Stroke Rehabilitation: Throw Out Those Cones!

Stroke Rehabilitation: Throw Out Those Cones!

Do you feel like you’re in a rut? Always doing the same thing? Feeling uninspired? News flash: If you’re bored, your patients are too. It’s time for a change! Some of the most exciting research today is in neuroplasticity and the impact we have as therapists.

We’ve all heard about neuroplasticity and the potential for change in stroke survivors and traumatic brain-injured (TBI) patients, but why is it so important? Only when we better understand the impact of neural changes, how the brain responds to stimuli, and how learning takes place can our treatment truly be most effective.

All learning related to neuroplasticity is not created equal

It’s important to know that all learning related to neuroplasticity is not created equal. Most therapists have learned that repetition is the force behind improvement in motor skills and neuroplasticity. But the use of repetition in neurorehabilitation, sometimes referred to as activity-dependent plasticity, doesn’t produce the same functional reorganization of cortical maps as other therapies, often referred to as learning-dependent plasticity.

The best learning experiences appear to be limited to experiences that involve the development of new skills. Treatments that are goal-driven and task oriented (not solely repetitive in nature) are more likely to induce long-term plasticity in motor and sensory maps. If learning-dependent plasticity creates the strongest neuroplastic changes, then we should strive to engage our patients in a learning-based approach to rehabilitation.

3 Key driving forces to brain change and adaptation

The three key driving forces to brain change and adaptation are what we do, how we do it and in what environment. Environmental enrichment is the stimulation of the brain by physical and social surroundings. Evidence demonstrates that working in enriched environments results in more neurons, longer dendrites, greater brain mass and more intra and intercortex connectivity.

How to create the best learning experience

To create the best learning experience, make sure the activity you select:

  • is goal-driven and task-oriented
  • involves active problem solving
  • is responsive to environmental demands
  • has real-world relevance

The environment should be appropriate to the activity, especially during ADLs and IADLs. An appropriate environment helps the patient better understand what is expected during the treatment session. Avoid contrived, artificial, or simulated environments. Instead of asking your patient to “pretend”, use real objects in real situations.

Note: Cones, pegboards and most gym equipment aren’t considered enriched environments!

It’s important that each therapy session involves some degree of experiential learning. So get creative, find enriched environments within your setting and throw away those cones!