Did you know that one in three people in the world will need neurorehabilitation at some point in their lives? It is not strange if we take into account that every year 15 million people suffer a stroke, of which 5 million will suffer from some type of disability, according to the World Health Organization.
Fortunately, the paradigm shift that has occurred in neurological care in recent decades has helped us understand that the effects of brain injury are not always permanent. We now know the regenerative potential of the brain, as well as its ability to reorganize its dynamics, in such a way that neurorehabilitation helps many people to recover their lives.
Brain plasticity, key to recovering lost functions
When a person suffers from a neurological pathology, everything changes. Family roles are modified, routines are altered and family dynamics need to be restructured.
Following brain injury or disease, biochemical, anatomical, and physiological changes occur that result in a different brain. That “new” brain has typically lost some of the neural connections that made possible certain behaviors, such as talking, writing, walking, or even remembering what we did yesterday.
Neurorehabilitation is responsible for retraining the brain to reestablish connections, so that we can recover lost abilities and skills. This is possible thanks to neuroplasticity, which is precisely the ability of the brain to adapt its functioning in response to stimuli, either through structural and/or functional changes.
The neuroplasticity that neurorehabilitation takes advantage of is the same one that is at the base of learning and involves the creation of new neural networks. The same neural signals that promote learning in an intact brain are activated during the relearning process in the damaged brain.
This means that the brain is not a static organ but much more dynamic than we thought and changes with experiences. Processes such as the generation of new neurons, the migration of nerve cells and the formation of new neuronal connections are at the base of brain plasticity. This process of learning and relearning is what allows rehabilitation.
In fact, neuroscientists from the Charité Universitätsmedizin found that it is possible to rewire the brain through intense training and early rehabilitation. They found that intensive neurorehabilitation could restore the functioning and connections of damaged left hemisphere regions to facilitate language in people who have suffered aphasia after brain injury.
Researchers at Johns Hopkins University also found that if the motor cortex, the part of the brain that regulates coordinated intentional movements, is destroyed, the medial premotor cortex could take over if the person performs rehabilitation exercises that include those coordinated motor tasks.
These neuroscientists also verified the existence of a “window of opportunity”, which would be an ideal period to start neurorehabilitation, generally a few days after having suffered brain damage.
Windows of opportunity, take advantage of the period of greatest sensitivity of the brain
The objective of any neurorehabilitation program is to restore the person’s health, independence, and functionality. Obviously, the success of rehabilitation depends on many factors, such as the extent of the damage, the neural plasticity of the residual circuits, and the speed with which the recovery process begins.
A study carried out at the University of South Australia, found conclusive evidence that there is a window of opportunity that allows the brain to more easily “repair” itself after suffering a stroke. These neuroscientists verified that during the first days after a stroke, and up to two weeks later, the brain has a greater capacity to modify its neural connections and its plasticity increases.
Everything seems to indicate that this window of opportunity is not exclusive to strokes. Another investigation carried out at the University of Aarhus, found that this sensitive period also exists in the early stages of multiple sclerosis. This means that neurorehabilitation should not be used solely as a symptomatic treatment, but has great potential to protect against neurodegeneration and positively modify the course of the disease.
The “windows of opportunity” are specific time frames that allow to maximize the benefits of learning since the brain is particularly sensitive to these tasks. Therefore, starting neurorehabilitation as soon as possible increases the chances of success.
However, that does not mean that neurorehabilitation will not be effective later on. The brain can also be rewired months later, even years, even if it costs a little more.
One of the keys lies in the personalization of the neurorehabilitation program. It must be created a patient journey map for each patient and his family, so that the intervention plan is adjusted to the specific needs of each person, to help him project himself into the future in all senses, which also includes addressing emotional difficulties and the behavioral changes that often accompany brain dysfunction.
In general, neurorehabilitation is not only aimed at enhancing the autonomy of people in their day-to-day activities, helping them to recover their physical, cognitive and emotional abilities after a neurological injury, but it is also used to prevent possible complications that can cause a further deterioration of those functions. Therefore, it usually leads to an improvement in the quality of life that is always worth it.
Sources:
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Hordacre, B. et. Al. (2021) Evidence for a Window of Enhanced Plasticity in the Human Motor Cortex Following Ischemic Stroke. Neurorehabilitation and Neural Repair; 35(4):307-320.
Riemenschneider, M. et. Al. (2018) Is there an overlooked “window of opportunity” in MS exercise therapy? Perspectives for early MS rehabilitation. Multiple Sclerosis Journal; 24(7).
Zeiler, S. R. et. Al. (2016) Paradoxical Motor Recovery From a First Stroke After Induction of a Second Stroke: Reopening a Postischemic Sensitive Period. Neurorehabilitation and Neural Repair; 30(8).
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