Regaining Movements – Learned Abandonment

Do you feel like you've reached your limits? Has recovery slowed down, or maybe even stopped? Despite all the exercises and development, your arm and leg movements are not improving? The general belief is that after a stroke or other injury, certain movements are lost because the brain areas responsible for them are damaged – but this is only part of the problem.

There is another phenomenon working in the background that may stand in the way of development and be the missing link in the recovery.

This is Learned Abandonment.

What is Learned Dropout?

Learned avoidance is the phenomenon in which the brain and body abandon or do not use certain movements after neurological injuries; not only because the brain regions responsible for the movement have been damaged, but also because during recovery from neurological injury – when performing these movements is difficult or impossible – the brain has learned not to use these difficult or impossible movements to solve problems.

How does it develop?

In a neurological injury, certain movements become difficult or impossible due to the damage to the brain. In the period following the injury, the survivor is often too weak to move the affected limb – and after the first few unsuccessful attempts, they may not even try again.

The problem is that in the weeks and months following the injury, the nervous system begins to repair itself. Surviving nerve cells try to take over the functions of the dead cells. If certain movements are not used during this period, they are left out of the repair process.

What we don't use, we will lose sooner or later.

If the body later uses these movements and fails, this serves as a further confirmation signal to the nervous system that these movements do not work, and it abandons them; and after a while, this state becomes fixed in the brain's neural connections.

Why do we lose movement at all after a brain injury?

Loss of movement is a common consequence of injury to brain areas and neglect. The process and its recovery are both complicated because the nervous system is complex, but to a certain extent adaptable, and all its members are interconnected.

There are indeed some areas of the brain whose damage affects arm and leg movements.

• One of these is the motor cortex, which is responsible for initiating movements – and controls arm and leg movements, among other things. Even mild damage to this area can manifest as weakness in limb movements.
• Damage to the somatosensory cortex can also impair movement. This area of the brain is responsible for processing sensations from the body – after processing, all signals from the sensory organs and sensory cells arrive here.
  And if the processing of sensations – for example, those that provide information about the position of the limbs, their environment, or muscle tension – is not appropriate, then the movements that use these sensations will not be appropriate either.
• The thalamus is the brain's processing center: it processes, organizes, distributes, and transmits numerous sensations and movements and commands that come into the brain. It receives information from the sensory and motor cortex, the cerebellum (which is responsible for controlling movement and coordinating movement commands), but it also receives inputs from the brainstem (reflex functions) and the basal ganglia system (movements that can be performed automatically, without attention, such as practiced dance steps).
  The thalamus is the most important brain center. It is just as vulnerable to stroke as other areas of the brain, and damage to it can also affect limb movements.

However, the injury itself is only part of the trauma – be it a stroke or other damage. In various injuries and strokes (whether ischemic or hemorrhagic), insufficient blood supply to the brain leads to cell death, and thus to the death of certain areas of the brain. Nerve cells are extremely sensitive to the availability of sugar and oxygen delivered by the cerebral arteries, and without them they survive for a very short time.

If the blood supply to the brain is disrupted, it damages the arteries themselves and also the nerves through the loss of nutrient and oxygen supply.

In severely affected areas, nerve cells die. However, there are parts of the affected region (the border regions of the lesion) where cells suffer a stroke or injury, but survive the effect; and enter a kind of “sleeping” state. And although dead nerve cells are unable to regain their function, these “sleepers”, at the edge of the damaged areas, which were only affected by the lack of blood supply, can later begin to regenerate.

This regeneration begins in the first few months after the injury: the previously “sleeping” neurons begin to wake up, and their return is often accompanied by spectacular improvements. Appropriate developments are critical during this period, as they help the returning neurons to receive the appropriate impulses for their activity and regain their function.

Some of the connections of these returning neurons have died due to the injury, but during this period they try to form new ones in their place. The brain tries to reorganize itself, to mitigate the damage as much as possible. And that is why, if after the injury, certain movements are abandoned or not used by the survivors – they do not even try them, or they do not try them enough – then those movements are left out of this restoration.

The nervous system learns to abandon these movements on its own; a condition may develop in which the use of certain muscles and limbs becomes impossible because the brain does not consider that type of movement as a command that can be issued.

