February 13, 2015

Does Reaching a Plateau Really Happen?

Regaining a skill 11 years after my stroke made me wonder why I believed in plateaus when
I was an OT.  Here are four factors that changed my belief about recovery after a stroke.

What Has Changed.  1)  Brain plasticity will blow your mind.  Click here to learn how an adult's brain grows new stem cells every night and makes them migrate to where they are needed.
2)  There is lots of new technology like electric muscle stimulation with biofeedback (click here).
3)  Blogging lets stroke survivors share their triumphs.  My continued progress is not unique.  4)  People who have a stroke as young or middle-aged adults have higher expectations placed on them that people who have strokes in their 70s and 80s.  Family members cannot maintain their own health if they do everything for a disabled adult for decades.  Reducing the time a family can care for a stroke survivor is expensive.  Assisted living where assistance costs extra is a long-term solution many families cannot afford. 

What Perpetuates the Myth.  Therapists see clients for days or weeks.  This small window is suited to orthopedic cases like hip replacements because bones and muscles repair themselves fairly quickly.  Brain recovery takes longer because the brain is so complex.  Therapists do not see the progress stroke survivors make in the next stage of rehab (e.g. out-patient) or after therapy ends.

The Alternative.  Using the word plateau shuts down the conversation.  "Will I get better?" is an opportunity to ask if there is something a client wants to do.  Here is something I wanted.  I have baby-fine short hair so I need a good haircut.  Before I sit down in a beauty salon chair I have to back up and then straddle the wide footrest.  The chair was initially an obstacle to having a good hair day so I never get tired of defeating it.  Challenges that pushed my continued recovery were walking backwards, twisting my trunk so I can reach far behind me to grab the armrest, and sitting down with my feet 18 inches apart.

The Bottom Line.  Skill acquisition can stop because of our beliefs as well as our abilities.  My progress has slowed over the years, but I have repeatedly seen
new goals spur new gains.  This evidence has changed what I think will happen to me.   


  1. Rebecca, I've found an easier way of getting into the salon chair. Straddling that wide will throw your center of gravity off. Step into the space between the footrest and the chair. Holding onto the armrest, turn 90 degrees and then switch positions of your hand to the opposite arm rest. Turn the remaining 90 degrees and sit down.

  2. Oh and about plateaus... they happen in the short term, I was there. I found like you, trying a different techniques breaks the plateau.