NEUROPLASTICITY AND STROKES: LEARNING AT EVERY AGE WITH DR. STRAUSS
A stroke, or more accurately a cerebrovascular accident (CVA) or insult (CVI), happens when our brain cells suddenly die off as a result of having no oxygen. This happens either when an artery gets blocked by a clot or by narrowing, or when an artery bursts and one gets bleeding in the brain.
Strokes are devastating events, often leading to death. In the old days, if we survived, we were left mangled and twisted, unable to move our arms or legs, or perhaps unable to speak or understand what was said to us.
My grandfather on my dad’s side had such a stroke during Christmas dinner in 1955. For fifteen years he lay in a bedroom in my aunt’s house, lovingly tended to by another aunt who never married as a result. He was completely unable to communicate (making only animal-like grunting noises) and unable to look after even his most basic functions from that day on until the day he died, coincidentally also on Christmas Day. I remember not much more of my grandfather than the brief sideways glance I would have of this weird shape on a bed in the dimness of his bedroom, when I ran, terrified of him, past his door down the hall, during the vacations I spent on my aunt and uncle’s farm.
Our knowledge about neuroplasticity has recently started to improve matters. Years ago, based on what they observed, neurologists believed that a stroke victim had about six months to one year during which to recover and whatever functions were not recovered after that, became permanent damage. Now, and over the past few years, scientists have come to understand that a very special protein, involved in neuroplasticity, called brain-derived neurotrophic factor (BDNF) can get most if not all of the motor damage from stroke undone.
As a result, a neurologist friend of mine gets his patients who suffered a stroke regularly to do one of two things. He gets them to bind their dominant hand behind their backs and spend a few hours a day, going about their daily activities with their non-dominant hand (that is of course if that hand is not paralyzed). Or, if they can still walk and maintain their balance he gets them to take off their socks and raise their non-dominant bare foot up and with its big toe, trace their name and address on the door of their refrigerator as if their big toe was a ball point or felt-tipped pen.
Why does this simple intervention work? Doing these activities is as if we are paving new roads in the brain—roads in wilderness areas not used before, the non-dominant motor parts of the brain. We use the tool called BDNF to lay the pavement down and broaden the road. Because the brain is not a box with airtight little compartments, the very same BDNF trickles into the damaged areas caused by the stroke. There it also helps with repairing the potholes in the pavement of that road, and the brain may eventually regain full or partial use of that road.
(I now give the same advice to my patients who suffer from memory loss and problems with attention and concentration due to anxiety or depression—it seems that it really helps them to regain that eventually as well).
Another area in this same field that has gained a lot of traction, backed up by research, is to do aerobic exercise in general. When we do aerobic exercise, BNDF increases and this in turn causes new brain cells to form and new synapses (connections) to be established. This in turn allows the brain to make new pathways that can get those paralyzed muscles to move again.
The most important part in this rehabilitation process is repetition—the higher number of repetitions, the better rewiring takes place.
Of course we would all rather not have any stroke at all. The news here is good as well. Up to 80% of all strokes are preventable—by paying attention to managing risk factors and by recognizing the early signs of an impending stroke.
Manageable risk factors include keeping our blood pressure normal, not smoking or stopping smoking, keeping physically active, shedding pounds gradually if overweight, preventing diabetes or managing it optimally, and managing atrial fibrillation optimally.
The signs of an impending stroke are easily remembered by the word FAST. These letters stand for the following:
F—our Face droops, especially noticeable when one smiles;
A— when we lift up our Arms, one of the two starts to drift down;
S—our Speech sounds slurred; and
T—Time is of the essence. Phone 9-1-1 and get to an ER as soon as possible.
As we are managing the risk factors of CVA and strokes itself better, the death rates in the developed world is going down. In Canada it went down by 62% in the years between 1969 and 1999.
Suffering a stroke is a serious matter, but is it not wonderful today that we can use the neuroplastic capability of the brain to overcome a lot of its effects if we survive it? Had my grandfather lived today, he would have had a much better chance of survival and even of full recovery. Had we known then what we know today, I would have had fond memories of the grandfather that I never really knew at all.
About Dr. Pieter Strauss:
Dr. Strauss was born in South Africa, emigrating to Canada with his family in 1995. He has a private practice in the Fraser Valley and sees patients with mental health issues in his community. He was Head of the Psychiatry Department at a regional hospital with a staff of nine psychiatrists until last year when he decided to focus on his practice and his work at our hotel. Dr. Strauss has always been interested in long-term human relationships and envisioned enhancing relationships.