Lynette Diaz, COTA/L
Tuesday, June 9th, 2020
How many repetitions does it take to create changes in the brain? How many repetitions must one complete before movement is strong, volitional and functional? Research indicates the number is high and the answer is more complex than we may think. Factors to be considered are, quality of repetitions, attention during repetitions, number of joints involved in movement, area of injury in the brain to name a few. It would stand to reason the more complex a movement is the more repetitions would be required.
Randolph J. Nudo is the first to be credited with speaking of the importance and power of repetitive practice in stroke recovery. His research would suggest that approximately 2000 repetitions of a single joint are required to see rewiring in the brain. Edward Taub is credited with introducing constraint induced therapy that also advocates for a high number of repetitions, approximately 200 per session in order to create neuroplastic changes in the brain. Neuroplasticity is the brains ability to form and re-organize neural connections in response to learning or re-learning a skill following an injury, such as a stroke. Neuroplasticity is the rewiring of the brain that allows for recovery of lost skills and movement.
Thus the research suggests a high number of repetitions are required when it comes to rewiring the brain to create neuroplastic changes. However, high repetitions alone may not be enough. Randolph J. Nudo’s research also suggests that the key is to perform meaningful or even novel tasks in which your brain is required to pay attention. For example simply lifting your affected arm 200 times without a specific purpose is not as meaningful to your brain as attempting to lift your arm 200 times in order to brush your teeth or to feed yourself. It is the high number of repetitions paired with meaningful activities that drive neuroplastic changes.
On your journey to recovery, it is important to decide what skills or tasks you’d like to do again. Work with your therapy team to determine how those repetitions can be done in session and also at home. Using a mirror or video taping movement are also good strategies so that you and your therapy team can assess the quality of the movement. To get in enough repetitions it is imperative that meaningful repetitive practice be done at home. So exactly how many repetitions do we need? The bottom line is a lot! Purposeful, meaningful movements, done repeatedly both in therapy and at home. Repetition, attention and meaning are the golden trio to recovering movement.