Using High Repetitions in Stroke Rehab

Finally someone putting out a number of repetitions for neuroplasticity to take hold. But notice the caveat, challenging, and I'm sure your therapist will want you to do them perfectly. Even though you learn faster by correcting your mistakes or varying your routine. I would need spasticity fixed before I could even attempt any of these. http://www.stroke-rehab.com/support-files/strokerecoverytipsseptember2016.pdf A word you hear often in stroke rehabilitation is neuroplasticity. Neuroplasticity in simple terms basically refers to the brain’s ability to rewire itself and create new connections. Repetitive practice of a task has been shown to make changes in the human cortex. For example, practicing a task such as playing the piano can increase the finger representation in the motor cortex. On the other hand, lack of movement of a muscle can result in decreases in representation of the muscle in the motor cortex. If parts of the brain are damaged that control cer- tain muscle movements, sometimes neuroplasticity can allow for other areas of the brain to take over. Research has shown that in order to help foster these neuroplastic changes, it is important to have high repetition practice. Animal studies have shown that 400-600 repetitions of a challenging task are needed per day to make changes in the brain. Therapists at most centers do not have a patient perform anywhere near this number of repetitions of a task. Random performance of a task such as practicing a few hundred reps one or two days a week will not result in very noticeable changes, but practicing a task for high reps daily over several weeks would result in much more noticeable im- provement. Unfortunately, patients often only go to therapy a couple of times a week and do not perform a high number of repetitions of a challenging task. If you want to see better results with an activity, it is recommended to incorporate high reps of the task daily for several weeks. The type of task attempted will be different for each stroke patient depending on their impairment and capabilities. Trying to type may be appropriate for one patient needing to work on fine motor control whereas trying to slide a washcloth across a table may be appropriate for another who lacks fine motor movement. If you pick a task that is easy to perform, then you will not stimulate the brain in the same way as if you pick a more complicated task for yourself. One task may be too easy for one patient and too complicated for another so you have to adjust the task/activity to your abilities. Some ideas for tasks are listed below (tasks can be done with adaptive equipment if needed):  
Pushing piano keys 
Typing 
Clapping Not possible due to spasticity 
Rolling dice 
Catching 
Throwing
Moving or sliding an object 
Reach/grasp/release of an object Not possible due to spasticity
Holding an object between both hands and lifting it.
Rolling, kicking or bouncing a ball

Turning off a light switch

Dot to dot activity

Writing

Folding a washcloth

Painting strokes (can attach brush to hand with an assistive device if can’t grip)

Using a tool

Bringing a utensil to the mouth

Picking up a cup

Playing a finger app on the phone (e.g. Cut the Rope, Fruit Ninja)

Trying to hit a balloon.

Playing a board game such as Simon.

Opening a container

Turning a page in a book or magazine

If you look at the above list of activities and feel like they are too hard be-

cause you have severe hemiplegia or paralysis, then try to work what move-

ment you do have. Remember you can also use adaptive equipment to help

such as a Grip Aid Glove, a universal cuff, a keyboard aid, etc. if you don’t have finger movement. Easier tasks to start with might be placing your paralyzed hand on top of a ball (e.g. a basketball or soccer ball) and try to slightly roll the ball a few inches side to side or trying to use the arm to push a light object on a table.

For training to be most effective, a task should be meaningful and engaging to the patient and be associated with a goal. You should be able to adapt and progress the task as well. For example, if the goal was to shoot a basketball into a hoop, you could start as mentioned above by first just placing the affected hand on a ball and rolling it. You could then progress to holding the ball between two hands and lifting it, then lifting it higher (adapting holds as necessary), throwing the ball down, throwing the ball out, throwing the ball up, and throwing the ball into different hoops of different heights. In my opinion, tasks should be chosen by the patient to increase motivation. For example, I treated a patient who liked to shoot guns and his goal was to be able to hold and pull the trigger of a gun. He was very motivated to relearn this task.

We weren’t able to use a real gun in our clinic, but we practiced movements with other materials, and he practiced with an unloaded gun at home. I would have never chosen this task as a therapist, however, by talking with the patient, I found something that motivated him and sparked his interest and increased his participation in therapy.

If you have no arm movement, then mirror therapy may be an alternative.

In mirror therapy, you watch the reflection of the non-affected limb in a mirror and your brain perceives the reflection as your affected limb. By watching repetitive movement of the working limb in the mirror, it has been shown in some studies that new connections can be made for the paralyzed side because the brain perceives that the paralyzed side is working (even though it is actually only a reflection of the non-affected arm working).

Remember, doing therapy a couple of days a week for a short period is not enough. To get the most out of your rehabilitation, you should be working at home daily. Make sure to choose somewhat challenging tasks that you are motivated to do, and that repetition is key to achieving your goals.