How the brain can relearn what injury takes away

For most of us, picking up a cup of coffee is unremarkable. The hand opens, the fingers settle around the cup, the wrist adjusts, and the arm lifts. The whole sequence takes moments. But when a stroke or some other sudden event interrupts this sequence, the coffee break is no longer a pleasure. A simple, familiar act suddenly becomes a major problem.

Every year, 12 million new patients suffer a stroke. Another 69 million people suffer from traumatic brain injury (TBI). At least 6,000 people in the Emirates are living with Parkinson’s Disease, and at least as many with Multiple Sclerosis. Any of these conditions make the most familiar and simplest actions difficult.

The opportunity and the need to intervene is huge. How can one restore the ability to walk, to talk, to use the hand? How can one relearn something as simple – and yet as complicated – as picking up a cup and drinking the coffee? How do you teach the brain to recover what it has lost?

Recovery is almost always feasible. It may take time; it cannot be complete, but it can be substantial. Importantly, recovery is not restricted to the young. Recovery requires that injured cells resume their normal function in the brain and re-attach to the circuits in which they take part. That process is called neuroplasticity.

Neuroplasticity is one of the most powerful processes in the nervous system and continues through a person’s lifetime. Not only is it central to the recovery process, but it also underlies our ability to learn new things and to grow as human beings.

The basis for neuroplasticity is repetition. Imagine a non-Arabic speaker who one day decides to learn Arabic. At first, the student would have no words, no grammar, and no proper pronunciation. Over time, the student acquires some vocabulary and learns to say some things reasonably well, but still imperfectly. With practice, however, the student learns to recognise and express the proper sounds and then words, and expressions. In time, the student can reproduce them, and if all goes well, acquire fluency and idiomatic speech. It’s all a matter of repetition and practice. Repetition is equally the key to neurological recovery, irrespective of whether it be a matter of relearning to walk, regain control of a weakened hand, overcome a visual field defect, speak, calculate or strategise.

One often hears that practice makes perfect. Actually, that’s not quite true. It’s not just practice: it’s perfect practice. And that is precisely why the quality of rehabilitation matters so much. It’s important to have the right type of therapy, the right level of intensity, the right sequence of practice, and the right goals to work through. It is also important to have psychological support to overcome the inevitable discouraging moments when things don’t progress quite as quickly as one might wish.

One of the more cutting-edge contributions to neurorehabilitation has been the addition of neuromodulation technologies that enhance neuroplasticity. These include non-invasive magnetic stimulation of the brain, systems for stimulation of the vagus nerve, virtual and expanded reality, and telerehabilitation. Another advance has been the ability to monitor progress using wearable technologies that track gait, activity, and sleep. Other devices that help reduce stress have also been introduced.

As a result, the consequences of stroke, injury, and other neurological conditions should no longer be seen as irreversible. There is a huge amount that can be done to restore function, return to self-sufficiency and – something that is sometimes forgotten and rarely articulated – enhance dignity and self-worth. Our job is to heal the patient, and not just the condition. We are getting better at doing this day by day. We can now be more optimistic than ever before.

Dr Teo Forcht Dagi is a Neurosurgeon, and Chairman and Chief Medical Officer at Indoma