If you or a loved one had a stroke or other brain injury, you may wonder how and if the brain can repair itself. The answer is yes, it can, and the process is called neuroplasticity.
It’s happening in the brain throughout your lifetime as you learn new information and activities. It’s also crucial during recovery after a traumatic or non-traumatic injury to the central nervous system, including the brain and spine.
“Basically, I like to think of the words neuro and plastic,” said Alissa Rudloe, a physical therapist at Encompass Health Rehabilitation Hospital of Tallahassee. “Plastic can change, but it takes a stimulus. It has to go under heat for the stability of the structure to change. Then you have neuro, which is related to the brain. The brain and nervous system have to have some stimuli to change and reorganize.”
What is neuroplasticity?
Neuroplasticity is the brain’s ability to reorganize and adapt its structure and function, so you can learn and retain new information. After an injury or illness that affects the brain or spinal cord, neuroplasticity can help regenerate damaged nerve cells, also known as neurons, to help you regain lost function, both mentally and physically.
“It’s like building new road maps and connections,” Rudloe said. “If a road is damaged, we repair or build new ones. Think of the brain reorganizing and making new connections in response to damage.”
Types of neuroplasticity
There are two basic types of neuroplasticity: functional and structural.
- Functional plasticity occurs when the brain has been injured or damaged in some way, including from a stroke or traumatic brain injury. It is the concept that different areas of the brain control different functions. If the brain is damaged in one area, another area can take up that function.
- Structural plasticity is the brain’s ability to physically remodel by growing new connections between nerve cells and even growing new nerve cells.
10 Principles of neuroplasticity
The concept of neuroplasticity is nothing new. The first theory about its role in recovery was published by William James in “Principle of Psychology,” in 1890.
More than 100 years later, researchers developed the 10 principles of neuroplasticity. These principles now serve as the basis for recovery after a brain injury. They are:
- Use it or lose it. Every ability and action is connected to a neurocircuit in your brain. If they are not practiced or used, they will weaken, and you’ll lose your ability to perform those tasks.
- Use it and improve it. Practice drives your brain function to improve over time.
- Specificity. The brain forms specific new circuits in response to new tasks, so if you want to get better at walking, Rudloe said, you should start walking.
- Repetition. If you want to create a change in your brain, you must practice and repeat.
- Intensity. If it’s not intense enough, your brain function is not going to improve.
- Timing. The sooner you begin rehabilitation after a stroke or brain injury, the better.
- Salience. The activities and therapy you perform need to be important to you. For example, if you want to return to gardening, your recovery should include gardening or activities that simulate it.
- Age. The older you are, the more difficult it is for your brain to repair itself, but that doesn’t mean improvements and recovery are not possible.
- Transference. Learning one skill or activity can transfer to another. “That means doing stairs could also help improve your walking,” Rudloe said. “Learning in one area can influence another.”
- Interference. On the other hand, learning a new skill could also set you back or interfere in another area.
Rehabilitation after stroke or brain injury
As a physical therapist in the inpatient rehabilitation setting, Rudloe said the principles of neuroplasticity are an integral part of the care plan when it comes to treating individuals recovering from stroke or other brain-related injuries, even those that are considered degenerative.
“If you have a degenerative disease like Parkinson’s, it’s important to keep up with therapy,” she said. “We try to educate these individuals when they leave the hospital that they’re not done with therapy. They need to keep on exercising. It goes back to that use it or lose it rule.”
In the inpatient rehabilitation setting, individuals receive therapy for three hours a day, five days a week. “I tell people you don’t want to go to a nursing home after a stroke because it’s not going to be intense enough,” Rudloe said. “You’ll maybe get one hour a day. That’s what’s so good about Encompass Health. You’re going to get three hours a day, and it’s going to create plasticity in the brain. Your therapists are going to make it intense enough.”
The therapy you receive in an inpatient rehabilitation hospital like Encompass Health may include speech, occupational and physical therapies that are customized to your lifestyle prior to your injury or illness. Your goals in inpatient rehabilitation will not only include practicing everyday activities like eating, dressing and walking, but can also incorporate hobbies and other activities you enjoy, such as golf, playing with grandchildren or caring for a pet.
Neuroplasticity in action
Rudloe recalls a former patient of hers who had an incomplete spinal cord injury. He came to Encompass Health Tallahassee with the goal of walking again.
