I was reading about this topic in the FlintRehab site. A good site I believe, for therapy ideas. Here is a snippet:
Massed practice helps with recovery from the effects of a neurological injury, but how much repetition is enough? Let’s look at supporting research for the answer.
In animal studies on neuroplasticity after stroke, it was shown that 400-600 repetitions per day of challenging functional tasks can lead to changes in the brain.
However, the average therapy session for upper limb rehabilitation only requires about 32 repetitions. That’s far below what the brain needs, which can explain why many survivors hit a plateau after about 3-6 months. Dozens of repetitions are a good start, but hundreds of repetitions are preferred to maximize gains in function.
I suppose those repetitions could be everyday tasks like playing an instrument, knitting, buttoning a shirt, etc. or actual machine, weight, resistance bands, exercises and the like.
While perusing the internet, I came upon a couple of articles on the first real bodybuilder Eugene Sandow.
He didn’t have that huge bloated over-developed body like today’s Mr. or Mrs. Olympia, but more in the line of Greek statues. If you look up his routine, most of his workout was done with mere 5 lb. dumbbells
For each movement he used mindful contraction of the muscle and very high reps…usually 50. I tried the 5 lb. but had to move to the 2 1/2 lighter dumbbells. You might enjoy looking him up and his routine. There are youtubes on it.
My emphasis here though, is high repetition to increase neuroplasticity. I was in therapy yesterday and my therapist had me do movements that consisted of; at the most 30 reps.
What you do at home is most valuable.
Regards: Derek
Perhaps there are two interpretations of “massed”¿
Perhaps three!
Definitely high numbers of reps help. When we’re talking about neuroplasticity the brain requires that it’s a challenge is met repeatedly in different contexts with different characteristics in order for it to be effective in introducing change. If it’s met in a simple rote terms then the brain discounts it as being anything useful and it gets put on the forget list.
It is postulated that one of the purposes of sleep especially in very young children is the forgetting of strategies that did not work or are not required, or are being replaced by better strategies
Thus reps for muscle building are different to reps for neuroplasticity because muscle building can be repetition of the same simplistic actions.
I also think that “massed” as relevance in this context of ‘together with others’. Humans are tribal animals who major on cooperation hence having rich vocabulary and complex sentence formation. So class-based exercises have a relevance over lone exercise regimes
I agree I think flint have useful stuff .
Do you have any experience of their music glove It’s quite expensive so I haven’t taken the plunge but it may be something that’s relevant for me. I believe it requires a minimum amount of dexterity and I may be coming up to the point where I have that.
@SimonInEdinburgh Hi Simon: yes, just doing a high set of curls with dumbbells without thinking would not produce much Neuro. But as my therapist said and what Sandow encouraged was the mind over muscle technique. Be very aware and focus on every repetition and if possible watch the affected arm especially as it moves “as if your recovery depended on it”.
When I do sit-to stand squats from a chair I always have my right leg in full focus, feeling every up and down movement. This is the affected side.
When I play the piano, although clumsy, I know that my stiff fingers are getting hundreds of reps in, and with some enjoyment to boot.
In an earlier post I mentioned taking every thing out of my kitchen or bathroom cabinet with my stiff hand and arm and then putting it back: mundane, but if you “focus” can be valuable. Its all about the “mind set”. Walking can become mindless in a way but extremely valuable for the entire body.
Coming up with new challenges is grist for the mill and sometimes rather exciting.
Buying that erasable marker board and writing on it daily is improving my terrible hand writing.
I don’t need the Motor type gadgets that Flint sells, but they seem to be a Godsend to many. I have movement in all of my right side, but often with pain and rigidity that I have to fight everyday.
As far as cognitive improvement: discussions with friends and family and writing in various forums like this and my art forums is helpful as well as keeping a journal.
Regards, Derek
It seems that 400-600 reps is the standard for several Rehab outfits. Saebo recommends the same for their hand training, as do Neurofenix (that, or 60 minutes worth). I have to admit I find it incredibly boring just sitting there on my own picking up and putting down objects. Exercising to music has been more acceptable to me. Aquarobics has been a godsend. I’m exercising with other people, doing many, many reps and have found it fun and useful.
I wholly fully completely agree that multiple reps are boring, that doing it with other people has a beneficial effect.
Is your group exercise in person physiotherapy?
I keep wondering the weather a forum like this has hope of adding a cooperative element into our recovery exercises.
At risk of having more than one question diverting things - how do you find the neuro ball? I found the plastic buttons to stiff and the exercises to unimaginative and simple to help with the integrated movements that normal acts of daily living require but possibly useful for foundational aspects
The only group exercise I take part in is the Aquarobics at the local swimming pool. There are no group exercise classes (that I know of) that are physio/neuro based. Having said that, there are 3 of us stroke survivors in the class and we all agree it is really beneficial (and sometimes quite challenging), but it is great fun and being in the water means we can do things that just wouldn’t be possible outside the pool (eg running on the spot).
