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The Long Path to Repairing a Damaged Brain

01/10/2013 05:49 pm ET | Updated Mar 12, 2013

Watch the TEDTalk that inspired this post.

"I pondered the irony of my experience -- a brain scientist having a stroke. I celebrated the joy I felt and the lessons I had learned. I was touched by the daunting reality; I was a stroke survivor."
-- Jill Bolte Taylor in "My Stroke of Insight"

There is no doubt that Dr. Bolte's inspirational sense of motivation and "stroke of insight" were strong factors in her recovery. But almost buried near the end of her 19-minute video she mentions one very critical thing, "It took me eight years to completely recover."

Each year, about 800,000 people suffer a stroke and not all of them are as fortunate as Dr. Bolte. Her book, My Stroke of Insight, details her hard work to regain her life and does not forget the fact that the return of her abilities did not happen overnight. In addition to her "stroke of insight", there were many other changes that took place in her brain. "... I had to relearn basic personal care, including how to dress myself. I needed to be taught to put my socks on before my shoes and why."

After a stroke or brain injury, the wires in your brain, those axons and dendrites of a nerve cell, start sprouting new "stems," new growth to seek out new connections. - Dr. Richard Senelick

When a stroke or brain injury harms a brain, it damages the connection between nerve cells. Remember your mother telling you to think with your "grey matter?" That grey matter is actually billions of nerve cells connected to each other by wires (axons) that carry the messages to move your arm or tell a waiter what you want for lunch.

Think about your garden -- or a garden you've seen on television. When you prune a bush, the plant grows back bigger, more lush, and healthier; it literally sprouts beautiful new growth. After a stroke or brain injury, the wires in your brain, those axons and dendrites of a nerve cell, start sprouting new "stems," new growth to seek out new connections. This is called collateral sprouting, and this regeneration is an important element of neural plasticity -- the brain's ability to repair itself.

Dose-Function-Motivation

We know from both animal and human research that with the right amount and type of therapy, we can both instruct other areas of the brain to take over the function of the damaged brain and also direct the damaged axons to connect with nerve cells that work. This is how you recover from a stroke, and this is what takes so long to repair. If you want to learn a new skill, you must repeat it many times. Just as multiple repetitions -- that is, practice -- improve your piano playing or golf swing, so do multiple repetitions of a task help drive the axons to connect with the nerve cells that will restore function.

Dose Matters

When we take a medication for a medical problem, we carefully adjust the dose. Too little antibiotic and the infection gets worse or never goes away. The same is true of rehabilitation. The intensity and amount of therapy matters. Much like it takes hours of practice to learn and improve playing a musical instrument, it takes hours of therapy to retrain the brain, nervous system and muscles. Malcolm Gladwell's highly popular book, Outliers, estimates 10,000 hours as the time it takes to become a high-level athlete or musician. It takes that much practice (repetitions) to train the brain and body. Remember, it took Dr. Bolte eight years to fully recover. That is 3.5 hours a day of working on getting better -- not an unreasonable comparison.

Function Matters

If you want to learn to play a piano, you need to practice on a piano and not just read about it. The same is true for rehabilitation. If you have a stroke and lose the use of your right arm, you will need to do tasks and therapy that require the use of your right arm. Performing these tasks will help rewire your brain. The more "functional" tasks you perform the more you will improve and more positive changes will take place in your nervous system. There is a good reason we tell you to keep your brain engaged as you get older.

Motivation Matters

Dr. Bolte is a perfect example of the person who is highly motivated and therefore has a good chance of getting better. Caregivers and therapists motivate stroke survivors, but survivors also draw motivation from their surroundings. Dr. Bolte was fortunate to find her own "nirvana", and gives a great deal of credit to her mother, G.G. "I needed those around me to be encouraging. I needed to know I still had value," she says. "I needed to have dreams to work toward."

For everyone, the strength of both a visible and invisible means of support makes an enormous difference in their recovery. In the video we see an engaging, funny and articulate woman with an important message. But, it is equally important that we do not ignore her long and difficult journey and those who are not always able to complete that journey.

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