This book is a must read. It is a valuable resource for stroke survivors, anyone whose life has been affected by stroke, and health care professionals working in rehabilitation. While the focus may be on recovery from stroke, much of the information in this book could apply to traumatic brain and spinal cord injury. Written in an easy to understand, conversational tone, complex topics are simplified and made meaningful through storytelling and analogies. What inspires hope is the potential for ongoing recovery. This book walks the reader along a path of recovery: from the initial injury, to the mechanisms for recovery, to the future of rehabilitation. Dismissing the negative connotations of "plateau", this book provides hope and inspiration for continuum along the path of recovery. Each step along the path is supported by basic science, concepts of neuroplasticity, and the resilience of the human spirit. HIGHS, LOWS, AND PLATEAUS A path to recovery from stroke By ANNE BURLEIGH JACOBS, Stephen Adams AuthorHouse Copyright © 2014 Anne Burleigh Jacobs, PT, PhD All rights reserved. ISBN: 978-1-4918-6231-5 Contents Acknowledgements, vii, Introduction to the Author, ix, Preface, xi, Chapter 1. What Is A Stroke?, 1, Chapter 2. Emergency Treatment of Stroke, 5, Chapter 3. Stroke Strikes AnyWhere, AnyTime, 9, Chapter 4. The Not So Obvious Effects of Stroke, 15, Chapter 5. History and the Plastic Brain, 23, Chapter 6. Restoring Electrical Pathways, 29, Chapter 7. "Plateau" Is Not A 4-Lettered Word, 47, Chapter 8. Injury To The Brain and Then What, 53, Chapter 9. Stages in the Continuum of Recovery, 63, Chapter 10. Requirements For Learning and Plasticity, 79, Chapter 11. Emerging Tools In Rehabilitation, 87, Chapter 12. Simple Rules To Promote Improvement, 95, Appendix. References and Recommended Reading, 97, About the Author:, 105, CHAPTER 1 What Is A Stroke? This book focuses on the mechanisms of recovery from a stroke, but to understand recovery one needs a basic understanding of injury. Much of the information applies to other injuries of the central nervous system, including traumatic brain injury and spinal cord injury. In general, injury to the central nervous system involves a disruption of blood flow, inflammation, and damage to the cellular structure. Stroke is the result of disrupted blood flow to the brain. The more technical term is Cerebral Vascular Accident (CVA): cerebral = brain, vascular = blood flow, accident = unexpected. The more attention-catching media term is Brain Attack – much like a Heart Attack. A heart attack occurs when blood flow to the heart is interrupted and the cells that are electrical in nature stop functioning. Likewise, a brain attack occurs when the blood flow to the brain is interrupted causing the cells that are electrical in nature to stop communicating. The symptoms of the brain attack (stroke) will depend on which pathway for blood flow is interrupted and thus the corresponding region of cells whose communication is compromised. There are two main types of stroke: Ischemic and Hemorrhagic . With the ischemic stroke, there is actually a blockage in the blood vessel preventing the flow of blood past that point. A clot that forms in place (thrombosis) or a clot that has broken loose and traveled from some distant blood vessel (embolism) forms a blockage. Cells on the far side of the blockage are denied blood flow and begin to die. With the hemorrhagic stroke, there is actually a bleeding vessel within the brain environment. The most common hemorrhagic causes include an Aneurysm, an ArterioVenous Malformation, and a Hematoma following a blow to the head. Blood is actually toxic to neurons (brain cells). Usually, neurons never come into direct contact with blood. Instead, a small helper cell called an astrocyte places one foot on a blood vessel and one foot on a brain cell and then oxygen and nutrition diffuse out of the blood vessel, through the astrocyte and to the brain cell. So, when there is a bleed in the brain environment, cells in direct contact with blood begin to die. As neurons die, the cell walls collapse and the chemical content of the cell is released, poisoning other cells in the surrounding area. But, it is important to appreciate that not all of the cells in the area die. Brain cells are pretty clever. Recognizing that the brain environment has become a war zone, the surviving cells turn down their energy production and go silent ... waiting for the danger to pass. That war zone is a mess – a zone of swelling, cellular debris, and chemical toxins. Last winter, there was a terrible storm that moved through the mountains where we live. Trees were down everywhere and with them were downed power lines and phone lines. No Power, No Communication. Silence after the storm. Neurons are electrical cells. They conduct a signal and communicate with other cells via a chemical-electrical cascade. When neurons die o