LET’S UNDERSTAND 'NEUROPLASTICITY'

The Takeaway:

In my opinion it is crucial that as health Professional's we explain (in easy to understand language) to stroke survivors and their caregivers that 'Neuroplasticity' makes recovery possible at any stage after a stroke. Talking to a Canadian colleague this week reinforced for me that the majority of people do not understand what this means. In order to have the motivation to undertake the repetitive therapy that is required for 3 hours a day it helps to know that 'some process' is going on in the brain. That is why you need to explain about 'Neuroplasticity' to your patients before they go home. This newsletter intends to help.

What goes on in your brain NOW

Your brain can change its structure (even after the damage that a stroke has caused) continually: while you watch a movie, think about how you are going to give that presentation, or remember your child falling and banging their knee.

You have an amazing ability here and now, and you will not even realize that it is happening inside you. Even when you are just sitting at home or moving around at work or working out in the gym, the material in your brain (the neurons) will be changing their shape and their connections with each other in response to everything you experience.

Any stroke survivor will worry that they are unable to develop new movements and function. I have seen incredible transformations in stroke survivors through applying innovative therapies in the clinical trials of my 'Neuroplasticity Research Group (NRG)'. NRG Recent Press Release

All of these therapies are based on neuroplasticity. I am writing this newsletter so you can easily explain to a stroke survivor how their brains can and will change with certain types of practice. This will prime and motivate them to undertake those repetitive tasks.

Is there a 'Secret' to enhance Neuroplasticity?

The point is that your brain is constantly changing. There is no secret formula to enhance this ability because it is happening at every moment of your life. But, you need to understand this fact, or you may believe that the stroke survivor’s brain is not capable of recovery. Norman Doidge, in his brilliant book The Brain's Way of Healing: Remarkable Discoveries and Recoveries from the Frontiers of Neuroplasticity, defines neuroplasticity as: “The property of the brain that enables it to change its own structure and functioning in response to activity and mental experience.” Norman's book quite literally changed my life and passion for rehabilitation!! Link to the Book

Through easy-to-read descriptions of the astonishing transformations after different forms of brain damage (including stroke), Doidge talks about the revolutionary discovery that the human brain can change itself, which is completely contrary to 400 years of medical and scientific beliefs.

WHAT IS ACTUALLY HAPPENING IN THE BRAIN?

Neuroplasticity is a process in which the nerve cells (neurons) in your brain change their structure, either by developing more connections to other nerve cells or by thickening simply in response to the everyday experiences in a person’s life.

Think of your brain as a power grid where billions of pathways, or roads, are lighting up every time you think, feel, or do something. Based on what you have done in your life, some of these pathways are used often and are well travelled. The pathways represent our habits and our established ways of thinking (conscious and unconscious) and feeling in response to circumstances or events.

Every time we think in a certain way or we practice a particular task (new or old) or we feel a specific emotion, we strengthen these pathways. When we think about something that we have not done before, we set down a blueprint within this power grid for that new action, but we need to follow up, and this is the important message.

What can be done where no active movement exists?

When no ability to carry out the task exists—for instance, after a stroke—we need to use either a visualization or a mental practice to strengthen the new pathways until that action becomes possible. When I meet stroke survivors who can not pull their toes or their feet toward themselves while they lay on a bed, I introduce to him the following tasks:

1. Initially visualizing that movement happening a few minutes every day until there were flickers of movement starting.
2. Using mirror therapy for their feet for a few minutes every day. (I explained about mirror therapy in a previous newsletter Mirror Therapy Explained)
3. Assisted movement, using an elastic band or a bandage to pull their feet toward them for a few minutes.

This technique built on creating the blueprint to move their feet and then strengthened the pathway until it was happening unconsciously.

What can be done where active movement DOES exist?

When there is actual voluntary movement available in the limbs, repeating certain movements will embed and strengthen it as a new pattern in our brains. This is where repetitive movements with directed attention (where you genuinely concentrate and focus on the new action, feeling, or thought) has its benefits. It is certainly not a passive approach.

When I work with a current patient, Lisa, and she can move her shoulder forward, the blueprint/pathway for that movement is clearly already created. But getting her to repeat the movement hundreds of times in the correct way until it becomes habitual or unconscious will strengthen that blueprint in her brain.

Repeated practice makes it easier for our brains to travel these new pathways, think about something differently, learn a new task, or choose a different emotion. So, we start carving out a new road, and if we keep traveling that road our brains begin to use this pathway more and this new way of thinking, feeling, or doing becomes second nature.

Important Message:

But here is the really important message: The old pathway gets used less and less and it weakens. That means that the new pathway become the chosen one that we unconsciously use going forward. Neuroplasticity is as much about inhibiting old pathways and blueprints for movements and emotions and feelings that we don’t want to experience.

This process of rewiring your brain by forming new connections and weakening old ones is neuroplasticity in action. The good news is that we all have the ability to learn and change by rewiring our brains. This fact has been recognized officially in the updated 2023 National Clinical Guidelines for Stroke for the United Kingdom and Ireland.[2] The guidelines state that regardless of time since stroke ALL stroke survivors have the potential to recover. (I explained the main messages from these guidelines in a previous newsletter Updated UK & Irish Clinical Guidelines for Recovery After Stroke)

Not All Rehabilitation Needs to Be Physical (Interesting)

What is phenomenal is that these do not have to be physical experiences; they can also be mental experiences where a person visualizes or thinks about an experience that has occurred in the past or may (in their own minds) happen in the future.

