Brain Primers & Stroke Recovery

Brain Primers


Stroke Recovery

Brain Primers

Stroke recovery can be challenging for clients and clinicians. As clinicians, we sometimes feel challenged in finding interventions that work, making our jobs feel hard and leaving clients feeling hopeless. This article describes three simple and effective brain priming interventions you can use right away so intervention selection doesn’t feel so daunting. BRAIN PRIMERS are simple and effective...Not only that, BRAIN PRIMING activities are safe and easy to use!

What are Brain Primers?

Brain primers are strategies that prepare the brain to recover; they get the brain working. Generally speaking, priming stimulates something else to occur. For example, suction is a priming mechanism often used to get a water pump to deliver water.

Research demonstrates that certain parts of the brain fire before movement occurs, especially with observation, thinking and when completing goal directed actions such as reaching for a pen. When a person decides to write with a pen, the brain is working. As soon as the attempt to look at the pen occurs, early visual regions fire and thinking about picking up the pen stimulates the premotor cortex. Envisioning writing or watching another causes similar effects!

A Disorganized Brain

Organizing brain activity is important following a stroke. Damaged and disorganized brain patterns make task completion difficult. Depending on the severity of the stroke, a person can experience multiple client factor deficits, such as changes in muscle and joint functions (abnormal muscle tone, decreased strength and range of motion, etc.), negatively impacting motor skills and sometimes leading to learned non-use.

What Motor Recovery Needs

Research tells us that motor recovery requires repetition and practice - a person has to move. There are often dilemmas around movement faced by clinicians and survivors. Too much intensity immediately following a stroke can cause further brain damage; this can be detrimental in the early, acute stages following stroke. Then, if a person’s limb doesn’t move well for some time, they can enter the subacute and chronic phases with mobility limitations. How do we as clinicians help? What are survivors to do?

Brain Primers

Scenarios like the ones mentioned above make intervention planning difficult, not to mention leaving survivors feeling scared and frustrated. Brain Primers can help. They are safe to use and, as mentioned above, they help get the brain going. Brain primers promote changes and order within the brain, thereby allowing the brain to help itself on the path to recovery.

Three specific brain priming interventions discussed in this article:

  • Visualization/Mental Imagery

  • Mirror Therapy (MT), also known as Mirror Visual Feedback (MVF)

  • Action Observation.

Visualization/Mental Imagery

Visualization is the process of imagining. While it sounds easy, using one’s imagination takes considerable focus. Think about the number of random thoughts that cross your mind during conversation. People commonly jump from one subject to another, often without warning. The same often occurs when trying to visualize an experience. Therefore, using this technique can improve focus and attention while also eliciting effective firing of brain neurons necessary for movement.

The best visualizations are multisensory. They incorporate sensation such as the way something feels when touched, the weight of a limb or object, a smell associated with an activity and more. This technique can be done any time and anywhere, including during therapy down time and before engaging in a task. Investigate these free recordings from Saebo.

Mirror Therapy/Mirror Visual Feedback

Mirror therapy is a safe and effective intervention that uses a visual illusion to make the brain believe the affected limb is moving. Besides getting motor areas firing (a key ingredient in getting limbs to move), mirror therapy helps regulate over and under active regions while also improving communication among the two hemispheres. A mirror is required for this intervention.

I wrote about Mirror Therapy in more detail in another blog post. Check it out here.

Action Observation

Action observation involves watching another person or recording of a person moving. Any time we watch someone perform an action, our brains jump into action! Engaging in action observation can be as simple as watching another person walk down the hall or pick up a cup to take a drink! Interventions can be more specific and detailed as well. This article, “Action Observation Therapy for Upper Limb Recovery in Patients with Stroke: A Randomized Controlled Pilot Study” (Mancuso, et. al., 2021), provides good details about this intervention. It may be a good place to start for practitioners interested in developing a program. Here are Action Observation Video Examples:

All three of these interventions are supported by scientific evidence. For a deep dive into research, check out the EBRSR (Evidence-Based Review of Stroke Rehabilitation.

If you want to learn more about brain primers, check out the Noggins And Neurons Podcast with Robert Teasell, MD, where he spoke about brain primers (and getting unstuck in rehab).

Do you want to simplify your OT practice with evidence-based interventions and other resources? Creative Concepts can help - Learn More…