Details Are the Devil

Peter G Levine
The Stroke Recovery Blog

Monday, April 29, 2013

Because it involves the brain, stroke recovery is complicated. The brain is complicated, so anything that involves the brain is complicated as well.

Except that's not true. And it's more than not true. Complexity, when it comes to stroke recovery, is evil.

Of course, complexity is out there if you want it. There are "treatment options" that force therapists to spend thousands of dollars and weeks of their life getting trained in the devil in the details. Some of these treatment options have been around for 40 years, but new ones are invented every year. Do these therapies work? They generally fall into two categories:

1. Been around forever, the data doesn't look good.
2. They're completely untested.

Anyhoo... with regard to stroke, complexity is evil. Complexity separates the survivor from recovery. Why? It turns out that no matter what any clinician is telling you, only you can make you better. Remember the old-fashioned way of saying "teach me?" It was "learn me." Learn me to do math. No one can you learn you stuff. You have to learn it. That seems rational to just about everyone when it comes to learning that involves the brain; things like learning math and chemistry and French. But for some reasons when we talking about movement, its not considered learning. But it is.

• Learning math involves changes in the structure and function of neurons in the brain. So does learning how to move.
• Learning math involves neurons in the cortex (the outer shell of the brain). So does learning how to move.
• Learning math involves repeated attempts towards the correct outcome. So does learning how to move.
• Learning math increasing complexity. So does learning how to move.

How complexity kills recovery.

• If instructions from a clinician are complicated ("Move your arm up but keep you shoulder down now turn your hand blah blah blah") movement performance gets worse.
• If the pieces that go into recovery are complicated the survivor will not be able to drive their nervous system towards recovery. Complexity make it impossible for survivors to work towards recovery on their own.
• Learning complicated treatment options ties up clinician's scarce education resources (time and money).

In every sense of the word, regaining the ability to move after stroke is learning. People, especially clinicians, want to talk about muscle weakness. "These exercise will help you move better." No they won't. What helps you relearn how to move after stroke is moving, not exercise. Of course, there's a fine line between the exercise and movement needed to relearn movement. But the emphasis on trying to build muscle is as mistaken as changing the oil in a car with no gas: Its a good thing, but hardly the main issue.

See the original article:
      Details Are the Devil
      in The Stroke Recovery Blog