Use it or Lose it - stroke rehab

This seems to be one of the golden pillars of stroke rehab. I think everyone is mostly wrong on this.

You are told as soon as the first therapist talks to you that you need to use any movement/sensation you have or you will lose it. They believe it because they see survivors who initially had some movement  and a month or two later that movement is gone. They question the survivor about how often they tried the movement and the response usually is, 'Except for therapy sessions I never tried that movement'. This is correlation not causation. Poor analytical thinking on their part. They are probably thinking about atrophied muscles and their lack of use.

I'll argue that the reason it was lost is that that area was partially damaged; in the penumbra or blood drainage area and the neuronal cascade of death was initiated and neurons died over the next week or so. The initial tries worked because the neurons were still alive and barely functioning.

This just points out the absolute imperative to find out how to stop that death cascade.  177 possibilities here.This can also be the reason that very early therapy does not have a good success rate. Movement regresses for a while until the cascade resolves itself and the surviving neurons start taking on their tasks. This would look like failure on early rehab.

This should be fairly easy to figure out, you can use nanowires to listen in on single neurons or lay a grid across the cortex to listen in.

Some of the causes of those neuron deaths;

1.  Excitotoxicity

2.  Glutamate poisoning

3.  Capillaries that don't open due to pericytes

4.  Inflammatory action leaking through the blood brain barrier