“We have a brain for one reason and one reason only, and that’s to produce adaptable and complex movements.” This quote may come as a surprise. As we are often only concerned with our client’s muscles, joint, lungs, and hearts. The reality is that all training is brain training, we just don’t think of it that way.

In our previous article, we showed you this picture to help understand neuroplasticity and how neurons that wire together, fire together. In this blog we’ll use the same picture to understand how sensory input to the brain affects motor output.

The sensory area (purple) is on the front “slice” of the parietal lobe. The neurons here will be activated by sensory input such as touch, vibration, threat, pressure, temperature and joint position. Lying just in front of the sensory area is the motor area (blue), which is the back “slice” of the frontal lobe. The neurons here are activated through volitional movement.

In both the sensory and motor areas of the brain, you can see in the illustration that specific areas are dedicated to specific body parts. And those areas are represented in the same areas for sensory and motor (e.g., where the hand is located in the sensory area is in the same place in motor area along the “slice”).

Why sensory input matters for stroke survivors

The bottom line is that for you to move an area well, your brain must be able feel, or “sense”, the area well. This is why issues like peripheral neuropathy in the feet so greatly affect the ability to balance and walk. Having good sensory input from an area of the body is a prerequisite for good motor control when we try to move an area.

One of the most prominent dysfunctions after stroke is a reduced ability to move one side of the body. This can occur at many different levels, from total paralysis to reduced coordination of fine motor skills. Common examples include limb spasticity, usually in flexion (e.g., a clenched fist held close into the chest), or what is termed “drop foot”, an inability to dorsiflex (lift) the foot, which severely interferes with a safe, functional gait pattern. This happens because the stroke damaged areas in the motor cortex associated with the affected body part.

The good news is that by increased sensory input to the affected area, we can begin to improve motor output. You have likely seen this already if you have ever used things like percussion guns or kinesiology tape. The many new “toys” we see in the fitness industry these days are simply sensory input devices, providing the sensory area with more and novel input, which then allows the motor area to “fire” better and provide better movement (i.e., improved range of motion, more strength, etc.).

A 2017 study found that “kinesio tape application to the tibialis anterior has significant effects on motor recovery of the lower extremity, spasticity, ambulation capacity, HRQoL (health-related quality of life) and gait compared to the control group and baseline.” (1)

The concept of sensory input affecting motor output and how to harness it is not only for stroke recovery, but also for general fitness, performance, and pain clients!

Begin learning a neuro-centric approach to medical fitness and how to work with stroke survivors with our Stroke Recovery Fitness Specialist online course, available through the MedFit Classroom.

Pat Marques is a Z-Health Master Trainer and NSCA-CPT specializing in training the nervous system to improve performance and get out of pain.  After retiring from the Active Duty Army, Pat pursued his education and certifications in exercise science, initially working with wounded, ill, and injured soldiers. During this time that Pat discovered the power of using a neurological approach to training to get out of pain and improve fitness and performance. He currently provides exercise therapy, movement reeducation, and strength and conditioning for all levels of clients at NeuroAthlete, from chronic pain sufferers to Olympic-level and professional athletes.

References

1. Belma Fusun Koseoglu, Asuman Dogan, Hilmi Umut Tatli, Didem Sezgin Ozcan,Cemile Sevgi Polat (2017). Can kinesio tape be used as an ankle training method in the rehabilitation of the stroke patients? Complimentary Strategies in Clinical Practice, Vol. 27.

Neuroplasticity is the brain’s ability to reorganize itself by forming new neural connections. This occurs through the changing of neurons, the organization of their networks, and their function via new experiences. Neuroplasticity is also called neural plasticity, brain plasticity, cortical plasticity, or cortical re-mapping.

You are experiencing neuroplasticity every time you learn something new, such as how to use a new computer program, a new line of music, a new app on your phone, or a new exercise in your workouts. Learning is neuroplasticity.

