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How have relatively new insights regarding neuroplasticity changed the practice of physical therapy, especially for stroke survivors?

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Physical Therapist

Answer transcribed from Brightway's interview with physical therapist Susan Little:

Let’s start with what neuroplasticity means. Neuroplasticity is the ability of our brain to heal and the ability of our brain to regrow connections for many years. In fact, on the internet, you may see that any cell in our body can grow and replicate with the exception of our brain cells. However, we know now that really much healing and recovery can happen within our brains if we do the right things. We don't know what all the right things are, but we do know that there is a tremendous amount of room for neuroplasticity. As a physical therapist, I really have two big paths to help people improve. One path is compensation, such as giving somebody a walker if they have a bad balance. Does that improve their bad balance? Maybe. By the fact that they're moving more, their balance may improve, but no it really is a crutch. It’s not improving, it is compensation, and those things are important. We need to keep people safe and help people get moving, but they're not recovering. The piece of recovery and the path that I'm more excited about is making people heal. This is tapping into their neuroplasticity, their ability to really improve their brain and resume activities the way that they had been doing prior to their injury.


That again is still being worked on how exactly we do that, but I think in simple terms, ironically, it's very old adages that are found to be true. For instance, we know the old adage of “use it or lose it”. It is true that in order for our brain to heal, we need to force it to do things that are difficult and things that we think we can't do. I love it when I say to my patient “okay, we're gonna do this” and they say to me “but I can't do that”. I then say “exactly, that's why we're going to do it because that's what's going to make you better”. Our brain is tremendously efficient. If it doesn't require something or isn't demanded to do something, it loses its ability to do it. I joke with my husband that if we’re married, we divide and conquer, so I never deal with car issues anymore. I've told him I have lost that part of my brain because I have not used it, so it is his job now. Mind you, I spent many years on my own where I managed my car and took care of it, but I haven't used it since and I have lost it. That is the idea of neuroplasticity and applies very much to what we do in physical therapy. 


Along with that, we know other things that drive neuroplasticity. Lots of repetition through the act of practicing will drive that neuroplasticity. With that said, we don't know everything that we need to know. I think the most exciting thing that is coming along with neuroplasticity is something called neurotractography, which is a type of MRI where we can visualize the actual “wires” and “plugs” that are running from our brain to our body. In a brain injury, those plugs get cut. Comparing this to if we cut the plug to our TV, that TV is not going to work, and that's what we see when people lose function in their hand or their arm. With rehab, we work hard to develop that neuroplasticity but up until this point, we haven't been able to visualize “hey did we tape that cord back together to make the TV work again, or didn't we”. Now, we can visualize those and that is in a very early stage, but I really think in the next decade, what we do with individuals after stroke and brain injury will be much more advanced because we can now visualize if what we are doing in the clinic is resulting in that neuroplasticity that we want it.