Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Showing posts with label repetitions. Show all posts
Showing posts with label repetitions. Show all posts

Thursday, February 19, 2026

Less Experience Leads to Faster Neural Adaptation

 How EXACTLY will your competent? doctor use this to get you fully recovered? Completely upend their rehab protocols! Repetition has always been the mantra for stroke rehab.

Less Experience Leads to Faster Neural Adaptation

Summary: For over a century, the cornerstone of psychology has been the Pavlovian idea that we learn through repetition—the more a bell rings before food, the stronger the association. However, a groundbreaking study is upending this 100-year-old assumption.

Researchers discovered that the brain actually learns more efficiently when rewards are rare and spaced far apart. Rather than “practice makes perfect,” the brain’s dopamine system prioritizes the timing between events. This discovery suggests that our neural circuitry is designed to extract maximum information from infrequent experiences, providing a new biological explanation for why “cramming” for exams fails while spaced-out learning succeeds.

Key Facts

  • The Timing Rule: The brain determines how much to learn based on the time between cue-reward pairings, rather than the total number of repetitions.
  • Dopamine Acceleration: When rewards are spaced further apart, the brain requires significantly fewer repetitions before it begins releasing dopamine in anticipation of the reward.
  • Sparse Learning Efficiency: Mice that received rewards only 10% of the time learned at the same rate—or faster—than those who received rewards 20 times more frequently.
  • The “Cramming” Effect: When experiences happen too close together, the brain “downregulates” its learning, explaining why frequent, repetitive exposure can lead to diminishing returns in memory.
  • AI Implications: This discovery could lead to faster artificial intelligence. Current AI requires billions of data points to learn, but a model based on this “sparse learning” theory could learn more quickly from fewer experiences.

Source: UCSF

More than a century ago, Pavlov trained his dog to associate the sound of a bell with food. Ever since, scientists assumed the dog learned this through repetition: The more times the dog heard the bell and then got fed, the better it learned that the sound meant food would soon follow.

Now, scientists at UC San Francisco are upending this 100-year-old assumption about associative learning. The new theory asserts that it depends less on how many times something happens and more on how much time passes between rewards.

This shows a brain and a clock.
New research reveals that the brain’s dopamine system is tuned to prioritize the time between rewards rather than the sheer number of repetitions, upending a century of learning theory. Credit: Neuroscience News

“It turns out that the time between these cue-reward pairings helps the brain determine how much to learn from that experience,” said Vijay Mohan K. Namboobidiri, PhD, an associate professor of Neurology and senior author of the study, published Feb. 12 in Nature Neuroscience.

When the experiences happen closer together, the brain learns less from each instance, Namboodiri said, adding that this could explain why students who cram for exams don’t do as well as those who studied throughout the semester.

Learning the cues

Scientists have traditionally thought of associative learning as a process of trial and error. Once the brain has detected that certain cues might lead to rewards, it begins to predict them. Scientists have postulated that at first the brain only releases dopamine when a reward like tasty food arrives. 

But if the reward arrives often enough, the brain begins to anticipate it with a release of dopamine as soon as it gets the cue. The dopamine hit refines the brain’s prediction, the theory goes, strengthening the link with the cue if the reward arrives — or weakening it if the reward fails to appear. 

Namboodiri and postdoctoral scholar Dennis Burke, PhD, trained mice to associate a brief sound with getting sugar-sweetened water, varying the time between trials. They spaced the trials 30 to 60 seconds apart for some of the mice, and five to 10 minutes apart, or more, for others. The result was that the mice whose trials were closer together received many more rewards than those who trials were spaced farther apart in the same amount of time. 

If associative learning depended only on repetition, the mice with more trials should have learned faster. Instead, the mice that got very few rewards learned the same amount as those that got 20 times more trials over the same amount of time. 

“What this tells us is that associative learning is less ‘practice makes perfect’ and more ‘timing is everything,’” said Burke, the first author of the study. 

Namboodiri and Burke then looked at what dopamine was doing in the mouse brain. 

When the rewards were spaced further apart, the mice needed fewer repetitions before their brains began to respond to the sound with dopamine.

