http://www.newyorker.com/magazine/2015/11/23/helping-hand-annals-of-medicine-karen-russell
A couple of fascinating paragraph from here:
Stroke-induced injury to the brain may
have a silver lining, neurologically speaking. The tissue death that
results from stroke appears to trigger a self-repair program in the
brain. For between one and three months, the brain enters a growth phase
of molecular, physiological, and structural change that in some ways
resembles the brain environment of infancy and early childhood. The
brain becomes, as one researcher told me, “exquisitely sensitive to our
behavior.” What follows is a sort of “G.P.S. recalculating” period.
Networks of brain cells begin to reroute around the stroke lesion, and
neurons adjacent to the lesion start to take over some of the dead
cells’ functions. S. Thomas Carmichael, a neuroscientist and neurologist
at U.C.L.A., compared the period of plasticity to the explosion of
seedlings after a forest fire: it’s a fecund time, but those shoots are
tender, vulnerable, easily damaged. He cautioned that it’s essential to
harness that growth. “You wouldn’t turn this growth phase on and plunk
somebody in front of the television to binge-watch ‘Modern Family,’ ” he
joked.
But,
for many patients, that is essentially what happens. A 2004 University
of Melbourne study, titled “Inactive and Alone,” showed that, in the
early weeks of acute-stroke care, most patients spend fifty-three per
cent of their time in their hospital beds. According to a later study,
stroke patients who receive physical therapy for their paretic arm make,
on average, thirty-two reaches per session. When neuroscientists
perform studies on post-stroke mice, rats, and monkeys, the animals are
required to make as many as four hundred to five hundred reaches per
session. “Around thirty reaches per rehab session is having no impact on
impairment,” Krakauer said. “We are providing physical therapy at
homeopathic doses.”
Another
problem, Krakauer said, is that patients are being prematurely made to
learn compensatory strategies. They lean heavily on their good side to
get out of bed, to get to the toilet, to wash and feed themselves. As
one neurologist described it, learning such strategies can mean “the
difference between having someone wipe your butt and wiping your own
butt.” But Krakauer worries that the accommodations that make a patient
more independent in the short term actually “stamp in suboptimal
strategies.” True recovery, for Krakauer, would mean that a patient was
able to move her paretic arm as she did before the stroke.
Dean,
ReplyDeleteI read the whole story and and this approach to chronic stroke makes a lot of sense to me. I closely fit the profile of who they are trying to help.
I get excited about this type of research, because I think it would really help me achieve the amount & type of movement with intention needed to rewire my brain, but I am frustrated that it will be years before this type of thing is really available.