Interesting fact: The most important chemical messenger (neurotransmitter) that is released in the brain (and which controls brain function) is glutamate. Its job is to send messages between nerve cells.

An extraordinary fact revealed by modern science is that thinking (such as by people with sports injuries or rehabilitation patients visualizing they are undertaking activities), learning (becoming educated in new facts) and acting (actually moving our body and limbs to undertake activities) can turn our genes on and off, thus shaping our brain anatomy and our behavior.

The actual changes that happen in the brain cells, the chemicals that cause these changes, and? the mechanisms of what changes the brain structure are not germane to this book, but you must be 100 percent confident in the last 20 years medical technology has allowed proof that the damaged area(s) of a brain due to a stroke can restructure (rewire) to allow a stroke survivor to regain their physical function. This is what our Neuroplasticity Research Group (NRG) studies and the reason why we invest so much energy into developing new treatments for stroke rehabilitation.

PATIENCE AND PRACTICE ARE THE PATHWAY TO RECOVERY

Think back to the first time you learned a foreign language in school or learned to play a new musical instrument. At the time, it probably seemed like an extremely difficult and time-consuming process: learn all the verb tenses and all the new nouns, or learn slowly and patiently how to read sheet music.

You could easily have said, I just don’t have the ability to learn this or I am just not clever enough. But instead, you probably knuckled down and learned slowly and in doing so you took a growth mindset approach: you practiced extensively, and then practiced again and again until the new skill was automatic. You also realized somehow (we will discuss this idea of knowing how to see progress) that you were making progress and this feedback will have helped to keep you motivated.

Now, speaking and understanding that new language or reading that sheet music is more than likely second nature to you—something that can be done without huge effort. It’s amazing how much improvement can be achieved and this is the basis for neuroplasticity. It is essentially the science behind the growth mindset. It is the reason we can develop new skills and knowledge through repetitive effort, practice, and persistence.

WHY TEACH NEUROPLASTICITY TO CAREGIVERS OF STROKE SURVIVORS?

When caregivers and stroke survivors understand neuroplasticity, their perception of their own ability to recover physical function changes. It becomes easier to understand growth mindset, and to embrace failure, obstacles, and repetitive practice.

So, let’s get started with some simple facts:

• Your brain structure is never static. It continues to change even into old age.
• Just like a skeletal muscle, the brain gets stronger the more you use it.
• The brain is a pattern-seeking device. When nerves in the brain are activated in a particular pattern repeatedly and repetitively, it is quicker and easier for the brain to repeat that pattern in the future.
• The brain remembers and learns how to carry out a new task. It will carry it out quicker the next time it is asked. The time after that it is even easier and so on.

Through repeated practice and repetition, we can build pathways that make our brains stronger, smarter, and repaired.

IMAGINE IF YOU COULD IMPROVE RECOVERY EVEN WITHOUT MOVING

You’re reading about neuroplasticity and thinking that you need to start moving that arm, that weak leg, start taking more steps or try to stand up more. All of this makes sense and will certainly assist in creating new pathways that rewire your brain. However, what if you could simply sit in your chair and imagine that you are moving your arm or leg, see yourself walking around your house and down the front walk and around the neighborhood, or visualize yourself standing, balancing on each leg.

Do you think this could be beneficial to improve your recovery? The answer of course is yes.

Norman Doidge describes it in this way:

“One reason we can change our brains simply by imagining is that, from a neuroscientific point of view, imagining an act and doing it are not as different as they sound. When people close their eyes and visualize a simple object, such as the letter a, the primary visual cortex lights up, just as it would if the subjects were actually looking at the letter. Brain scans show that in action and imagination many of the same parts of the brain are activated. That is why visualizing can improve performance.

So, I will be encouraging you to include visualization exercises or what is termed “mental practice” into any home stroke physical rehabilitation daily routine.

PROMOTING NEUROPLASTICITY AFTER HAVING A STROKE

According to Mental Health @ Home, our brains like stimulation and novelty. Challenge and focused attention are the key elements that can promote neuroplasticity. In addition, physical exercise can slow age related atrophy (loss of brain cells) in the brain.

NEUROPLASTICIANS (All Healthcare Professionals)

Norman Doidge coined the term “neuroplasticians” to describe those professionals who practice this new science of changing brains. I think it’s fair for me to call myself a neuroplastician: my Neuroplasticity Research Group (NRG) and the many projects and researchers that have blossomed from it over the past 12 years are proof that neuroplasticity can undoubtedly benefit stroke survivors. Our clinical trials have proven this to be the case. Norman Doidge and his message inspire us to help others. It makes my job one of the most pleasing in the world.

Every stroke survivor recovers differently. As a healthcare Professional, or caregiver you need to understand that some of the best rehabilitation is achieved by educating the patient about how and why their bodies respond to what they genuinely believe will work. Unless you have the patience to sit down and explain this rule, it will be pointless to start the physical rehabilitation program. The next newsletter explains how the brain can act like a pharmacy when we believe in our treatments. I intend to discuss placebo or self-belief effects, and how crucially important measurement is to the motivation to keep going.

Have a good week.

Ken