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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
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
later, your progress
slowed or even
stopped. The good
news is that we
now know that
with a lot of specific
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.
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
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?
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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