Then, the researchers tried a different variation. They repeatedly played the sound — spacing the cues 60 seconds apart — but only gave the mice sugar water 10% of the time. These mice needed far fewer rewards before they began releasing dopamine after the cue, regardless of whether it was followed by a reward. 

More rapid learning

The findings could shift the way we look at learning and addiction. Smoking, for example, is intermittent and can involve cues — like the sight or smell of cigarettes — that increase the urge to smoke. Because a nicotine patch delivers nicotine constantly, it may disrupt the brain’s association between nicotine and the resulting dopamine reward, blunting the urge to smoke and making it easier to quit. 

Next, Namboodiri plans to investigate how his new theory could speed up artificial intelligence. Current AI systems learn quite slowly, because they are based on the prevailing model of associative learning, making small refinements after every interaction between billions of data points. 

“A model that borrows from what we’ve discovered could potentially learn more quickly from fewer experiences,” Namboodiri said. “For the moment, though, our brains can learn a lot faster than our machines and this study helps explain why.”

Authors: Additional authors on the study include Annie Taylor, Huijeong Jeong, SeulAh Lee, Leo Zsembik, Brenda Wu, Joseph Floeder, Gautam Naik, and Ritchie Chan, all of UCSF.

Funding: This work was supported by the National Institutes of Health (grants R00MH118422, R01MH129582, F32DA060044). the National Science Foundation, the Klingenstein-Simons Fellowship, the David and Lucile Packard Foundation, and Shurl and Kay Curci Foundation.

Key Questions Answered:

Q: Does this mean I should stop practicing things every day?

A: Not necessarily, but it means “spacing” is more important than “grinding.” If you’re trying to learn a new language or instrument, your brain will actually absorb more from three 20-minute sessions spread throughout the day than one solid hour of repetition.

Q: Why would the brain prefer rare events over common ones?

A: From an evolutionary standpoint, rare rewards (like finding a hidden fruit tree) are more “informative” than common ones. If something happens all the time, the brain treats it as background noise. If it’s rare, the brain pays extra attention to the timing to make sure it doesn’t miss the next opportunity.

Q: How does this link to addiction?

A: It explains why intermittent rewards (like gambling or social media notifications) are so addictive. Because the rewards are unpredictable and spaced out, the brain’s dopamine system remains highly sensitive and “learns” the habit much more deeply than if the reward was constant.

Editorial Notes:

  • This article was edited by a Neuroscience News editor.
  • Journal paper reviewed in full.
  • Additional context added by our staff.

About this learning and neuroscience research

Author: Laura Kurtzman
Source: UCSF
Contact: Laura Kurtzman – UCSF
Image: The image is credited to Neuroscience News

Original Research: Open access.
Duration between rewards controls the rate of behavioral and dopaminergic learning” by Dennis A. Burke, Annie Taylor, Huijeong Jeong, SeulAh Lee, Leo Zsembik, Brenda Wu, Joseph R. Floeder, Gautam A. Naik, Ritchie Chen & Vijay Mohan K Namboodiri. Nature Neuroscience
DOI:10.1038/s41593-026-02206-2

Wednesday, October 14, 2020

The Efficiency, Efficacy, and Retention of Task Practice in Chronic Stroke

But these are just guidelines, so useless. Give us a number, any number and survivors will do the reps. (1 million?,  5 million?, 50 million?)

The Efficiency, Efficacy, and Retention of Task Practice in Chronic Stroke

 
First Published August 24, 2020 Research Article Find in PubMed 

In motor skill learning, larger doses of practice lead to greater efficacy of practice, lower efficiency of practice, and better long-term retention. Whether such learning principles apply to motor practice after stroke is unclear. Here, we developed novel mixed-effects models of the change in the perceived quality of arm movements during and following task practice. The models were fitted to data from a recent randomized controlled trial of the effect of dose of task practice in chronic stroke. Analysis of the models’ learning and retention rates demonstrated an increase in efficacy of practice with greater doses, a decrease in efficiency of practice with both additional dosages and additional bouts of training, and fast initial decay following practice. Two additional effects modulated retention: a positive “self-practice” effect, and a negative effect of dose. Our results further suggest that for patients with sufficient arm use post-practice, self-practice will further improve use.

