Improving the Brain Body Connection for Stroke Recovery

 

Sight, sound, touch, learning, language, emotions, creativity and reasoning are high level functions of the brain which many mammals possess, but it is the human brain that is able to continuously learn and dynamically change throughout its lifespan.

It is commonly accepted that there are different functions governed by your right brain and left brain. This is evident when someone sustains a cerebrovascular accident (CVA), more commonly known as a stroke. A CVA occurs when blood flow to the brain is compromised.

The Brain Body Connection After Stroke

Stroke symptoms can include sudden numbness or weakness of the face or arm and leg on one side of the body, trouble speaking or understanding speech,loss of balance or coordination and severe headache

Photo by  Frank Busch  on  Unsplash

Photo by Frank Busch on Unsplash

 
 

The specific impact to the brain will be different for each stroke survivor however, most will experience physical, cognitive and sensory control deficits that ultimately affect their functional mobility and independence. That is why it is so important to start addressing the brain body connection with rehabilitation starting at day one. And that is not just true for stroke, many injuries such as concussions affect motor and sensory control.

Neurological Rehabilitation

With most traumatic injuries, there are many physical and cognitive changes that occur. For CVA specifically, the systems responsible for tactile feeling, hearing and language are impacted. Often times, the physical changes affect one or both sides of the body, known as hemiparesis or hemiplegia, depending on the severity of central nervous system injury.

Hemiparesis is characterized as decreased strength and/or sensation involving one side of the body, while hemiplegia is unilateral paralysis of the body. As a result, hemispatial neglect, or lack of response or decreased attention to the affected side, is common with many who have suffered a stroke. Left hemispatial neglect (the result of a right-sided stroke) occurs more frequently.

Movement professionals work with those that suffer a CVA, and other traumatic injuries, to promote as much functional return as possible while considering the effects of any current neurophysiological deficits. During this neurological rehabilitation it’s critical to include both motor and sensory input to improve motor responses and minimize or eliminate hemispatial (unilateral) neglect.

Neuroplasticity and Rehabilitation

Treatment philosophy of stroke and neurological rehabilitation is constantly growing as new evidence emerges, but one thing remains constant - neuroplasticity is key to any treatment protocol. Neuroplasticity is the brain’s ability to change throughout its lifespan; either strengthening or weakening the connection of messages to the designated areas of the brain or creating new pathways outside “normal” neural pathways.

Through neuroplasticity the brain is able to change, making neuroplasticity exercises key to stroke recovery.

When designing treatment plans clinicians regularly consider neuroplasticity and look to use a variety of methods to help their patients achieve the most success. Rhythmic cueing, mirror therapy, and mental practice drills are some of the ways they target the brain to establish healthier movement patterns. The WAV Sensorimotor Trainer engages the sensory perception required for functional movements and helps train the brain in favor of healthy movement.

A preliminary investigation of the brain function of healthy movers using the WAV shows it activates many brain areas including cerebellum, motor cortex, supplementary motor area (SMA) and parietal lobe.The SMA is thought to control postural stabilization of the body, the coordination of both sides of the body during a bimanual activity, and control sequencing of movements. How awesome!

Neuroplasticity Exercises

Neuroplasticity exercises for rehabilitation of motor control combine both motor and sensory input to create effective functional output. Side lying activities are chosen for acute stroke rehabilitation when applicable. This position modifies gravity and external forces placed on the hemiparetic side.

For example, if the right side displays hemiparesis and neglect, we may choose to lie on the left side to allow the right side of the body to explore space in open chain movements. We may also consider lying on the right side to approproximate shoulder and pelvic girdle to achieve more proprioception awareness of support. This "single side" approach may offer a bias of movement from one side while offering contralateral activation from the brain.

There are two research based approaches that highlight the importance of both motor and sensory awareness in rehabilitative exercises. These form the basis for this month’s movement, Sensible Sidelying.

  1. Training in ipsilateral patterns, like in sidelying, requires moving the limbs in a coordinated fashion. Limb activation training involves getting the patient to perform active limb movements on the contralesional side of the body in an attempt to bring more attention to that side of the body. This has been shown to significantly reduce visual neglect.

