Neuroplasicity

Phrenology, 1835 / Wellcome Images Several people have written in with stories of dismal therapists saying "If your walk hasn't improved by X time, you will probably wear your ankle brace forever." I got the same sort of comment. I switched therapists and hospitals. After years of work, I walk heel-toe.

Neuroplasicity is the brain’s capacity to create new pathways when there is damage. This is a major point of stroke rehab: to get your brain's attention so that it can form these new pathways. "Right after a stroke you have a burst of spontaneous plasticity, when you can recover language, sensation, movement control, balance, simultaneously," says Prof. Tom Carmichael, who studies brain repair after stroke at UCLA.

Plasicity slows down after a few months. Then it continues, differently. "If someone has trouble walking two years after a stroke, they can definitely improve their gait, get better control of their legs, but it takes a lot more work. And it occurs more slowly. It usually occurs with the focus on that one thing—walking—and it doesn't occur while hand function will occur. The focus on one thing and work really hard on it in the chronic phase,” says Carmichael.

You can keep improving but it takes immense work. There is a lot of new rehab research going on, such as robots to help patients do thousands of reps.

Dismal therapists deserve second opinions.