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Sunday, June 9, 2019

Design and experimental characterization of a shoulder-elbow exoskeleton with compliant joints for post-stroke rehabilitation

Looking at the size and complexity your hospital will never justify the cost. And I doubt you could get enough repetitions in while at the hospital to fully recover your upper limb.  Although you should ask your hospital what is the criteria to bring in new stroke rehab.  Obviously it is not cost since they can't even afford music CDs or a streaming music application. I'm guessing they have nothing that evaluates stroke research to see about bringing it in. THAT IS HOW FUCKING INCOMPETENT THEY ARE!

Design and experimental characterization of a shoulder-elbow exoskeleton with compliant joints for post-stroke rehabilitation

EmilioTrigili, SimonaCrea,Member,IEEE,MatteoMoisè,AndreaBaldoni,Marco Cempini, GiorgiaErcolini,Member, IEEE,Dario Marconi, FedericoPosteraro, Maria ChiaraCarrozza,Member, IEEE,andNicolaVitiello, Member, IEEE

Abstract This paper presents the design and experimental characterization of a 4-degree-of-freedom shoulder-elbow exoskeleton (NESM) for upper-limb neurorehabilitation and treatment of spasticity. The NESM employs a self-aligning mechanism based on passive rotational joints to smoothly self-align the robot’s rotational axes to theuser’s ones. Compliant yet high-torque series-elastic actuators allow the NESM to safely interact with the user, particularly in response to sudden unpredicted movements, such as those caused by spastic contractions. The NESM control system provides a variety of rehabilitation exercises, enabling the customization of therapy to patients exhibiting a range of movement capabilities. Available exercises include passive mobilization, active-assisted, active-resisted, and active-disturbed training modes. The experimental characterization of two NESM actuation units demonstrated position and torque control performance suitable for use in neurorehabilitation applications, including up to 7 Hz of bandwidth in torque control. An algorithm for online detection of spastic contractions or sudden object collisions has been implemented and tested as well, with results suggesting that the current system can ensure safe interaction with patients.

Thursday, May 30, 2019

Robot-Assisted Training Does Not Improve Upper Limb Function After Stroke

A 44% success rate would assuredly be good enough for most stroke patients to try it.  Using the Action Research Arm Test for validation is not useful, it is subjective.  And did you also not consider that the therapy repetitions was not enough? I suggest you analyze why it didn't meet your criteria and try again. Survivors try movements millions of times and still don't give up. Why do you give up after 1 try?

Robot-Assisted Training Does Not Improve Upper Limb Function After Stroke

MILAN, Italy -- May 27, 2019 -- Robot-assisted training of the upper limb does not improve upper limb function, compared with usual care, for patients with moderate or severe upper limb functional limitation after a stroke, according to a study presented here at the 5th European Stroke Organisation Conference (ESOC).

“Loss of arm function is a common problem after stroke,” reported Helen Rodgers, MD, Stroke Research Group, Newcastle University, Newcastle upon Tyne, United Kingdom, and colleagues. “We compared the clinical effectiveness of robot-assisted training using the MIT-Manus robotic gym with an enhanced upper limb therapy programme based on repetitive functional task practice and with usual care.”

Between April 14, 2014, and April 30, 2018, 770 patients who experienced a stroke were randomised to either robot-assisted training (n = 257), an enhanced upper limb therapy programme (n = 259), or usual care (n = 254).

The robotic gym system and EULT was delivered for 45 minutes, 3 times per week for 12 weeks.

The primary outcome of upper limb function success -- defined using the Action Research Arm Test (ARAT) at 3 months -- was achieved by 103 (44%) of 232 patients in the robot-assisted training group, by 118 (50%) of 234 patients in the EULT group, and by 85 (42%) of the 203 patients in the usual care group.

Compared with usual care, robot-assisted training (adjusted odds ratio [aOR] = 1.17; 98.3% confidence interval [CI], 0.70-1.96) and EULT (aOR = 1.51; 98.3% CI, 0.90-2.51) did not improve upper limb function, and the effects of robot-assisted training did not differ from EULT (aOR = 0.78; 98.3% CI, 0.48-1.27).

More participants in the robot-assisted training group and EULT group had serious adverse events than in the usual care group, but none were attributable to the intervention.