For brain injuries such as stroke, neuroplasticity takes on an even greater importance. Because the injury literally damaged or even destroyed neurons, we must harness neuroplasticity to build new neural connections to do regain or improve upon the resulting dysfunction. The cool thing is that other areas of the brain, those not normally associated with a given action, can assist if the stimulus is strong enough.

Why neuroplasticity matters for all brain injury survivors

The concept of neuroplasticity is very important and if you work with stroke survivors it is a concept you will want to explain at some level. Here are some points of why neuroplasticity is so important:

• Neuroplasticity provides hope – Despite the fact that the concept of neuroplasticity has been around for several decades, it is still not widely understood in the public arena. When we explain neuroplasticity to our pain and brain injury clients, they often reply that knowing this gives them hope. Hope is especially important for a stroke survivor, in which the loss of a major motor function occurs so swiftly that it can seem to be a very daunting process to recover from.
• We can target neuroplastic change – The great thing about learning a neuro-centric approach to training and exercise therapy is that the nervous system is very orderly and so we can be very targeted in our training to regain or improve dysfunctions.
• Neurons that wire together, fire together – Understanding some basic neuroanatomy can go a long way. The bottom line is that areas of the brain that live close to one another can affect one another. Here is an easy example:

• • In the picture above, we see the sensory (purple) and motor (blue) cortices of the brain; if we had an issue with knee articulation, we could stimulate that area by moving the hip and/or ankle, which would “fire” into the knee area just by their proximity.
  • Here is a less obvious example: Also, notice how close the eyes and the hands are in the sensory and motor maps; you can help motor control of the hands by doing eye exercises.
• You have lots of “backup disks” in the brain – A stroke can damage whole neuronal areas beyond repair. While this sounds daunting, it is still possible to regain function. One aspect of neuroplasticity is that other areas of the brain can actually take over to learn and perform tasks they are not normally associated with, given the right kind and amount of stimulus.

The concept of neuroplasticity and how to harness it is not only for stroke recovery, but also for general fitness, performance, and pain clients! Begin learning a neuro-centric approach to medical fitness and how to work with stroke survivors with our Stroke Recovery Fitness Specialist online course, available through the MedFit Classroom!

Dr. Grove Higgins is a chiropractor, rehabilitationist, soft tissue injury expert, researcher, anatomy instructor, biomechanist, human performance expert, speaker, and corporate health consultant. In 2015, Dr. Higgins cofounded Neuroathlete with Coach Patrick Marques (LTC, US Army Ret.) and Peter Hoversten. Neuroathlete’s goal is to more broadly deliver neurological training to a global audience.

Master Trainer Pat Marques served in the Active Duty Army for 20 years in the Infantry and Special Forces, including combat tours in Iraq. Upon retiring Pat decided to try and combine his two passions – soldiers and fitness. He was able to work with soldiers through adaptive physical training, helping them deal with amputations, chronic pain, PTS, and traumatic brain injury. Pat has completed over 600 hours of neurological training, becoming a Z-Health Master Trainer. He currently provides exercise therapy, movement reeducation, and strength and conditioning for all levels of clients at NeuroAthlete, from chronic pain sufferers to Olympic-level athletes. 

15 Million People Suffer Stroke Each Year. There is a huge “real” need for stroke survivors to have continued physical therapy after their insurance has covered their (usually very limited) physical therapy sessions.

It’s an important time for fitness professionals to step up and gain stronger knowledge in physical rehabilitation with stroke survivors. This need is worldwide!

I know this because I have helped survivors worldwide and heard their stories of struggle. I’ve personally heard their human desire to get their bodies back to movements for everyday life. This includes things like walking, arm and hand function, balance, cognitive skills, stability, driving and much more!! Hundreds of thousands of survivors are desperately seeking proper care and guidance.

