As a private practice musculoskeletal physiotherapist, I rarely get the opportunity to work with neurorehabilitation patients – such as people who have had a traumatic brain injury or stroke. So, when I had a 72-year-old man come in to see me 7 years after his first stroke, with left sided weakness (including a subluxated shoulder) and spasticity, I jumped at the chance to help him improve his quality of life. Through my university training, I am well aware that functional improvements can be made post-stroke, but I had only ever worked with stroke patients in the acute hospital setting. I was confident that we could improve this patient’s functional abilities, however I did not want to give him false hope of recovery and waste his time and money. So how long is too long post-stroke to begin your rehabilitation?

I started doing some research and came across some very encouraging information. It confirmed to me that recovery is possible at any age and any stage post-stroke.  Studies have shown that your brain is capable of changing for your entire life through neuroplasticity.  Post-stroke, neuroplasticity allows your brain to rewire functions that were once held in damaged areas of the brain over to new, healthy parts of the brain. The key to this rewiring is repetition, repetition, repetition!

Neuroplasticity is activated through practice. Whenever you practice something, your brain becomes engaged and starts to grow and adapt itself to get better at the task.  In the 4 months since I started working with this patient (initally 2x30min sessions per week, now 1x30mins per week), he has been able to lift his hand to his mouth, grip various sized objects and lift his feet better over door landings. His left shoulder is no longer sitting in a subluxated position and therfore his left arm movments are less painfull to achieve. But one of his long term goals is to be able to eat his meals without assistance. This patient is determined to become more independent and despite battling with fatigue, he is well on the way to achieving this goal.

What I have also learnt is that optimism is vital in post-stroke recovery, and therfore you should always strive for full recovery.  When you fall under the limiting beliefs of a poor stroke prognosis (for example, being told that you’ll be stuck in a wheelchair for the rest of your life) then you fall under the nocebo effect, where bad things become true simply because you believe that it will come true.  This isn’t to say that you won’t have to work really hard, because you will. But believing in yourself will help you achieve a higher recovery than anyone predicted.  Medical practitioners need to give you a realistic prognosis post-stroke, but what ever happened to the good old kiwi number-8 wire attitude?  And how good does it feel to prove people wrong?!

So to summarise, I believe the brain is an amazing piece of machinery that drives our body, and despite all our medical research we have no way of knowing what each individual’s full potential really is. The key is a positive attitude, perseverance with exercises and listening to your body. Fatigue can limit ones progress, but doing what you can as often as you can, will make a difference no matter how small or trivial it seems while you are doing the exercises. There have been a number of times that my patient has wanted to throw the tennis ball across the room with his good arm out of frustration. But he also acknowledges that his work with that ball has helped his progress.   Never give up on yourself, and if you think Physiotherapy and Pilates rehabilitation exercises could help you, or a loved one, reach their full potential after a stroke then please contact myself or one of our friendly team to find out more.

Rachel Barrett
Botany Studio Manager