Neuroplasticity – The Brain's Repairing Mechanism

 Injuries to the head can result in long term damage to areas of the brain, varying depending on where on the head the injury was sustained. While a variety of therapeutic services can be employed to regain a certain level of functionality the brain also has a unique response to regional damage – neuroplasticity.

Neuroplasticity is the brain's ability to reorganize itself through lifetime creation of new neuron pathways. From birth developmental plasticity begins, as neuron branches and synapses form to process new sensory information. At the age of two or three, a child's brain has around 15,000 synapses per neuron. This is around twice as many as in the adult brain as neurons strengthen, weaken, and are eliminated with age. While this process slows down, the brain retains the ability to grow new neurons throughout life in response to new stimuli. One such circumstance under which the brain may begin to regenerate in this way is when a certain area of it is damaged.

Known as functional plasticity, in response to an area of the brain loosing functionality, often the surrounding healthy areas will take over those processes, restoring former abilities. Neurons which remain undamaged will grow new nerve endings to create new connections where the original links were broken due to injury. As well as restoring connections, undamaged neuron axons can create entirely new pathways, developing nerve endings that connect with other undamaged neurons, to carry out necessary functions. Especially in children, when damage is sustained in one hemisphere of the brain, the corresponding area in the other half of the brain may take on functions traditionally performed in the initial hemisphere.

One example of when natural adult neurogenesis (formation of new neuron endings) can occur is following a stroke. Strokes are caused either when a blood clot prevents sufficient oxygen flow to the brain or when a blood vessel bursts leading to internal bleeding in the head. If left untreated, a stroke can cause certain areas of the brain to cease to function. Strokes can cause long-lasting physical and psychological problems, however, the brain may attempt to compensate for permanent localized damage by re-routing function pathways.

Head injuries can cause debilitating damage that leave the patient with reduced functionality. Therapeutic rehabilitation, such as physiotherapy, occupational therapy, and speech therapy can go some way to recovering a patient's abilities, however, the body's natural propensity to repair itself, many also contribute to patient recovery following a localized head injury.

Stroke-Related Language Complications

 Conditions resulting from stroke damage can vary depending on which area of the brain was affected. Certain areas of the brain are responsible for the production, and synthesis, of language information and if these are damaged as a result of a stroke, the consequent communication problems are referred to as aphasia. There are four main types of aphasia – anomic aphasia, Broca's aphasia, Wernicke's aphasia, and global aphasia - each caused by damage to a different area of the brain.

Anomic Aphasia

Anomia is a condition in which a patient suffers a deficit of expressive language and is the most common, and also least severe form, of aphasia. While a patient with anomic aphasia may struggle to find the right word to describe something, especially nouns and verbs, they have no trouble understanding the speech of others and are able to read adequately, though writing may come with more difficulty.

Broca's Aphasia

Also known as expressive aphasia, this form is the result of damage in the frontal area of the left hemisphere of the brain. This area, known as Broca's area, is thought to be involved in the production of speech and damage to it can result in problems with forming full sentences. Though sufferers of expressive aphasia may be able to produce basic words to convey their message they struggle to form full sentences, often missing out important words, such as prepositions. As well as being unable to produce fluid speech they may also struggle to understand the speech of others.

Wernicke's Aphasia

On the other side of possible aphasic manifestations is Wernicke's, or receptive, aphasia. Occurring when the back section of the left brain hemisphere is affected, Wernicke's aphasia is characterized by difficulty understanding the meaning of written or spoken words. Patients still produce fluent, connected sentences, yet they unknowingly use nonsensical, made up words. They may still understand the flow of another person's speech and can work out from the rhythm of it whether they are asking a question or conveying an emotion, but have no understanding of the meaning of the words used. This is because the affected area, known as Wernicke's area, is thought to be the locus of human language comprehension.

Global Aphasia

Both Broca's and Wernicke's aphasias can vary in degree of severity but the most serious form, global aphasia, occurs when there is widespread language impairment. When both language areas of the left brain hemisphere are damaged, patients lose all language abilities, both in terms of comprehension and production and this form of aphasia most commonly occurs immediately after a stroke.