As far as the Neuroball is concerned, I agree it is of limited value. I bought it because it was similar in concept to the equipment I used when on the Upper Limb Programme at UCL a few years ago. That was far more sophisticated however (and far out of the price range of an average user) with far more interesting games. My bicep spasticity means I can only use the Neuroball for a limited amount of time, so I just complete the daily amount of reps required and then stop.
@MinnieB I tried water aerobics or aqua fit as it’s called at the place I went to this morning, for the first time today. It was fun and challenging, my coordination needs work but I’m going back, so guess I thought it will be of benefit, anything and everything I’ll give a go.
Have you tried looking on the AgeUK website for any venues near to you? Age UK services in your area The one I go to does Strength & Balance, Gentle Dance and Chair Yoga; I go to the Strength & Balance class which has been an absolute boon for me and I’m hoping to start the Chair Yoga next week And the beauty about them is there are people of mixed abilities and conditions all there for the same reasons you
@SimonInEdinburgh Great discussion and this is how we learn and share ideas.
About the mundane and the boring repetition: Now I’ve mentioned before that one of my exercises, if you can call it that, is to take everything out of the cabinets and put them back with my affected hand/arm.
(just one example of something boring).
Now if you do an activity like this with what is called “intentionality” and do it with all the focus you can muster, because your recovery depends on it, then the brain has to engage. The Zen masters put emphasis on complete focus on the task at hand., Example doing the dishes could be a bore, but if you focus on one dish at a time and it being the only thing you want to do with all your attention (intentionality) the task can become more enjoyable or at least not such a chore. To learn to paint again, I print out the basic shapes: squares, rectangles, triangles, circles, blobs etc. Then I fill the shapes in with the brush and paint colors (sorry about the American spelling) lol. When I do this it is the most important thing in the world “At That Moment”. It is hard to keep the mind from wandering but…you have to.
This of course is just an addendum to activities that involve a challenge to the brain or as is mentioned group activities. In OT, I had to pick up wooden Cubes with a pair of tongs and put them in a box, then take them out with my "bad’ hand. That was a challenge. there were about 20 blocks. There were other game-like activities in OT and I miss it.
Another term for Intentionality is the all popular; “Mindfulness”.
The only thing Age UK offers, is Bingo and that’s 15 miles away. The only exercise offered to stroke survivors around here is out running the Tumbleweed!
That’s great. You do get better with practice. I remember the first few times I went, I had to hold onto the side, but now I can stand chest high and (mostly) do the same as everyone else. Some moves are too fast, so I slow them down a bit, but they still fit in with the music.
I suppose that’s the disadvantage of living more rural compared a to town or city I suppose. Demand wouldn’t be high enough to justify the cost of running such programmes. It’s a shame because all the exercises are suitable for stroke survivors too.
In one book about stroke, a rehabilitation centre had stroke survivors washing windows, this action would produce hundreds of repetitions with a set goal. After stroke, in combination with other activities to get me walking, I found that hoovering was beneficial, I had four rooms and two corridors to hoover, and that was enough to produce hundreds of steps, back and forth.
As an augmentation to f2f esp. where immobility or distance is a factor
I too find hoovering, laundry, car washing, gardening useful as repetitive exercises that isn’t so (seemingly) nugetry as the grasp manual type activity - I would add a cooking but I’ve been banned from the kitchen for 45 years because somebody else loves doing the food stuff
@SimonInEdinburgh @Rups
Is “Hoovering” the same as “Vacuuming” ? lol
I let my willing wife do it as it makes me a bit wonky during the movement. So I stick to the kitchen and cook every night. Last night I made tortellini with Vodka sauce, peas, onion and a side salad. Easy peezy.
I have other wee chores that make me feel useful like cleaning the bathrooms.
If you clean bathrooms, and cook such delicacies as Vodka tortellini, I know your wife is happy. If you do dishes as well, you are definitely a keeper.
Yes in fact It’s only hoovering if you happen to have bought your vacuum equipment from Hoover
And it isn’t primarily about feeling useful It’s finding useful non nugatory things that can be used as exercises characteristics required of to build neuroplasticity
Aye, it is a neologism for vacuuming, in the same way that googling has become one for searching the internet, usually applied to brands that at one time or other have dominated the market at any one particular time. Oddly enough, Hoover is an American company, yet the neologism took off in Britain but not so much in America.
@Rups @SimonInEdinburgh
We have a tissue company here that has been around for years called Kleenex. People will say hand me a kleenex please no matter what kind of tissue it is.
Cooking and cleaning the bathrooms is mostly done with my "bad " hand and arm , so I’m getting quite a bit of repetition
I also empty the dishwasher and put away the cutlery…one handed…
diverting things - how do you find the neuro ball? I found the plastic buttons to stiff and the exercises to unimaginative and simple to help with the integrated movements that normal acts of daily living require but possibly useful for foundational aspects
but I’m going back, so guess I thought it will be of benefit, anything and everything I’ll give a go.
And the beauty about them is there are people of mixed abilities and conditions all there for the same reasons you 
