Equalizer In Stroke Recovery


DACNB Special to the Boca and Delray newspapers

Neuroplasticity is the process by which the brain and nervous system can change and be “re-wired” according to the environmental stimulus it is exposed to. In essence, the brain re-organizes itself forming new neural connections. This allows for the nerve cells in the brain to compensate for injury and disease and to adjust their activities in response to new situations or to changes in their environment. With this information, there is new hope for individuals that have recently suffered a stroke but also for those patients that have had significant functional deficits for years without proper rehabilitation.

The fundamental principle underlying neuroplasticity is based on the idea that individual synaptic connections are routinely being removed or re-created, largely dependent upon the activity of the corresponding neurological pathway. The activity-dependence of synaptic plasticity is demonstrated in the Hebbian Theory: “neurons that fire together, wire together” and “neurons that fire out of sync, fail to link”. If adjacent nerve cells that are in close temporal proximity continuously produce neurological impulses, their functional properties may converge and increase. Conversely, nerve cells that are not regularly activated simultaneously may be less likely to functionally converge.

Concerning stroke, there is typically injury or death to nerve cells in certain regions of the brain.  Referencing the theory that “neurons that fire together, wire together”, we find in stroke that the nerve cells that are damaged or die in certain pathways affect the entire length of the pathway.  Thus from one anatomical area that physiologically suffers the stroke, several other regions can be affected.  Neuroplasticiy is a true game changer in stroke rehabilitation and recovery in that we can activate distinct regions of the injured pathway and produce results in the affected areas.    The pathway undergoes re-organization and new neural connections are formed by-passing injured locations.

A proper examination with an accurate diagnosis is very important in directing the treatment to the correct location in the nervous system. Traditional rehabilitation encompasses speech therapy, physical therapy, and occupational therapy.  However, technology and knowledge in the field of neurological rehabilitation has advanced significantly in the last ten years. Three cutting-edge rehabilitative procedures will be reviewed and include Interactive Metronome, Dynavision D2, and mirror therapy. These therapies are all based on neuroplasticity which states that the brain can change or mold according to the environmental stimuli it is exposed to.  They are also very heavily researched and allow the examiner and therapist to objectify the findings allowing for proper progression.

In referencing Interactive Metronome, this is primarily a motor- timing therapy. It works on a neurological process called efferent copy which integrates the cerebellum and the frontal lobe, two very important parts of the brain that allow us to have executive functions and independent thought processes. The exercise requires the user to keep up with a computer generated beat that is delivered in both an auditory and visual manner.

In regards to the Dynavision D2, this is a revolutionary diagnostic and rehabilitative tool.  It works on visuo-motor-spatial skills as well as the efferent copy mechanisms referred to earlier.  This therapy also has a positive effect on the cerebellum and the frontal lobe. The user is required to manually compress targets made up of LED lights that are blinking in a strategically established manner according to the neurological presentation of the person. The information is recorded and attention is focused on speed and sequence.

Lastly, CAPS or computerized assessment of postural systems is a diagnostic and rehabilitative modality. One of the first signs of neurological injury is disequilibrium which sometimes cannot be visually perceived or even elicited on a bed side exam. The CAPS unit is able to measure the smallest amounts of sway on a very sensitive accelerometer and provides an abundance of information for the practitioner to more effectively diagnose the deficiency and create an appropriate treatment plan. It is also used for therapeutic interventions by working on expanding what is termed the center of mass (COM) from the center of pressure (COP).

Dr. John Conde is a Board Certified Chiropractic Neurologist, one of only one thousand in the country. He holds diplomate status through the American Chiropractic Neurology Board. He provides specialized care for difficult cases of back neck pain, numbness-tingling, vertigo-dizziness balance disorders, fibromyalgia, migraines, AD/HD, autism, and dyslexia. His office is located at the Atlantic Grove in Delray Beach, FL and can be reached at 561-330-6096, drconde@thecondecenter.com, and at www.thecondecenter.com