Often global aphasia is caused by swelling around the brain and may improve as this goes down. Similarly, area-specific language problems may decrease during the post-stroke recovery period. However, in instances where full language abilities are not regained speech and language therapies may be use to try and restore speech or, in extreme cases, to develop alternative ways of communicating.

Relearning the Activities of Daily Living

 For patients who are recovering from a recent stroke, or similar brain injury, one of the struggles they face is the loss of independence in everyday life. The basics of self-care – eating, bathing, dressing, toileting, transferring (walking), and continence – which we usually take for granted, become activities that cannot be done without assistance. These activities of daily living (ADL) are tasks that must be relearned.

Regaining the ability to care for oneself is synonymous with returning to living an independent life. This is achieved through a process of occupational therapy which involves both relearning the muscular movements necessary to carry out tasks as well as increasing confidence levels in one's abilities in order to achieve a full recovery.

Task-specific Training

In order to relearn the processes needed to carry out the ADLs patients must undergo a regimen of exercises to regain coordination and strength, and to improve motor skills. These exercises are task-specific and tailored to the patient depending on which components they are missing. They focus around using repetition to build up muscle strength and memory.

A variety of techniques are used to retrain the muscles. For example, mirror therapy in which a mirror is placed on a table so that it covers the affected arm and reflects the unaffected one. This triggers mirror neurons, which are in the same area of the brain as motor neurons, making the patient think both arms are carrying out the same action. Recovery can also be aided through brain stimulation. Wires are placed on the scalp through which current stimulation is sent to the brain. This excites damaged areas of the brain, helping to increase the chances of them recovering.

The tasks do produce improvements in function and also cortical reorganization, however, these improvements do not generalize and transfer beyond the targeted activity or area. As such a range of exercises is required to improve motor activity in several areas.

Cognitive Strategy Training

While task-specific training is the only way to help patients recover their previous coordination and muscle power, this can be supplemented by cognitive strategy training. This involves utilizing the brain's ability to reorganize and create new pathways to improve cognitive skills such as attention, working memory, logical thinking, reading, and occasionally psychosocial functioning. This can be used in tandem with the physical exercises to increase self-esteem, and problem-solving strategies, as well as regulating training frustration.

Recovery can be a long and discouraging process. In order for the combination of these training techniques to have any lasting effect on motor improvement consistency is crucial. However, with time these exercises can enable stroke rehabilitation patients to live independently again.  

Everything You Need to Know About Strokes

This week we tell you everything you need to know about strokes: how they are caused, how you can recognise one, and how they are treated.

Causes

Strokes are caused when the brain does not receive enough oxygen. There are two ways in which this can occur. An ishemic stroke, the more common form, is caused by clots in the blood vessels which supply the brain which stop the blood flow. The second, rarer form is the hemorrhagic stroke, which is caused by ruptured blood vessels bleeding into, or around, the brain.

Symptoms

There are various physiological indicators that a stroke has occurred. It is often signalled by a sudden numbness in the face, arm, or leg, and especially on a single side of the body. This may be accompanied by sudden confusion, and the inability to speak or understand others' speech.

Trouble seeing in one, or both, eyes can result from a stroke, as can having difficulty walking, and losing balance and coordination. The final symptom of a stroke is a sudden, and severe headache.

The sooner a stroke is identified and treated, the less permanent damage it is likely to do. This is because, the sooner treatment is administered, the more of the brain can be saved.

Cures and Therapies

Accute stroke therapies are administered to try and stop the stroke while it is happening, either to stop the bleeding or to dissolve the clot. If the cause of the stroke is ischemic aspirin is given, as this has the effect of thinning the blood, preventing further clots. With hemorrhagic strokes it it a little less straight forward as the patient must be monitored to ascertain what the cause of the bleeding is. It may be as a result of blood thinning medicines, high blood pressure, head trauma, or blood vessel malformation. Once the cause is identified tre

atment can then be tailored to the patient's need. Immediate emergency care for hemorrhagic strokes is concerned with controlling the bleeding, and medications may be given to reduce blood pressure or to slow the blood flow.

In the case of quickly identified and treated strokes there may be very little lasting damage, however, for some, there may be a need for a range of therapies to relearn certain skills. Strokes can cause paralysis or movement control problems, pain, difficulties using or understanding language, memory and thinking problems, and emotional disturbances, depending on which area of the brain is affected. Rehabilitation therapy involves the input of a range of specialists including physiotherapists, psychologists, occupational therapists, speech and language therapists, dietitians, specialist nurses and doctors, all of whom work to help patients relearn skills to make them as independent as possible.