“[The] results [of RATULS] do not support the use of robot-assisted training as provided in this trial in routine clinical practice,” the authors concluded

[Presentation title: A Multi-Centre Randomised Controlled Trial Comparing: Robot-Assisted Training: an Enhanced Upper Limb Therapy Programme and Usual Care]

Saturday, May 25, 2019

Robotic hand system design for mirror therapy rehabilitation after stroke

Bad, bad research. No comparison to just plain mirror therapy. Why use robotics when no stroke patient will ever be able to use it outside of a hospital? Or do you really think that enough repetitions can occur during therapy to recover? If so, what is the quantity needed?

 

Robotic hand system design for mirror therapy rehabilitation after stroke

  • Shu-Wei Pu
  • Jen-Yuan ChangEmail author
  1. 1.Department of Power Mechanical EngineeringNational Tsing Hua UniversityHsinchuTaiwan
Technical Paper
  • 18 Downloads

Abstract

This paper developed a robotics-assisted device for the stroke patients to perform the hand rehabilitation. Not only the system can perform passive range of motion exercises for impaired hand, but also can perform mirror therapy for pinching and hand grasping motions under the guidance of the posture sensing glove worn on patient’s functional hand. Moreover, the framework and operation flow of the developed system has been and delineated in this paper. Practical results with human subjects are shown in this paper to examine the usability of proposed system, trial experiment of advance mirror therapy that use the proposed system to interact with realities is also presented in this paper.

Notes

Acknowledgements

The authors greatly appreciate the supports from Ministry of Science and Technology of Taiwan Grant (MOST 105-2218-E-007-007) for the work discussed herein.

Wednesday, May 22, 2019

Robot assisted training for the upper limb after stroke (RATULS): a multicentre randomised controlled trial

I bet this didn't show results because not enough repetitions were done.  They mention intensity of training, 20 hours needed from a Cochrane review but don't assign failure to what they even mention. Bad analysis and research, their mentors and senior researchers should have caught that.

Robot assisted training for the upper limb after stroke (RATULS): a multicentre randomised controlled trial

Open AccessPublished:May 22, 2019DOI:https://doi.org/10.1016/S0140-6736(19)31055-4

Summary

Background

Loss of arm function is a common problem after stroke. Robot-assisted training might improve arm function and activities of daily living. We compared the clinical effectiveness of robot-assisted training using the MIT-Manus robotic gym with an enhanced upper limb therapy (EULT) programme based on repetitive functional task practice and with usual care.

Methods

RATULS was a pragmatic, multicentre, randomised controlled trial done at four UK centres. Stroke patients aged at least 18 years with moderate or severe upper limb functional limitation, between 1 week and 5 years after their first stroke, were randomly assigned (1:1:1) to receive robot-assisted training, EULT, or usual care. Robot-assisted training and EULT were provided for 45 min, three times per week for 12 weeks. Randomisation was internet-based using permuted block sequences. Treatment allocation was masked from outcome assessors but not from participants or therapists. The primary outcome was upper limb function success (defined using the Action Research Arm Test [ARAT]) at 3 months. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN69371850.

Findings

Between April 14, 2014, and April 30, 2018, 770 participants were enrolled and randomly assigned to either robot-assisted training (n=257), EULT (n=259), or usual care (n=254). The primary outcome of ARAT success was achieved by 103 (44%) of 232 patients in the robot-assisted training group, 118 (50%) of 234 in the EULT group, and 85 (42%) of 203 in the usual care group. Compared with usual care, robot-assisted training (adjusted odds ratio [aOR] 1·17 [98·3% CI 0·70–1·96]) and EULT (aOR 1·51 [0·90–2·51]) did not improve upper limb function; the effects of robot-assisted training did not differ from EULT (aOR 0·78 [0·48–1·27]). More participants in the robot-assisted training group (39 [15%] of 257) and EULT group (33 [13%] of 259) had serious adverse events than in the usual care group (20 [8%] of 254), but none were attributable to the intervention.

Interpretation

Robot-assisted training and EULT did not improve upper limb function after stroke compared with usual care for patients with moderate or severe upper limb functional limitation. These results do not support the use of robot-assisted training as provided in this trial in routine clinical practice.

Funding

National Institute for Health Research Health Technology Assessment Programme.

