In patients with stroke due to brain damage, initially there may be no movement in one side of the arm and leg, depending on the severity of the disease. In the following days and weeks, voluntary movements are seen gradually as a result of the ability of the brain to adapt itself, namely its plasticity . The person begins to be able to pull the leg and arm. Often these first movements are rather crude and simple than those normally performed. For example, when the patient tries to raise his hand, his shoulder also rises. He cannot pull on his ankle alone, he pulls on his entire leg. Certain movements cannot be performed in isolation; instead, a group of movements can be done in combination. This is called synergistic action.
Do Synergistic Movements Prevent Healing?
The fact that the patient, who could not move his paralyzed arm or leg at all until a few days ago, started to move, even roughly, is undoubtedly a positive step in overcoming the paralysis. However, the important thing is how these first movements can be developed and made functionally meaningful. Because being able to pull the arm a little but not be able to use the hand, being able to pull the leg and extend it but not being able to walk means that great limitations continue in one’s life. Strategies for approaching synergistic movements have an important place in the history of neurological rehabilitation spanning nearly 100 years. There are those who argue that functional movements should be based on these primitive movements.
Why Do Synergistic Movements Occur?
Although synergistic action prevents the person from using the paralyzed side arm and leg comfortably, it is an indication that the paralysis is healing. In stroke, the parts of the brain that make the movement orders can be damaged due to clotting in the brain, blockage of the cerebral vessels or cerebral hemorrhage. In this case, weakness develops in the muscles of the body part controlled by that brain part. After a brain injury, the brain tries to adapt itself to the new situation. For this purpose, the parts adjacent to the damaged area or the healthy part of the brain on the opposite side can take over the lost functions. It’s like a re-learning process. For the rehabilitation process after stroke, it is often compared to a baby learning to walk or to use his hand for the first time. At first, the movements are rude, clumsy. But with intense repetitions and exercises, the skills gradually increase. With physical therapy, movement patterns can be separated into its components and it is aimed to perform hand, finger, wrist, elbow, shoulder movements independently of each other.
Plenty of Repetition is the Key to Stroke Treatment
The way to eliminate unwanted muscle movements after a stroke is to practice intense movement. For this, hundreds of repetitions of exercises suitable for the current situation of the person should be applied every day. The fact that the exercises are for a certain purpose increases the efficiency. For example, it may be more effective to move an object in a way that requires a finer grip, rather than lowering and raising the arm 100 times without paying attention to fine movements. The fact that the exercises are very easy reduces their contribution to development. If it is too difficult, the person will feel unsuccessful and his motivation may decrease. Between these two, exercises at the level of difficulty suitable for the person should be applied, difficulties and goals should be developed as development is high.
The key to learning is repetition. With practice, the neural circuits in the brain related to that movement become stronger. Since synergistic movement patterns include abnormal movements, if patients repeat these patterns too much, it can be worried that the wrong movement patterns will become well established. However, this danger exists only if the person does not try to do his best towards a certain goal. Exercising, even if it involves abnormal movement patterns, is more beneficial than no exercise at all. If the patient focuses on moving better with each repetition, their skill in that movement will increase over time. With enough repetitions, the brain begins to break synergistic patterns and isolated movements become feasible.