Stroke Smart Magazine

January/February 2007
AMAZING BRAIN

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Changing Your Mind

By Stephen J. Page, Ph.D.

For decades, researchers have known that different areas of the brain control different functions. One area of the brain controls speech, another area controls vision, another controls movement, etc. When the blood supply to an area is reduced or cut off due to a stroke, the brain cells in that area die. As a result, the functions that were once controlled by these regions are weakened or lost altogether.

Many clinicians will tell you that once a particular brain area dies from a stroke, there is little hope of regaining abilities controlled by that region of the brain. For example, your doctor or therapist may have told you that you will not walk again. However, we now know that this long-held belief is only half true. The bad news: Once a particular area of the brain is dead, it is indeed gone forever. And, after about six months, the brain does slow down its process of trying to recover on its own, called “spontaneous recovery.” You may have seen this in your own body. At one time, recovery may have been very rapid and noticeable, even without rehabilitation. But later, your progress slowed or even stopped. The good news is that we now know that with a lot of specific practice, the brain can reconfigure and send signals to your body around the damaged or dead areas. And this process, called “plasticity” (because the brain is malleable and can be shaped like a piece of plastic) can occur even years after a stroke.

Getting Your Brain to be “Plastic”

Plasticity, and efforts to produce plastic changes in stroke patients, is an active research area for groups like ours. It makes sense. If we can identify the conditions that cause the brain to heal, then maybe we can tweak rehabilitation to make it more efficient. Although research is ongoing, we have had some recent successes with therapies such as modified constraint-induced therapy and mental practice. With these successes, we have learned that there are things that patients can do to at least make conditions more conducive for a “plastic” change.

Repetition

One of my research assistants and I play basketball together. Not well sometimes, and certainly not as well as we played when we were younger. Age may have something to do with this. But, so does the amount of time we practice now versus when we were younger. Not surprisingly, research supports this idea. Highly skilled performers tend to have very well-developed brain maps of the activities at which they are skilled. And these brain maps are well developed due largely to practice. When you practice a skill over and over again, you are literally giving your brain the opportunity to re-map that skill. This remapping is at least partly responsible for any skill improvements you see.

Much like top athletes, when stroke patients use their arms repetitively, they are putting demands on the brain to figure out new ways to map around the damaged region and send new signals to the arms.

Learning a skill by remapping the brain takes many practice attempts, but the repetition-plasticity relationship is one of the cornerstones of some exciting new therapies.

Expert performers such as Tiger Woods and Michael Jordan are legendary for their obsessive, repetitive practice behaviors. Are you?

Specificity

If you want to learn a motor skill, such as throwing a dart, you do not practice lifting the arm up and down with your other hand. You practice specific things such as gripping and throwing the dart or a similar object. So, I am always amazed when a patient's goal is writing, yet his rehab plan does not include any of the skills needed for writing. Or when patients want to improve their speech, yet they are not making efforts to speak or to make sounds that mimic speech.

Research has shown that repetition is not enough; practice needs to be not only repetitive, but also task specific. This means that, lifting your arm up and down is only useful if the thing you want to do involves this particular movement. If your goal is drinking from a coffee cup, you should practice movements that help you learn to pick up the cup. Can you extend the elbow toward the cup? Can you extend the fingers around the cup and grab it? If not, perhaps these are the movements you should work on. The key seems to be to analyze the task, break it into smaller parts, and then practice those parts at which you are less skilled.

There are other things that may also impact whether a “plastic” change occurs. For instance, some researchers believe that a single practice session should last for hours at a time, called “massed practice.” Yet, shorter practice sessions (some as little as 30 minutes) that are performed repetitively have also produced plastic changes. However, whether it is speech, thinking, movement or another function, the research findings are clear: Plasticity can and does occur — even years after stroke — given the right types and amounts of practice.

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