Last article, I talked about what neuroplasticity means for people who've had a stroke, and how even a damaged brain can reorganize itself. Stroke rehabilitation is the lens I look through, and there are a couple of important points to keep in mind about stroke rehabilitation programmes:
1. There's no "one size fits all" approach. Different therapies work for different people, and some severe strokes (thankfully the minority) have very limited capacity for neuroplasticity.
2. The goal should be to help people post-stroke to achieve their personal maximum recovery potential.
The five principles that aid this maximum recovery potential are:
1. Repeated movements
Research tells us that about a minimum of 16 hours of activity-based therapy is needed for positive changes to occur. There is a limit to how much can be done during a physiotherapy session – so it's vital to continue these movements between sessions. I know what you are thinking, so in the next article I'll tell you about a therapy option that's anything but boring.
2. Reward-based
Stroke patients respond to real rewards. One stroke-recovery device which simulated picking up a knife and fork had marginal success. When replaced with a real knife and fork … and a piece of chocolate cake, suddenly stroke patients showed surprising determination and dexterity.
3. Incremental challenge and complexity
An activity must be neither too easy nor too challenging. Sounds obvious, but what a person finds "easy" or "hard" changes as recovery happens. Therapy must be progressive and continue to challenge to be effective.
4. Includes decisions
The stroke-afflicted must make active conscious decisions as part of their recovery. If I as a physiotherapist simply manipulate a patient's arm for them – this will have limited effect because they are not cognitively involved or solving the problem of "how do I move my arm to do such and such?".
5. Self-empowerment
Activities that the stroke afflicted can carry out themselves provide motivation and help re-establish self-esteem. This can have a positive affect on recovery.
Next week: How to put this into practice. You may be thinking "Do I have to buy up big on chocolate cake?" or "How can I always know if a task is too easy or too challenging?"
The answer to these questions involves using something you probably wanted your children to steer away from as teenagers (no not drugs). I'll talk about this in the next article.
Michael Sampson, B.Sc (Canterbury), Dip.Physio (Otago), M.App.Sci (Lincoln), is a clinical and research physiotherapist at Burwood Academy of Independent living in Christchurch, and at Canterbury District Health Board.