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.