Introduction

Upper limb problems commonly occur after a stroke, comprising loss of movement, coordination, sensation, and dexterity, which lead to difficulties with activities of daily living (ADL) such as washing and dressing. About 80% of people with acute stroke have upper limb motor impairment, and of those with reduced arm function early after stroke, 50% still have problems after 4 years.
The strongest predictor of recovery is severity of initial neurological deficit; patients with severe initial upper limb impairment are unlikely to recover arm function, with clear impact upon their quality of life. Patients report that loss of arm function is one of the most distressing long-term consequences of stroke. Improving upper limb function has been identified as a top ten research priority by stroke survivors, carers, and clinicians.
How to optimise stroke patients' upper limb recovery is unclear. Systematic reviews of therapy interventions suggest that patients benefit from therapy programmes in which they practise tasks directly rather than from interventions that focus on impairments.
Intensity of therapy is also important; a Cochrane overview
of systematic reviews found moderate quality Grading of Recommendations, Assessment, Development and Evaluations evidence that arm function after a stroke can be improved by the provision of at least 20 h of additional repetitive task training.
Robot-assisted arm training has shown promise for improving ADL, arm function, and arm muscle strength after stroke.
However, studies vary in patient characteristics, device used, duration and amount of training, control group, and outcome measures used. The benefits of robot-assisted arm training over conventional therapy of the same frequency and duration have not been shown

Thursday, April 4, 2019

Using Both Hands:Tangibles for Stroke Rehabilitation in the Home

The real reason survivors rarely exercise enough is because therapists don't have EXACT rehab protocols specifying what to do and repetitions needed. If the protocol said, 'Do 1,301,000 repetitions and you will get this result', then the survivor will do that. Stop blaming the survivor for your failure to create protocols.

Using Both Hands:Tangibles for Stroke Rehabilitation in the Home

ABSTRACT

 Stroke is one of the most common causes of long-term dis-ability in the world, significantly reducing quality of life through impairing motor functions and cognitive abilities.Whilst rehabilitation exercises can help in the recovery of motor function impairments, stroke survivors rarely exercise enough, leading to far from optimal recovery. In this paper, we investigate how upper limb stroke rehabilitation can be supported using interactive tangible bimanual de-vices in the home. We customise the rehabilitation activities based on individual rehabilitation requirements and motivation of stroke survivors. Through evaluation with five stroke survivors, we uncovered insight into how tangible stroke re-habilitation systems for the home should be designed. These revealed the special importance of tailorable form factors as well as supporting self-awareness and grip exercises in order to increase the independence of stroke survivors to carry out activities of daily living.CCS CONCEPTS•Human-centered computing→Field studies;Empir-ical studies in HCI;•Applied computing→Consumerhealth.
KEYWORDS
stroke, rehabilitation, bimanual, bilateral, tangible interac-tion, homeACM Reference Format:Mikko Kytö, Laura Maye, and David McGookin. 2019. Using BothHands: Tangibles for Stroke Rehabilitation in the Home. InCHIConference on Human Factors in Computing Systems Proceedings(CHI 2019), May 4–9, 2019, Glasgow, Scotland UK.ACM, New York,NY, USA, 14 pages. https://doi.org/10.1145/3290605.3300612

14 total pages if you want to read this. 

Wednesday, June 6, 2018

Immediate effects of rest periods on balance control in patients after stroke. A randomized controlled pilot trial

I thought repetitions were the most important part of recovery. 
Animal studies have shown that 400-600 repetitions of a challenging task are needed per day to make changes in the brain. With all this resting and most therapy sessions lasting an hour you'll never get in enough repetitions. 
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5968623/

Abstract

Objectives

This randomized controlled trial evaluates the effects of two different rest periods between as set of balance exercises after stroke during inpatient rehabilitation.

