The science of stroke rehabilitation: part one


'Biology is the study of complicated things that have the appearance of being designed with a purpose' - Richard Dawkins
'The brain is like a muscle, when it is in use we feel very good. Understanding is joyous' - Carl Sagan
'If we all light up, we can scare away the dark' - Michael David Rosenberg
'Practice makes permanent' - David Kelly


Stroke rehabilitation
is a science. Success requires different professionals working together at the cutting edge. To fully understand the principles of rehabilitation, we must know the nature of the brain. Within this article we will consider its evolution, structure and adaptive mechanisms. We will discuss research, science and medicine. We will then bring this knowledge together to explain the science of rehabilitation.

I hope to be a clear guide, but forgive me my eccentric parlance. It is hard not to feel inspired to see science used to such human benefit. I hope not to just explain rehabilitation, but to stoke the fires of knowledge-seeking inherent in us all. This article will open the window on the brain and explain how we may channel its natural mechanisms toward meaningful recovery.

The brain; first, in the middle and in the last


There is no deeper mystery and catharsis than understanding of the centre of our story, the brain. This porridge-like structure is the end result of evolution. The reptilian hindbrain hidden controls our baser functions, the primate midbrain our emotion and memory centres, and the very human frontal lobes, our abstract reasoning and learning. We see our complexity change with our brain's evolution, an organic narrative for the brilliance of life and adaption, stoked in the flames of harsh realities across eons.

The brain is responsible for not just out movements, but our whole perception of the world. Each stimulus, be it the music of Mozart or the smell of coffee, is cleverly processed and packaged into useable information. It explains the universe and asks for only oxygen, water and sugar in return. It is magnificently generous, and its penchant for pattern recognition and logical thinking is our greatest asset. All of this is fuelled by a simple blood network called your cerebral circulation.

Through the microscope we see that the brain is formed of neurons; metabolic powerhouses that talk to each other and the body, through complex dense fingers called dendrites ending in synapses. These very much resemble complex three dimensional spider webs, which undergo constant re-modeling. Collections of these neurons work together, to produce specific functions. The complexity of interaction cannot be understated, and has been fine-tuned by eons of trial and error. The brain is a complicated and purpose-built machine.

The creation of these cells is directed by a chorus of regulatory molecules and growth factors inspired by a range of internal and external stimuli. Neurons and their connections are strengthened by use. These cells and their connections form the intricate circuitry of our being and give intent to our form. You are your brain, and like you, it is complex and individual.

And like any precious and complex thing, its loss is devastating. A stroke, be it due to clot or bleed, steals it of its oxygen and fuel. Complex and ancient machinery grinds to a halt. Disability will be related to the brain region affected, and, to an extent, will vary by size of region. This may range from a paralysed limb to the loss of speech. The complexity of the brain betrays itself through catastrophic chain reactions. However, understanding this complexity can be used to our advantage.


Ben is a young NHS doctor in the Southwest. His interests include neurology, health communication, and medical ethics. He is also an avid advocate of compassionate care and quality improvement, running a project in the Southwest around medical humanities. Please follow and support: Dr Janaway on Facebook Dr Janaway on Twitter

The opinions expressed in this article are the author's alone and do not reflect those of the NHS or associated agencies. All facts are based on the best available evidence. The author is happy to receive questions. There are no conflicts of interest and due consideration has been given to the consequence of conclusion or interpretation.