everybody now: Repetition! I've written about this before here and here.

Everybody knows that repetitive practice (also known as repetitive task practice) is the way to reestablish executive (brain) control over the body. To regain control of an arm and hand repetitive practice can be used to reestablish that control. To regain control over a leg during walking, repetitive practice (walking) can be used to reestablish control over walking.

It's not rocket science. And it's not brain science, until it is.

The thing that they don't tell you is how many repetitions you have to do. The first person to talk about the power of repetitive practice was Randolph J. Nudo. You pretty much can't read any journal article on stroke rehab research that doesn't involve a reference to this guy. His suggestion was that 2500 repetitions would begin to change the brain enough to make that movement better. In constraint induced therapy there is approximately 200 repetitions per therapy session. In typical rehab there's about 32 repetitions or therapy session. It looks as if the number may be approximately a total of 1200 reps. That would require about three hours per day.

As you can imagine, these numbers are rather variable. The amount of focus brought to each repetition would be one variable. The complexity of the movement that you're trying to relearn would be another variable. The number of joints that the movement required would be a variable. The number of directions that that limb would have to move in order to carry out the task would be a variable.

But I think we can all agree that most stroke survivors don't attempt these numbers of repetitions. 

Here is the other question: How do you do all the repetitions you need to do without driving yourself crazy? 

Here is the only possible answer: Tie it to something that you care about.

Get cracking.


kate allatt said...

I have just found your blog.. We talk the same language:

Like mine too?


Would you should signpost my brainstem stroke with locked in syndrome, inspirational blog to the stroke community?
Here’s a sample:

Anonymous said...


We think off the same hymn sheet.
seen my blog? My brainstem stroke with locked in syndrome, inspirational blog to the stroke community?

Here’s a sample:

oc1dean said...

Smoking a cigar? I do that when walking to force myself to look ahead rather than down. Great for multitasking.

KHiggs said...

What if you have movement but struggle with spasticity in fingers. Would more reps help that, since" plasticity beats spasticity?"

Rebecca Dutton said...

I wish more therapists would help clients connect exercise to something they love. Two sets of ten is good for strengthening muscles but as you said, retraining the brain takes thousands of repetitions.

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