The Future of Stroke Rehabilitation: Improvements to Stroke Rehabilitation May Lie Within Dementia Treatment

Jazmine Afolayan is a graduate of Creekside High School in Fairburn, Georgia, where she wrote this paper for the Stanford Digital Education course Raise Your Voice. These days, she's furthering her studies in hopes of pursuing a solid future career in her home state.

By Jazmine Afolayan

Stroke researchers have developed effective treatments for the most restrictive side effects of stroke such as loss of movement and loss of speech. However, I propose that these treatments could potentially be improved by incorporating methods found in treatment for dementia patients. I propose that there are two takeaways from observing dementia treatment. First, stroke research should focus more on neurogenesis rather than neuroplasticity as a relevant biomarker, or a measure of specific body functions (in this case, neural function and development). Second, dementia research could offer insight on how stroke treatment could be developed into something more engaging and aware of the patient’s emotional health.

In my experience, stroke patients are treated through personal care for daily needs and such. After my grandmother had her stroke, she was admitted to a hospital. This would become her new abode. When I visited, she wasn’t doing much. She lost her ability to speak and walk, and the nurses were doing all they could to prolong her life. I often wonder, though, whether things may have gone differently if her treatment had prioritized restoration over prolonging the damaged life. My core question is: why address the after-effects instead of the issue at heart? Thus, I conducted research to create a feasible solution from my current knowledge, reasoning, and experience.

When an individual experiences a stroke, the blood flow in the brain is halted. Most stroke research addresses one type of stroke, the ischemic stroke, which occurs when blood flow through the brain is blocked. The result is that neurons stop functioning and die. A stroke takes the lives of many patients because it kills neurons that are important for daily function. Motor-based neurons are only some of many; neurons that are in charge of digestion, information processing, or other key functions, may die as well. Essentially, destruction of vital neurons is what makes experiencing a stroke so deadly. Although strokes occur in the brain, they can affect the entire body.

With regard to neurodegenerative diseases or other brain-related illnesses, two processes are worth noting: neurogenesis and neuroplasticity. Neurogenesis is the creation of new neurons, while neuroplasticity is the reformation of pathways between neurons. I argue that stroke research is limited in treatment methods because it focuses too much on neuroplasticity. Most stroke treatment is focused on motor recovery; it lacks focus on facilitating the creation of new neurons and thus lacks a variety of treatment methods and benefits.

Some researchers in the field have acknowledged the limitations that come with the usual treatment approach that embraces neuroplasticity alone. For example, Sheng Li, et al., in “Spasticity, Motor Recovery, and Neural Plasticity after Stroke,” acknowledge these limitations and argue that neuroplasticity is not always the solution; for example, different forms of motor deficiency may result from stroke, such as spasticity. Li defines spasticity as muscle stiffness that occurs when a damaged neuron attempts to send information to the muscle and although communication between neurons is occurring, information being sent cannot be interpreted by any of the neurons. Spasticity calls for treatment approaches beyond those that target neuroplasticity alone: something more may be necessary to help stroke patients whose circumstances may include spasticity.

How might those in the field shift their focus to neurogenesis and create more effective treatment? Li recommends pursuing RS hyperexcitability, the activation of neurons in the spinal tract, which facilitates muscle movement, in order to address spasticity and neuroplasticity to address general motor functions. However, I go further, to propose a possible way by which researchers could address stroke issues such as loss of motor function by making changes to the common stroke treatment methods. In “Rehabilitation for dementia using enjoyable video-sports games,” Yamaguchi, Maki, and Takahashi discuss criteria for improving dementia treatments. Their research addresses dementia, which is similar to stroke because treatment for both conditions requires training the brain towards recovery. The article advocates for treatment approaches with more fun, motivating, empathetic, and social aspects, which would make treatment more efficient. By following these guidelines, stroke researchers may develop new treatment options and possibly improve post-stroke lives.

What other benefits come with embracing neurogenesis in treatment? For one, treatments that pursue neurogenesis primarily focus on developing new neurons. The idea is that creative treatments could offer new experiences — even slightly new experiences — to patients each time. The novelties could help neurons “evolve” or produce new neurons that are upgraded versions of their predecessors. With more neurons, patients can execute more functions. In addition, creative treatments may allow neurons to change, becoming more diverse in function. In a 2013 study, Simone Kuhn, et al., found that playing video games engages people’s brain in ways that can counteract neurodegeneration, requiring spatial navigation, strategic planning, working memory, and motor skills. Following Yamaguchi’s guidelines, post-stroke video game therapy could effectively treat patients because video games are fun and challenging. Further, while video games are system-based, in many cases, like Super Mario, they feature randomized aspects and thus provide players with a unique challenge each time. Such games create a nonstop cycle of new experiences, contrary to the repetitive exercises in the neuroplasticity-based stroke treatments.