Results

Twenty patients after stroke [11 males; mean (SD) age 65.4 (11.5) years; duration of illness 5.3 (3.4) weeks; 16 (80%) left-sided strokes] were randomly allocated into two groups of either a full rest (FR) of 4 min (n = 10) or a short rest (SR) of 1 min between exercise sets (n = 10). Patients improved from baseline until immediately after exercises in one-leg standing time on the affected leg [SR: mean difference 5.1 s (SD 10.3) and FR: 2.0 s (2.4)] and tandem standing time (TST). [SR: 14.9 s (SD 24.6) and FR: 5.7 s (12.0)], but OLST and TST did not differ significantly between groups (p = 0.35 and p = 0.52, respectively).
Trial registration The study was registered retrospectively in the German Register of Clinical Trials with the ID: DRKS00013979
The online version of this article (10.1186/s13104-018-3450-2) contains supplementary material, which is available to authorized users.
Keywords: Stroke, Balance, Rest, Rehabilitation, Physiotherapy

Introduction

The effects of rest periods between physical exercises have considerable importance when viewed from the perspective of practice effectiveness as practice efficiency []. For instance in continuous tasks fatigue increases and acquisition and retention decreases when the rest period between trials decreases []. Therefore the rest periods between trials or exercises may play an important role in rehabilitation to improve performance. Some authors proposed that longer rest periods generally lead to more skill performance during practice [].
Controversially in the cognitive skill literature, however, between-session delays have been seen either as having a negligible effect on performance or as causing forgetting []. In contrast, in the procedural skill literature, overnight between-session delays can result in performance gains [].
For the motor rehabilitation of patients after stroke there is not much literature about optimal rest periods between exercise sets. In contrast to this, the use of rests should be a very important aspect of daily clinical physiotherapy. Some investigators in gait rehabilitation for example use rather long rest periods between the trials (2–3 min) [] but other used diametrically short rests of 10 s []. Until now no rigorous study has evaluated the immediate effects of different rest periods between common balance exercises after stroke.
The aim of the present study was therefore to investigate the immediate effects of different rest periods on the balance performance of patients after stroke.

Saturday, June 17, 2017

Stem cells may be the key to staying strong in old age

You might need this in conjunction with the non-interventions your doctor is doing. You will need lots of muscle mass to accomplish the millions of repetitions needed for your recovery.
https://www.mdlinx.com/internal-medicine/medical-news-article/2017/06/12/muscle-stem-cells-old-age-age/7207947/?
University of Rochester Medical Center
University of Rochester Medical Center researchers have discovered that loss of muscle stem cells is the main driving force behind muscle decline in old age in mice. Their finding challenges the current prevailing theory that age–related muscle decline is primarily caused by loss of motor neurons. Study authors hope to develop a drug or therapy that can slow muscle stem cell loss and muscle decline in the future.

As early as your mid 30s, the size and strength of your muscles begins to decline. The changes are subtle to start – activities that once came easily are not so easy now – but by your 70s or 80s, this decline can leave you frail and reliant on others even for simple daily tasks. While the speed of decline varies from person to person and may be slowed by diet and exercise, virtually no one completely escapes the decline.

“Even an elite trained athlete, who has high absolute muscle strength will still experience a decline with age,” said study author Joe Chakkalakal, PhD, assistant professor of Orthopaedics in the Center for Musculoskeletal Research at URMC.

Chakkalakal has been investigating exactly how muscle loss occurs in aging mice in order to figure out how humans might avoid it.

In a study, published in the journal eLife, Chakkalakal and lead author Wenxuan Liu, PhD, recent graduate of the Biomedical Genetics Department at URMC, define a new role for stem cells in the life long maintenance of muscle. All adults have a pool of stem cells that reside in muscle tissue that respond to exercise or injury – pumping out new muscle cells to repair or grow your muscles. While it was already known that muscle stem cells die off as you age, Chakkalakal’s study is the first to suggest that this is the main driving factor behind muscle loss.

To better understand the role of stem cells in age–related muscle decline, Chakkalakal and his team depleted muscle stem cells in mice without disrupting motor neurons, nerve cells that control muscle. The loss of stem cells sped up muscle decline in the mice, starting in middle, rather than old age. Mice that were genetically altered to prevent muscle stem cell loss maintained healthier muscles at older ages than age–matched control mice.

At the same time, Chakkalakal and his team did not find evidence to support motor neuron loss in aging mice. Very few muscle fibers had completely lost connection with their corresponding motor neurons, which questions the long–held and popular “Denervation/Re–innervation” theory. According to the theory, age–related muscle decline is primarily driven by motor neurons dying or losing connection with the muscle, which then causes the muscle cells to atrophy and die.