Strokes can be damaging but the key to full recovery is knowing and recognising the signs and taking early action to get medical help.  

Supporting a Loved One through Rehabilitation

Supporting a loved one through Rehabilitation can be one of the most difficult and isolating experiences there is. Serious injuries, and the subsequent care, can affect families and caregivers as much as the individual themselves. However, there are steps any caregiver can take to do make the transition to rehabilitation as smooth as possible.

The first thing to remember to do always is take care of yourself. If, at any point, you find yourself feeling too isolated or too stressed, reach out to other people – be they friends and family, an external support group, or a doctor. Learn to relax, get enough sleep, and find out which coping strategies work best for you – and this applies to all caregivers.

Brain Injuries

Daily structure and normality are extremely helpful for those coping with a brain injury. Be sure to stick to a routine every day, factoring in plenty of rest and limiting the number of visitors and amount of noise, so as to avoid over-stimulation. Include your loved one in family activities and conversations, wherever possible, and do whatever you can to be as natural as possible with them. Remember to be respectful, treating them as an adult and being sure to consider their likes and dislikes. Point out milestones and try not to lose patience. You should also bear general safety matters in mind – make sure there is no clutter around for the sufferer to trip on, and keep sharp objects out of harm’s way.

Stroke

The road to recovery after a stroke is different for every patient, as there are a number of complex variables which can lead to someone having a stroke. The most important thing to remember, then, is that comparisons with other people’s rehabilitation can only be harmful, not helpful. Steps forward can come quickly or slowly, so have patience, measure progress, and stay positive. Depression is extremely common after a stroke, so monitor your loved one’s mood and behavior, and step in if you notice any signs of depression. Also, it is important that you are clued-up on medication and instructions given by the physician, especially those which relate to preventing future strokes. Encourage a healthy diet and exercise, and make sure all medication is being taken as prescribed.

Sports Injuries

Sports injuries vary enormously – from acute injuries incurred during a game to wear-and-tear injuries from repeated use. They can also affect vastly different parts of the body and take different lengths of time to heal, but there are some general rules which should help with all of them. Firstly, be sure that the injured person sees the doctor regularly throughout their rehabilitation, and that they take their advice and instructions seriously. Motivate them through difficult aspects such as physical therapy while being sure not to encourage them to get back into their sport of choice before they are ready.

Wheelchair

It is important to bear in mind that, life in a wheelchair can be extremely challenging – particularly for those who are new to it. To begin with, the crucial thing is simply to be there for your loved one, and to remind them of this sensitively, without constantly reminding them of the things they can no longer do. One of the trickiest things, our patients’ families find, is learning to tread the fine line between drawing constant attention to the wheelchair and conspicuously not mentioning it. This may take time and effort, but you will get there. Adapt your home to make it as wheelchair friendly as possible – this is something your hospital or medical center can help you with. Finally, be prepared to help them in any way they need – especially at the beginning. There may be a number of everyday activities they find difficult to do on their own – from bathing to dressing – and it is imperative that you lay any reluctance to one side and do what is necessary. Over time, they may well learn to do these things without you.

Spinal Injuries

Experiencing a Spinal Cord Injury can profoundly change the way in which someone interacts with the world. As a caregiver, it is crucial that you make this transition as painless as possible. Sufferers often experience high levels of guilt, frustration, and depression – as well as physical pain – so it is your role to help prevent this, whenever possible, and never to let your loved one feel like a burden. Be prepared to face these emotions, and try to communicate openly and often with your loved one about them. On the whole, it is good to interact with them as you normally would. One of the best things to do is to work out early on which tasks the patient can complete independently and which tasks could use your assistance. Keep the whole family or household involved and be sure to nurture healthy, positive relationships – providing your loved one with as much contact with the outside world as possible.

When it comes to rehabilitation for any serious condition, your role is vital. Your love, care, and support can be the difference between a patient recovering, and them not recovering. It is a role which is exceedingly challenging, but which can be hugely rewarding and, whatever the condition of your loved one, it is always important to remember: you are doing a good job.