How To Deal With Plateauing In Stroke Recovery, Trying The Technique Of Tasking CompositionWith Dr. Nick Housley 29th Jul, 21
The recovery is often rapid in the first few weeks or months after stroke, but it may slow down after a while, and you may hit a plateau. However, you can still make progress with focused exercises towards specific goals.
Stroke Recovery Plateau
During the first three to six months after a stroke,
the progress is consistent and encouraging. But when you
get further along with stroke recovery, you may see a
little or no improvement. It is the stroke recovery plateau.
There are limits to how much a brain or biological system of a human can physically adapt to things, which is one of the reasons for plateauing in stroke recovery. Once a person reaches that limit, it becomes harder and harder to get additional benefits, and it takes more time and patience to do so.
However, it is a theoretical point. In literature, these kinds of doses can be very high, such as 5-8 hours of rehab per day or a saturated response that is difficult to obtain. Technically, there are biological limits, so it is also significant to determine if you can reasonably get to them. And in most circumstances, you probably will not, so it is a less probable event that you may reach your limit.
Overcoming Stroke Recovery Plateaus
You should do your motor practice for 6-12 months before terminating your rehabilitation and deciding that it is a plateau and you may not get better. Although you may not see any immediate results, you should remain motivated to practice. You can do real-world task practice along with robotics systems and use tasking composition and learned nonuse. Also, you can log or keep a record of your progress to check where you stand.
Use a hybrid approach
You should use a hybrid approach to get the best results. For this, you have to use a robotic system as well as repetitive task practice. Use a robotics system (such as Motus Hand) for 10-15 minutes of your training to help sort of prime the system and get motor networks going. Then do repetitive practice outside of the robot system to ensure that you can apply the skills in the real world.
The tasking composition procedure requires you to break down a specific goal into its parts, then to practice each component step exhaustively. For example, one person wants to brush his hair. It is a pretty simple task, but it is relatively complex. The patient has to learn how to pick up the comb from the table and manipulate it sufficiently to use it as a tool effectively. He has to coordinate his whole arm and then take it above his head to do that delicate and precise task. It takes a lot of steps to complete this simple task. Thus, the patient should break it down into steps and then practice those to achieve his goal.
Behavioral adaptation such as learned nonuse (previously known as hemiakinesia) is a technique where the patient learns not to use his functional side to perform any activity. Instead, he uses his affected side to do a task. He struggles and tries to do that task again and again until he is tired. And then, he uses his functional arm to perform that task. He will not be able to finish the tasks at first, but that is fine. With time and practice, he will adapt to this change and will be able to do the activities with his affected side.
The plateau phase in the stroke recovery process is normal. You have to be consistent, patient, and motivated to overcome this phase. You can change exercises, use a hybrid approach, do constrained induced therapy, practice tasking composition, and use a learned nonuse approach to past the stroke recovery plateau.