How am I getting better?
January 7, 2013 4:46 PM   Subscribe

I had a stroke the beginning of November. It was a ischemic stroke in my Pons, part of my brainstem, and afterwards I had poor control over the left side of my body. I know what happened, and why; I don't need that explained. What I don't understand is how I have improved so much.

The way I heard of it, some of my nerves died because of blockage of blood flow. Nerves don't regrow; they're gone forever. They were involved in controlling the left side of my body, and a few days after the stroke I couldn't walk, I couldn't lift my left hand above my head, I couldn't open my fingers all the way, and I couldn't move my left ring finger at all. All other motions were severely restricted (e.g. my grip was very weak). All of that I completely understand: the neural control over the muscles was gone because the circuit was broken.

I spent three nights in the hospital, and then 18 days in a rehab facility getting about 3 hours of rehab work per day. And it seemed like every morning when I woke up I had more and more back. I'm not 100%, and I never will be. But I can fully control my left hand, so I can type again. I can walk a mile with a cane, and walk fairly well even without it. I have long hair, and one happy day I realized I was able to tie my hair back for myself without help. My left grip now is nearly as strong as my right grip.

My recovery was, from my point of view, quite miraculous. What I don't understand is what was happening inside of me to re-enable all of the control and strength. If the nerves that used to do all of that have died, then what is doing it now? How did the circuits get reestablished?
posted by anonymous to Health & Fitness (16 answers total) 5 users marked this as a favorite
posted by telegraph at 4:49 PM on January 7, 2013 [9 favorites]

"Nerves don't regrow; they're gone forever."

That was the old dogma, which has been re-examined in recent years. Adult neurogenesis
posted by tdismukes at 4:51 PM on January 7, 2013 [7 favorites]

Yes, plasticity is the answer. There is a lot of redundancy in the nervous system, and multiple brain regions can supplement or take over important functions. Congratulations on your continuing recovery from your pontine stroke, I never knew one could have a non-lethal brainstem infarction.
posted by Nomyte at 4:54 PM on January 7, 2013 [3 favorites]

It might also be similar to what happened with people post-polio where there is a lot of damaged or destroyed nerves but the remaining nerves pick up the slack. Unfortunately later in life problems show up again as there are fewer nerves available once old age starts to take it toll.

The polio virus attacks specific neurons in the brain stem and spinal cord. In an effort to compensate for the loss of these motor neurons, surviving cells sprout new nerve-end terminals and connect with other muscle fibers. These new connections may result in recovery of movement and gradual gain in power in the affected limbs.
posted by srboisvert at 4:58 PM on January 7, 2013

Depending on how much you like reading scientific articles (this is a review, and is pretty readable) Recovery of Motor Function after Stroke. It's a bit old, but still covers a lot of the above.
posted by gaspode at 5:07 PM on January 7, 2013

This fascinating and very readable book addresses your question. It has a chapter on learning to move and speak after stroke.
posted by lulu68 at 6:08 PM on January 7, 2013 [2 favorites]

As covered in the above links, the intricate and nearly infinitely complex network of neurons in your brain attempts to reroute the lost connections, sort of like water spilling around a dam.

This may occur in conjunction with the natural regrowth of partially damaged neurons along the damaged pathways, but that portion of the theory of plasticity is still under debate. It has been documented in the neurons outside the brain, but recently a growing body of evidence suggests it occurs in the brain as well.
posted by hobo gitano de queretaro at 6:48 PM on January 7, 2013

Don't nerves form new networks to replace old ones?

Perhaps you were lucky, and received some excellent and immediate occupational therapy after your stroke.

My MIL had a stroke about 5 years ago. While she was hospitalized in a facility with excellent OT, she wasn't interested in doing it and as a result is confined to a wheelchair, mostly because she has moderate mobility issues on her left side.