“I think we've shown a formal demonstration that even for aging sedentary individuals, your stem cells are doing something,” said Chakkalakal. “They do play a role in the normal maintenance of your muscle throughout life.”

Chakkalakal is building on this discovery and searching for a drug target that will allow him to maintain the muscle stem cell pool and stave off muscle degeneration as long as possible and he hopes this discovery will help move the field forward.

Monday, October 31, 2016

How Repetition Can Heal Your Brain Faster during Stroke Recovery

But wouldn't incorrect movement actually make you learn faster? Why doesn't your therapist know that?

We know that learning from your mistakes is one of the best ways to learn,

How Repetition Can Heal Your Brain Faster during Stroke Recovery


You’ve heard us preach about the importance of neuroplasticity for stroke recovery before. It’s the #1 thing all stroke survivors should know about.
Neuroplasticity is the healing you need, and repetition is the tool for accessing that healing and speeding your recovery along.
In order to explain why repetition matters so much, we will give a brief overview of neuroplasticity first.

Neuroplasticity – The King of Rehab

Neuroplasticity is the mechanism that your brain uses to rewire itself.
There are two ways that neuroplasticity works: the creation of new connections between neurons (brain cells), and the deletion of old connections.
After stroke, a chunk of the brain is damaged and those brain cells are unable to carry out their tasks. For example, arm movement can become difficult after stroke if the part of the brain responsible for arm movement is affected.
In order to heal from this damage, the surrounding areas of the brain can pick up the slack. Meaning, they can learn the tasks that the damaged parts once controlled. This is neuroplasticity.
But neuroplasticity can only happen through repetitive practice.

Repetition & Neuroplasticity

So if you want to regain arm function after stroke, then you need to repeat arm rehab exercises over and over and over until it sticks and your brain has successfully rewired itself.
Because each time you move your arm, you begin to form and strengthen the connections between the neurons responsible for that arm movement.
That’s why learning a language is so difficult, for instance. We have to repeat new words over and over and over again until they stick. Similarly, that’s why learning how to play a new sport requires lots of practice.
You’re forming new connections in the brain, and it takes time.
So when you grow frustrated during rehab (which is perfectly normal and understandable – here’s an article on how to deal with it), remind yourself of the intricate work that you’re doing.
You’re rewiring your brain!
You’re calling upon your brain the same way that professional athletes call upon their brain. You’re forming new neural networks – and it’s phenomenal!

Repetition & Consistency

So you’ve got the repetition part down now, so you’re good, right? All your bases are covered…
Well, not quite.
The neurons in your brain need good repetition in order to strengthen themselves, but they also need consistency in order to stick.
For example, if you’re really good about repeating your rubber band hand exercises 50 times each, but you only do that once a week, then you’re in trouble.
Because 50 repetitions is great! But the time in between rehab sessions will cause those new connections to weaken.
So if you want to maximize your healing, you need to be repetitious and consistent with your rehab exercises.

Repetition & Motivation

All the examples we’ve been using so far have revolved around movement after stroke – and for good reason. It’s important for your quality of life, safety, and independence.
But another way that you can use neuroplasticity to improve your quality of life is by using it to hardwire motivation into your brain.
This is especially important for those who procrastinate on their rehab exercises or can’t find the willpower to keep going.
Because when you feel like giving up, there’s a thought in your brain telling you to give up. And if that’s a pattern, then your brain is really good at telling you to give up! (Repetitive practice still works even if you’re not aware of it.)
So if you tell yourself to keep going – to keep taking one small step each and every day – and you do that over and over and over, then you will hardwire persistence into your brain.
If you tell yourself that you’ve got this – that all your hard work will pay off even if you can’t see results yet – and you repeat that to yourself multiple times a day, then you will hardwire confidence into your brain.
You have the power to become whatever you want to become.
It’s just a matter of letting go of old connections (like self-doubt and fear) and forming new ones (like persistence and balance).
So, what will you use neuroplasticity for?
Will you repeat those rehab exercises consistently from here on out?
Will you talk kindly to yourself consistently, too?
We always encourage both 🙂

Tuesday, September 6, 2016

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.