“Every day we were doing gait training with him,” she said. “We would get him on our harness system and get him standing. We were putting weight on his legs and getting his legs moving on the treadmill. Now, he’s home and walking with a rollator. That’s amazing.”
What is dysphagia?
Like aphasia, it can be caused by neurological conditions such as brain injuries and stroke, but it also can stem from muscle disorders, certain cancers and blockages/strictures in the throat.
Depending on the cause, dysphagia can be temporary or long-term.
Conditions commonly associated with dysphagia include:
- Parkinson’s disease and multiple sclerosis
- Neck and throat cancers
- Late-stage Alzheimer’s disease and other dementias
- Cervical neck surgeries
Stages of dysphagia
There are three phases of swallowing that are impacted with dysphagia:
- Oral: This is the process of chewing food and mixing it with saliva to form a bolus in order for it to be moved from the front of the mouth to the back of the mouth. A person with dysphagia in this phase could have trouble breaking down the food enough to properly move it to the back of the mouth to trigger the swallowing reflex. This stage is also where tongue weakness or decreased sensation may impact the ability to clear food from the sides of the mouth causing it to pocket in the cheeks.
- Pharyngeal: This is where the swallowing reflex begins, and pharyngeal muscles push food down the throat to the esophagus. The epiglottis (a cartilage) inverts to protect the airway and sends the bolus towards the esophagus. This is when the upper esophageal sphincter opens to allow food to travel into the esophagus. A person with dysphagia in this phase might feel like the food is “entering the wrong pipe,” Delashaw said, because the muscles in the pharynx and/or larynx are not operating properly to prevent food or liquids from entering the airway.
- Esophageal: This is when the bolus is taken from the upper esophageal sphincter that has opened, allowing it to enter the esophagus. Peristalsis (muscle contractions) carries the bolus from the upper esophagus towards the stomach. In this phase, a person with dysphagia may feel like food is stuck in their throat or chest.
Symptoms of dysphagia
Dysphagia symptoms could include:
- Coughing or choking during or shortly after eating or drinking
- Heartburn or indigestion
- Feeling that food is stuck in the throat or chest
- Painful swallowing
- Regurgitation
- Food sitting in the mouth or being pocketed in the cheeks
- Unexplained weight loss
- Reduced desire to eat
Diagnosing dysphagia
Dysphagia is diagnosed by a healthcare provider. Speech-language pathologists diagnose dysphagia with a comprehensive oral exam and swallowing examination, which should include swallowing tests such as a FEES or MBS exam.
- FEES: FEES stands for fiberoptic endoscopic evaluation of swallowing. This is an exam where a speech-language pathologist inserts a small thin scope with a camera through the nose and allows visualization of the throat, larynx and vocal cords to assess swallow function as you eat and drink certain foods.
- MBS: During a modified barium swallow study, a speech-language pathologist will give you food and liquids covered in a small amount of barium. As you swallow, X-rays are performed to view your swallow in real-time.
Treatment of dysphagia
After a dysphagia diagnosis, a speech-language pathologist can help determine what consistency of food and liquids is safest to eliminate risk of choking or aspiration. They can also provide therapy and exercises to help strengthen the muscles used during the different stages of swallowing.
Treatment should always involve a discussion with the individual to determine their wishes regarding oral intake and development of dysphagia treatment.
“If difficulty is noted in the oral phase, we can design an exercise program to target movement for the muscles used when breaking down the food,” Delashaw said. “Say you had a stroke that impacted lip muscles, and you can’t hold food in your mouth. We’re going to work on increasing the control and strength of the lip muscles, so you do not lose liquids or foods out of the mouth.”
In addition to exercises, Delashaw said neuromuscular electrical stimulation could also be used to increase muscle awareness in the different stages of dysphagia.
In the esophageal stage, your speech-language pathologist could suggest obtaining a referral from your primary care doctor to a gastroenterologist for further evaluation.
Recovery from dysphagia
Depending on the diagnosis and related conditions, dysphagia could improve over time. If swallowing difficulty is related to a neurological condition, inpatient rehabilitation could help develop adaptive techniques and diet plans to meet your needs and quality of life standards.
The multidisciplinary approach in this setting also allows for other symptoms related to your condition to be addressed through intensive therapy. In addition to working with a speech-language pathologist, your therapy team would also include a physical therapist and occupational therapist to address mobility and strength as well as activities of daily living and quality of life.