What are stroke survivors trying to do? They're trying to move better.
Where does better movement come from? The brain!
Is the brain learning (new brain connections) or relearning (using existing connections)?
This debate has been around for a long time. Here's the question restated: If you've had a stroke and you're learning how to move better everyday. Is that movement learning or movement relearning? Is it new stuff (new neuroplastic change) or are you reactivating a part of the brain that used to do that movement?
I've been pretty successful selling to the world that it is all about neuroplasticity-- that it's all new learning. But that's only once the plateau has been reached. You know the plateau, that first big reduction in recovery? Prior to that most recovery comes from the brain "healing" (although "coming back on line" is a better description).
Click image to make bigger
Click image to make bigger
So, lets review:
Before the plateau: Using brain that already knows the movement.
After the plateau: Using new brain to do the old movement.
2 comments:
Many medical practitioners believe that stroke recovery reaches its peak after 6 months, beyond which the stroke patient does not have much more potential to improve further. I think this is not true, I know a stroke patient who continued to make progress beyond the 6 months after stroke, even till 2 years post-stroke. Her recovery was initially slow, as it was setback by complications from tpA, so rehabilitation could commence only after the complications had resolved. Yet, while late, as long as effort was being put in, there was continuous improvement way beyond the 6 months after stroke. So "slow and steady wins the race" does hold true. Of course, the earlier the patient works on rehabilitation, the sooner recovery can take place, but importantly as long as one doesn't give up, effort will pay off.
Yes! After stroke recovery continues until you either die or quit trying to recover.
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