I have been asked by stroke survivors and caregivers worldwide for help. After I published my first book in 2017, The Stroke of an Artist, The Journey of a Stroke Survivor and a Fitness Trainer, I began being contacted from all over the world for help. I wanted so badly to help them all.

I also received calls and messages from personal trainers who had a survivor client. I was surprised at how some reacted. For example, one trainer, after spending an hour sharing knowledge and telling him to seek out more education beyond the one-day certification he had, responded with “So basically…” — he tried to sum up in one sentence how to train a survivor. And he had it all covered. I thought, wow, that survivor’s recovery is determined by this trainer’s ego and lack of listening skills. Most trainers I spoke with wanted a quick answer to full-body stroke recovery. They did not want to take the time needed to extend their knowledge.

I decided to begin a Stroke Recovery support group via private Facebook group page. There are almost 3000 members. It breaks my heart, but it keeps me constantly motivated to do what I can to help them and try my best to educate fitness professionals.

It is wonderful to have such a gathering from all over the world in this stroke recovery support group. It is serial and fascinating.  Everyone is so kind and supportive in the group to one another. They encourage and try to help each other so much.

Last year, I received an email from a wonderful woman who lives on the New Jersey Coast. She had read my books and wanted to know if she could fly herself and her 82-year-old stroke survivor husband to Florence Oregon, to train with me. She shard some stories of trainers refusing to work with him and those who did not have the knowledge needed. She also shared a couple stories about physical therapist not wanting to bother with using specific equipment that was needed for him. This is so disappointing. He is now almost 4 years post-stroke and she has still searched out some guidance toward a better recovery for him. It saddens me with all that she has gone through, but I am grateful that I could help, the best I know how. I made some great life time friends.

I am honored that she reached out to me.  I am still in “ahh”, by the whole experience. Often stroke survivors and their caregivers do not find the help needed to further their recovery after physical therapy ends. Unfortunately, some survivors do not even get good physical therapy in the crucial, early stages in recovery, when it is essentially needed. She shared with me some not so good experiences she and her husband had faced, like many others I have spoken with.

They arrived the last week of September 2018, and we met to train almost every day for 4 weeks. It was a productive training month for him. He made some important gains, but has much more hard work to do. I am helping them find a professional near them with the neuro and biomechanics knowledge, needed to bring him further in recovery.

She shared with me that what sold her to come see me was a handwritten note I sent to her inside of the book order she had. She ordered “The Stroke of An Artist, The Journey of A Fitness Trainer and a Stroke Survivor.”  I knew she would get more out of help with that book if I sent her my second book “Tipping Toward Balance, A Fitness Trainer’s Guide to Stability and Balance.” I included it with the other book as a gift.  I had no idea that that would lead to her and her husband taking a journey from the Jersey coast to the Oregon coast to train with me in person.  It is very special.

I have surveyed 100s of stroke survivors in the challenges they have faced finding good guidance in further recovery. Even though there are good stories, there were a much higher amount of disappointing experiences many survivors and their caregivers have faced. Some keep pushing forward and some gave up.

Article reprinted with permission from Tracy Markley. 

Fitness Specialist and Educator Tracy Markley is the Founder of Tracy’s Personal Training, Pilates & Yoga in Florence, OR. Tracy has over 2 decades experience in the fitness industry; she holds numerous specialty certifications, including many for those with medical conditions & chronic disease. She’s also studied the Brain and the neurological system, and has had great success working with seniors and special populations in stroke recovery, neurological challenges and fall prevention. Tracy also serves on the MedFit Education Foundation Advisory Board

She’s authored 3 books: “The Stroke of An Artist, The Journey of A Fitness Trainer and A Stroke Survivor” and “Tipping Toward Balance, A Fitness Trainer’s Guide to Stability and Walking” and “Stroke Recovery, What Now? When Physical Therapy Ends, But Your Recovery Continues”. Her books bring hope, knowledge and exercises to those in need, as well as sharing her knowledge and experience with other fitness professionals.