Along with video games, leisure tends to promote neurogenesis and thus could help people redevelop cognitive skills. In “Leisure Activities and the Risk of Dementia in the Elderly” Joe Verghese lists activities such as playing musical instruments, dancing, and reading as activities that can reduce the risk of dementia. Such activities force the brain to process information (whether it be musical notes or steps) and to work the neurons. Cognitive skills or thinking processes lost after a stroke could possibly return as someone works to interpret information in different ways that are required by the leisure activity of their choice. Again we encounter the idea of strengthening brains through new experiences: ideal therapy may be providing each individual with an array of activities that can be performed differently each time (for example, playing multiple songs on clarinet, dancing to pop or rap songs, etc.).

In addition to highlighting the importance of neurogenesis, dementia treatment should also highlight the importance of a patient’s emotional well-being. In “Clinical Effectiveness of Musical Interventions” (2022), Felicity Baker talks about group musical performances possibly being used to alleviate dementia in older people. The benefits of engaging in such performances could be making social connections or experiencing enjoyment and connectedness. The focus in Baker’s study is to move away from one-on-one treatments such as patient-therapist communication. Baker presents the idea of making rehabilitation less of a medical appointment and more of a daily routine that makes the patient feel included and could possibly give them hope during their recovery phase. Another advantage to therapies that promote interacting with humans, or to doing treatment with individuals with the same condition, is that patients are able to relate to each other and discuss their similar circumstances. Patients meet different people and encounter different viewpoints when discussing their diagnosis, which offers the development of a vast perspective and encouragement during recovery. Emotional well-being of a patient is something important to consider as a patient’s emotional health is vital to their dedication to rehabilitation and life after recovery, promoting the success of their recovery.

Ultimately, stroke researchers may find it more effective to organize patient treatment around the ideas of neurogenesis and emotional health. Doing so may offer more benefits to stroke patients in comparison to treatment organizes around the sole idea of neuroplasticity, which would at best only aid in motor recovery. The shift in ideas is important because the purpose of rehabilitation is to save lives in the best possible manner, which calls for the pursuit of any process that ensures what is best for the patient. Although this suggestion shift in ideas promises improvements in stroke rehabilitation treatment, it is important to note that more research may be needed to show whether stroke patients can benefit in the same way as dementia patients, given that the two populations experience different brain illnesses. Apart from this, stroke researchers may find it useful to study the correlation between neurogenesis and the success of stroke rehabilitation. Some other topics that may require study are the extent to which neurogenesis occurs in older people, how their neurons change, and how the brain structure of stroke patients may differ from that of dementia patients. If the brain stops developing after a certain age, it could be that embracing neurogenesis may disserve older patients.

The simplest step in the direction of changing stroke rehabilitation methods would be to ask stroke therapists to learn more about their patients, discovering their likes and dislikes to find therapeutic activity that best suits them. Next, therapists would need to find ways to implement such activities in the hospital setting. Such steps are not difficult; however therapists would need to be willing to make changes. At the very least, stroke researchers may want to offer engaging treatments that emphasize neurogenesis as they would improve the overall well-being of stroke patients (physical, mental, and social health).

References

Li, Sheng. (2017). Spasticity, Motor Recovery, and Neural Plasticity after Stroke. Frontiers in Medicine.

Yamaguchi H., Maki, Y., & Takahashi K. (2011). Rehabilitation for dementia using enjoyable video-sports games. Google Scholar. International Psychogeriatrics, 23(4), 674-676. doi:10.1017/S1041610210001912

Kuhn Simone, et al. (2013). Playing Super Mario induces structural brain plasticity: gray matter changes resulting from training with a commercial video game. Mol Psychiatry 19, 265–271.

Verghese J. (2003). Leisure Activities and the Risk of Dementia in the Elderly. The New England Journal of Medicine.

Baker Felicity. (2022). Clinical Effectiveness of Musical Interventions. The Lancet.