Pushing Past "The Plateau"
I recently saw the phrase "Say no to the plateau" on the group meetings for Aphasia Network Connection's virtual schedule. Of course, I have heard the word "plateau" repeatedly throughout my career but recently it has come up a lot with a negative spin so I wanted to address the myth and dive into the information and evidence behind the topic of the plateau.
A recovery plateau can be frustrating and might make you feel hopeless. It is a segment of time that follows spontaneous and rapid recovery. It is a slower period of recovery.
In the past rehab professionals believed that recovery stalled after 3 months which is the typical time frame for spontaneous recovery. Historically, doctors believed that recovery stopped after the 6-month mark and stroke rehab programs often ended at that time. However, research has continued to indicate that recovery continues well past the one-year mark.
Plateaus are not permanent. The most inspiring journal article that I have found in researching this topic is the story of a man who regained use of his left hand after 23 years. Here is the abstract and link to the article “Motor recovery beginning 23 years after ischemic stroke” (Soros, Teasel Hanley, and Spence 2017)
https://doi.org/10.1152/jn.00868.2016.
“Widespread bilateral activation of both sides of the cerebrum and cerebellum are demonstrated on functional MRI after motor recovery of a completely nonfunctional left hand that began 23 yr after a severe stroke. This suggests that the generally accepted window of recovery beyond which further therapy is not indicated should be entirely reconsidered.”
SO… What is behind the idea of a progress plateau?
To break this down we have to understand neuroplasticity. To put it simply, we know that the brain can compensate for break downs and roadblocks by changing and shifting to make up for a deficit using different pathways.
I found this topic best explained by Daniel Laskowitz, a professor of neurology at Duke University:
“The central nervous system retains an innovative ability to recover and adapt secondary compensatory mechanisms to injury. The basis of recovery stems from neuroplasticity, defined as the ability for neurons in your brain to make adaptive changes on both a structural and functional level, resulting in recovery of functions thought to be lost.”
Now that you know that plateau is a normal part of recovery and does not stop the process I hope it gives you the means to stay motivated and consider a shift in your approach or try a different path.
How to get past the plateau?
I have found a multitude of published journal articles that demonstrate that patients have gained motor function, communication, and cognition improvements years after brain injury/stroke. I love therapy apps for this purpose and changing up your routine instead of just doing the same thing over and over. Some great therapy apps are Tactus therapy, Constant therapy, and Lingraphica.
If you need specific help determining the best apps or exercises for you please reach out to me at Danni@mobilefeesnwa.com
#1) Learn Something New:
Try learning to use a tablet if you never have before, learn to use a new remote, or listen to a new podcast. Anything that feels fresh and interesting to you and requires you to focus and learn new steps will do the trick.
#2) Support Groups:
Aphasia Recovery Connection has a full line up of support groups online. Here is the link for the virtual connection video tutorial on youtube: https://youtu.be/77eEOWASKE4
You will have to learn how to use “Zoom” but this will address #1 as well! Ask a friend to help you login the first time.
A quick google search will result in multiple support groups that are held online right now in our current pandemic.
#3) Feel gratitude for the progress you have made:
Gratitude shifts your focus and brings more things to be thankful for into your mind. There is so much to be thankful for and you have likely made significant gains in all areas. Yes, there is still room to improve but give yourself, caregivers, and your therapy team credit for the progress already made!
Resources:
www.tactustherapy.com therapy apps
https://www.aphasia.com/about-lingraphica/- lingraphica therapy apps
https://www.facebook.com/aphasiaARC/- Aphasia Recovery Connection Facebook Group
https://healthprofessions.ucf.edu/cdclinic/aphasia/- aphasia house- intensive rehab UCF
Where to find me:
Danni Welch, MS CCC-SLP
Caregiver Connection Facebook Group