Is the process reversible?

There is no simple, universal answer to this question either. There are examples of survivors successfully regaining lost movement, but unfortunately there are also those who do not. There are many factors that influence how and to what extent limb movement can be regained after a stroke.

However, just as new habits can be acquired and learned, there is always the possibility of relearning lost movements and reversing the loss.

The question that follows is how?

There are strategies you can use for this, but before we get into them, I need to address two important things.

Plasticity of the nervous system

The nervous system is plastic, meaning it can be molded – it constantly adapts to circumstances and influences. In the brain, no significant new neurons are created and existing neurons do not divide, but those that are there are constantly forming numerous new connections with each other.

These connections are temporary, and only those that are actually used will survive and become stronger. (This is the basis of learning. Learning new things – like dance steps – involves new connections, but dances that are practiced a lot, often giving the same contraction commands to the same muscles, become fixed.)

Plasticity is activity-dependent, so the more we use something, the more its neural connections become fixed.

Nerve cells under a microscope, stained with fluorescent dye

Sensory and motor function are equally important

As we mentioned above, after an injury, the brain sometimes has difficulty identifying certain body parts and limbs. Each part of the body has its own area in both the sensory and motor cortex, which is responsible for processing and controlling sensations. If there is a malfunction in the functioning of these areas, then even if a stimulus reaches the injured arm, the information does not reach the brain, or – in the opposite case – even if the movement command is sent from the brain, it does not reach the limb.

In extreme cases, there is so little input from the limb that the brain completely forgets that the limb even exists.

Without incoming sensation, there is no movement. Therefore, it is very important that in development, when we try to form and strengthen new connections of surviving nerve cells, we develop both motor and sensory functions equally.

Strategies to Reverse Abandonment

The most important ingredient is intrinsic motivation, which is the basis of all learning. You have to want to learn, to feel and move the limb again. You can't convince yourself that this movement is lost forever due to the injury.

You need to be aware of the sensations coming from the injured limb and give the movement commands, because this is how the neural connections develop and strengthen. You need to believe that after each practice, you will get a little better.

Rebuilding movement

The most important task when planning tasks is to set goals that are definitely achievable: smaller, fewer types of movements instead of complex, large movements. Large goals cannot be achieved immediately at the beginning of development, and failures only further strengthen the belief in the nervous system that these movements are lost.

Let's set smaller, but definitely achievable goals that provide a sense of achievement and reinforce to the brain that these movements are indeed feasible and effective! Only from here can further development begin.

Proper equipment

As with all training and learning, it is important to choose the right tools for the purpose and the person. Anything that provides support for the arms and legs, resists gravity, or helps practice sliding movements can be useful for reversing the Abandonment.

Mirror therapy

The essence of mirror therapy is to place a mirror between the moving and non-moving limb, and follow the movement of the healthy arm in it, while trying to copy the first with the non-moving limb. This practice helps to return and fix sensations, but requires great concentration and awareness to develop good anchoring and interpersonal relationships.

Choose an activity that brings you joy.

Learning goes much better if we do something that interests us and practice something that we find pleasure in. In development, we should choose movements that are important to us and that we use often in everyday life. Even small successes in these bring great joy, which is the strongest possible feedback to the brain that we are on the right track.

Positivity

Restoring the Abandoned Movements depends in part on the brain and nervous system recognizing and using the movement form. A positive attitude, optimism, the example of others and experiencing their successes help strengthen good brain connections.

Limited movement

If the limb cannot be moved at all, this method is not recommended because it reinforces the feeling of failure and bad experiences. However, if the limb can move at least a little, it can be a good development method.

During the method, a good limb is tied up and its movement is restricted, so that the other, less mobile limb is forced to perform the task. This method involves intense mental and physical strain, but helps restore movement. Recommended for advanced users.

Closing remarks

Although the elements listed here are very useful, without internal motivation, determination and perseverance, they cannot achieve great results on their own. Your task is to make up your mind, want to do it, and continue even if the results are difficult and slow to come. The brain and nervous system are complex, and already ingrained dynamics are difficult to rewrite, you need to be patient.

Stay optimistic, persevere, fight and ask for ARNI's help.