  2. First adding rotation to a side lying exercise encourages full system integration for trunk rotation. Stimulating the head and eyes to move in the direction of neglect has been shown to improve visual awareness on the hemineglect side.

Including sensory feedback with movements can help achieve self-awareness and possibly decrease neglect symptoms.

Layering sensory feedback with movements in an ipsilateral task while being mindful of cerebral abilities is a fantastic way to progress post stroke and even post operatively or post change in weight bearing status. Using the WAV to provide feedback for motor, visual and auditory cues aligns with current research. By simply pointing out a lack or overuse of muscular control with the auditory and visual feedback of the WAV coupled with movement professionals guidance can promote self-awareness and possibly decrease the neglect symptoms.

 
 


Sensible Side-Lying

Add rotation to encourage full system integration.

Part  1

  1. Begin in side-lying with your unaffected side down and the side of hemispatial neglect up.

  2. Bend your bottom leg to 90 degress and place the WAV on top of the bottom leg, from knee to ankle, to ground the supporting side of your body.

  3. Reach the top arm forward and direct your gaze to the fingers.

  4. Rotate the head, trunk and arm to explore space as you move. Remember to move within the available ROM (range of motion) to allow for success.

  5. Return to the start.


Part 2

Train for limb activation in side-lying position.
  1. Move the WAV to rest along your top leg, from the hip to the heel.

  2. Lift the leg to move the liquid from heel to hip.

  3. Return the leg downward to move the liquid back from hip to heel.

  4. Continue to lift and lower, calling attention to the visual and audible sensations of the WAV.

  • What am I doing?

Using the visual and auditory input of the WAV to effect motor output and sensory awareness.

Stimulating the brain body connection to improve overall functional activities.  

  • What am I mindful of?

    How does the WAV ground your body as you move the upper body through space?

    Does your gaze follow your hand, reaching and exploring space?

    Does the bottom leg stay connected to the ground and WAV even as you move your trunk and turn your head?

    When lifting and lowering the hip in abduction, how does the WAV liquid sound? Is it fast, slow, gushing or controlled?

    Can you feel the hip moving in sync with the sound of the WAV moving?


Footnotes
References for the impact of neuro based training for stroke and general rehabilitation for stroke patients referenced in this article can be found here:

  1. The definition of unilateral neglet and Stroke (n.d.) by Physiopedia
  2. Stroke: Also called Brain attack (n.d.) by Medline Plus
  3. Veerbeek JM, van Wegen E, van Peppen R, van der Wees PJ, Hendriks E, Rietberg M, Kwakkel G. What is the evidence for physical therapy poststroke? A systematic review and meta-analysis. PloS one. 2014 Feb 4;9(2):e87987.
  4. Prassas S, Thaut M, McIntosh G, Rice R. Effect of auditory rhythmic cueing on gait kinematic parameters of stroke patients. Gait & Posture. 1997 Dec 1;6(3):218-23.
  5. Dimyan, M. A., & Cohen, L. G. (2011). Neuroplasticity in the context of motor rehabilitation after stroke. Nature reviews. Neurology, 7(2), 76-85.
  6. Livingston-Thomas, J., Nelson, P., Karthikeyan, S., Antonescu, S., Jeffers, M. S., Marzolini, S., & Corbett, D. (2016). Exercise and environmental enrichment as enablers of task-specific neuroplasticity and stroke recovery. Neurotherapeutics, 13(2), 395-402.
  7. Nascimento LR, de Oliveira CQ, Ada L, Michaelsen SM, Teixeira-Salmela LF. Walking training with cueing of cadence improves walking speed and stride length after stroke more than walking training alone: a systematic review. Journal of physiotherapy. 2015 Jan 31;61(1):10-5.
  8. Beis J-M, Keller C, Morin N, Bartolomeo P, Bernati T, Chokron S, et al. Right spatial neglect after left hemisphere stroke: Qualitative and quantitative study. Neurology. 2004Aug;63(9):1600–5

This article is dedicated in loving memory of Irene Fitzick.


Lindsay is part of the movement team at WAV. As a top althete and final year doctoral student of physcial therapy she integrates the brain-body approach with her passion to help althetes avoid injury and achieve top performance.

Want to know more about using the WAV for senior fitness and rehabilitation? Contact us for more information about our sensory-based training approach.