Relearning after a brain injury, our best hope for recovery

Research continues to advocate for the plasticity of our brains, that brain structure can be altered in response to physiotherapy. This article with discuss the evolution of this idea and key principles around how the brain can change itself, giving you a greater understanding of the concept of neuroplasticity.

We used to think that no relationship existed between what a person did post acquired brain injury (ABI) and recovery. It was physiotherapists and other health professionals understanding that the damaged areas of the brain would only recover spontaneously, or not at all, and getting back lost function was wishful thinking. Thankfully, this is an outdated assumption, and transforming brain function through treatment is real.

Does this sound familiar?

After being diagnosed with stroke, you spend a week in intensive care, where you show a small amount of recovery. Then after a week, whereby you undergo a range of therapy treatments including physio, you are transferred to a rehab centre for a few weeks, and then sent home. You get another month of therapy as an outpatient and then your rehab treatment appears to be finished. At this point, your rehab and potential for recovery does not stop. You have just laid the foundations required to then continue to undergo evidence based therapy that will enhance your independence.

Neural plasticity is believed to be the basis for both the learning of the intact brain as well as the relearning of the damaged brain through physical therapy. To put it simply, the brain needs experience in order to alter its structure and function. To have the most effective experiences, we must apply a couple of key principles to our activities.

Use it and improve it, or lose it:

You may not realise it but as you acquire an ability, you actually create a system in the brain that did not exist previously. For example, the ability to read actually evolves in the brain, and a new connection of neurons has been formed that was previously absent in the non-reader. Had you not picked up that book and begun reading, you would have lost the potential connection you just formed. This is the idea of using part of your brain for a specific task, adding to your brain’s capacity, and improving its function.


Through repetition, the brain lays down neural connections becoming more efficient. Eventually whatever is repeated becomes so efficient that it will run automatically without our awareness. Take driving a car for example. At first we need to focus and think about all the many things required. In time though, the brain automates. In time you get so good, you are not consciously driving the car at all. This can clearly be useful, but if what we are repeating isn’t right, we get stuck in bad driving habits. The great news is that the brain always retains the capacity to change. If you are stuck, there are always options.

How do we apply these principles as neurological physiotherapists?

In order to get the most out of your neuro rehab, we as educators must first teach you the correct behaviour, ensure it is understood properly, and then appropriately practice until it becomes automatic. For example, Constraint-induced movement therapy (CI) forces the use of the affected side by restraining the unaffected side. With CI therapy, the therapist constrains the individual’s unaffected arm in a sling, and begins to teach the movement that we want to be relearned in the affected arm. The teaching is guided by the aforementioned principles to give the best chance of recovery.

So what does this all mean?

It means that someone with an acquired brain injury has the potential to improve their function, whether this be in the arm, the leg, or mobility in general. Yes, it does take determination, discipline, and of course time, but the outcomes can be very rewarding. We want to provide the opportunity for this population group to achieve more in their lifetime, and return to tasks they once performed.


Kleim, J. A., & Jones, T. A. (2008). Principles of experience-dependent neural plasticity: implications for rehabilitation after brain damage. Journal of speech, language, and hearing research, 51(1), S225-S239.