It was explained that if she tried really hard in the first year to regain function, should might have been able to walk again. But depression took its toll...
posted by KokuRyu at 7:11 PM on January 7, 2013

Neurogenesis does occur in the dentate gyrus of the hippocampus throughout life, and some of these new neurons do migrate to other areas. However, the number of newly produced neurons is fairly negligible compared to the total number of neurons in the brain. In fully grown adults, the rate of neuron death outpaces that of replacement by a substantial margin.

Most plasticity in the adult brain occurs via the growth of new dendritic branches and synapses. In other words, existing neurons are growing outwards and establishing new connections with surrounding neurons. These new connections can, over time, adapt to functionally supplement or replace damaged areas of the brain.

Imagine a company that is suddenly forced to downsize. Existing workers may be asked to take on additional tasks and responsibilities to cover the loss in capacity. At first, this is bound to result in some confusion, disorganization, and inefficiency, as employees learn to juggle their new work with their existing work. The quality or quantity of output may temporary fall. But new training programs are instituted to ease the transition. Over the weeks and months, employees adapt to the new workflow, and things begin to run much as before.

Rehab is like a training program for your little neuronal employees. It's directed practice that allows your brain to relearn how to function after a reduction in capacity.
posted by dephlogisticated at 7:52 PM on January 7, 2013 [3 favorites]

KokuRyu - there are devices that have had some moderate success in stroke rehabilitation even years after the injury. Your wife might consider those if you are interested in regaining some function.

And so that my comment isn't a derail, yeah, neuroplasticity is the reason. Even if neurons don't regrow, most of their function is determined by the connections between them, over biological cables called axons and dendrites. The axons and dendrites of the remaining neurons can get reshuffled or reprogrammed to have new function.

Adult neurogenesis (new nerve growth) is a thing, but it's not a huge effect and hasn't been shown much in cortex (big part of brain that strokes affect). Most of the recovery comes from rewiring.

Regarding the device above, it's actually a company started locally by a friend of mine who is a genius. This device allows more neuroplasticity years after the stroke event by reading the person's own muscle signals and adding mechanical assistance to the movements, which creates a setting favorable for neuroplasticity to happen.
posted by kellybird at 8:11 PM on January 7, 2013

I could have written this OP about my husband except that his clot was in his midbrain. Smack dab in the center, a dead spot the size of a quarter. We were told at first that he was going to be dead or a vegetable.....we've just passed the 4 year anniversary and he has made a complete recovery. He did after about a year.... he was 37, has a blood clotting disease that we didn't know about till his stroke. His Neuro said that young brains can do remarkable things.... I hope you continue to improve!!
posted by pearlybob at 8:30 PM on January 7, 2013 [1 favorite]

I like this book - The Brain That Changes Itself

From a review:
"the author is interested in the theory, but he's even more interested in how all of this can be applied to better the lives of real people. He talks about people with strokes who've learned to walk again, people with vestibular problems who've learned to substitute something else for their missing vestibular system, people who've been helped with ADHD, autism, retardation, and many other "incurable" conditions by altering their brains"
posted by skrozidile at 8:33 PM on January 7, 2013 [1 favorite]

Age can have a lot to do with neural plasticity, and also hormones.

You can look into CIMT for your residual weakness.
posted by (F)utility at 10:24 PM on January 7, 2013

Jill Bolte Taylor is a neuroscientist who had a stroke. She has a video on and also a book where she discusses her situation in greater detail. She explains a lot about neuroplasticity in a very simple, easy to understand manner.
posted by Solomon at 2:24 AM on January 8, 2013

I'll 3rd the recommendation for Doidge's The Brain That Changes Itself. Great book.
posted by tdismukes at 7:39 AM on January 8, 2013

Age and general health probably also aid in rapid recovery. I had a stroke in my late twenties, over 30 years ago; My whole left side was dead. I was otherwise very healthy and physically active and the docs were amazed at how quickly I recovered.
posted by mareli at 7:55 AM on January 8, 2013

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