Two Roads Diverged...

There are two ways to go after stroke: 
1. Compensation (technically: The compensatory approach)
2. Recovery (technically: The restorative approach)

Compensation involves getting on with your life by any means necessary. If your right hand doesn't work, you do everything with your left hand. If you can't walk because your foot drops, you put on an AFO. If you have trouble speaking, there's an app  for that.

Recovery involves using the intact part of the brain to take over for the "stroked" part of the brain.

It would be nice to say that the focus of clinical rehabilitation is on recovery. But for the most part, managed care only pays for compensation. Insurance companies want to get the survivor safe, functional, and out the door. Why do they want the survivor safe? Because an unsafe survivor will cost them more money down the road (think falls). Why do they want the survivor out the door? Because every day in any clinical setting costs a ton of money. But while survivors also want to be safe, and out the door, is it in their best interest to be "functional"?

On the face of it, sure, survivors want to be able to function. "Function" is a catchall word that means "getting on with your life." And it's seductive. Everyone wants to be functional. Everyone wants to be independent, and able to function.

But there is a problem with function. And it's not just a generalized idea that if you "focus on function" you'll ignore recovery. It's a very specific concept based in neuroscience.

It would make sense that if you focus on learning compensation, you would spend less time on recovery. And this would mean that you would become better at compensation, but less recovered. But it's more than just a time issue. It's a brain issue.

It turns out that something special happens to the brain after stroke. The brain is in an almost "infantile state" after stroke (in fact, after any brain injury). And "infantile state" is a good thing. The brain, through a release of special proteins is "primed" for learning— like an infant's brain. But what will it learn?

Well, it could learn to compensate. If you are right-handed and you have limited use of your right hand after stroke, the brain could learn to compensate. Your left hand would be doing a whole bunch of things never did before. The left hand is now handwriting, attempting to tie shoes, brushing the hair and teeth, and dressing. And it's doing it all alone — no right hand to help. So during this period in which the brain is "primed" for learning, the left hand does all the learning.

But if the focus is not compensation, but recovery, there will be more recovery. The brain is "primed" for learning, and it learns to recover.

Clinical research indicates you are smarter if you don't buy lumosity

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Lumosity is a scam. It costs $15 a month and it will change your brain. What does it do to your brain? It makes your brain better at playing the lumosity games.

Really you don't need fancy software and a computer interface to do what human brains have been doing for the last 200 thousand years. 

Heck, these guys don't even use the word neuroplasticity right. Their tagline is "Lumosity is based on the science of neuroplasticity." But neuroplasticity is not science. 

(note: The previous link was to luminosity's website. But they must've gotten enough flak about the whole "science of neuroplasticity" thing that they took it off their website. However, others have found, and recorded, the same statement.)

Neuroscience is a science. Biology, chemistry, zoology -- these are sciences. Saying neuroplasticity is a science is like saying E=MC2 is a science. In fact, both E=MC2 and neuroplasticity are theories. Given the fact that lumosity has a huge stable of neuroscientists, you think they'd be able to figure the nomenclature.

The fact is, the best way to "train your brain" is to challenge your brain. This challenging of the brain -- also called learning -- changes neurons. Learning stresses out neurons which react by creating new dendrites, that then form new synaptic connections. The best way to rewire your brain to learn something new is the old-school stuff; learning a new language, learning a new musical instrument, learning a new sport, etc.

I'm not sure I could put it better than this: "The (lumosity) scam is a pretty smart one because it melds together not just one but two classic plays in the world of conning – the idea that you don’t have to work hard for something because there’s a hidden shortcut, and the inherent belief that you could be brilliant if only you could tap some hidden skillset lurking somewhere in your brain-case."

How can stroke survivors drive this sort of change in their brain? It involves a lot of hard work. The work has to be very challenging. The bottom line is, there is no game, or machine or pill that will help you learn. And there's no game, machine or pill that will help you recover from stroke.

More up-to-date blog entry on "brain games" here.

"Science. Confusing everyone since the 1500s!"

Girl. 
For no particular reason.

An interesting article came out recently in the popular press. Bottom line: Oral contraceptives (OC) can increase risk of stroke. OC can also increase risks for other diseases as well.

Let's talk about stroke first. Current use of OC increases chance of a clot breaking of somewhere in the veins/arteries and causing stroke. Interesting side-note: Chances go up with the amount of estrogen in the OC. Nerdy way of saying this: "... the risk is directly proportional to the amount of estrogen present in the pill." 

The article also says there is an increase in brain and breast cancers. Brain cancer chance IS doubled but the type of brain cancer they're talking about is very rare so a doubling still makes it ... very rare. 

Breast cancer is increased but only if you are a recent user (within the prior year). 

And what of the affect of oral contraceptives (OC) on stroke? "Current OC use increases risks of venous thromboembolism and ischemic stroke. However, women of reproductive age are at low baseline risk, so the chances are small."