THE WAY BACK: Life after a stroke

A case of the power of graduality and the importance of self-discipline.

This article is inspired by a real case story, a musician friend of mine who had a stroke. He applied his experience as a musician in his training to recover lost functions, especially the motor ability of his right hand.

After a stroke, the way back to a normal life can be long and heavy, if indeed, a normal life is at all possible any longer. However, almost everyone can become better. It is a matter of strong will, persistence, patience and a sound approach. Lost functions are sometimes returning by themselves after a time, but in general, they must be forced back by systematic training. If the area in the brain for that function is irreparably damaged, another part of the brain can sometimes learn to handle it instead. That is certainly not coming by itself.

The first to realise is that the earlier after the stroke training starts, the better are the chances for recovery of functions. Both motor functions and purely mental abilities should be trained quickly. Waiting a day more or less matters.

What follows then is hard work that requires a firm determination not to give up. It will sometimes feel hopeless, but one must never succumb to that feeling. It is just to go on with the training.

Another thing to keep in mind is not to have unrealistic expectations. Changes will not be fast; they will come gradually, in very small steps over a very long time.

The self-discipline required for this training is relatively rare. According to my experience, people being used to some sort of systematic practice or training are better equipped to face this situation, because they have already developed the self-discipline. Sportsmen come to mind, but I think musicians (in the traditional sense) are even better prepared. A qualified musician is used to the hardest imaginable training of motor ability, perhaps beyond that of any sportsman. You simply cannot become a good musician (especially if you play classical guitar or piano, both requiring extreme motor ability of the hands) without developing the self-discipline for systematic training.

I have recently seen an example of this. A musician friend of mine had a stroke and lost the ability to move his right hand. He managed to regain the motor ability of his hand by persistent training. He played classical guitar, and he used an approach of very systematic practice to regain his manual motor ability. I am sure his practice on the guitar helped him to regain also other abilities. The motor ability of the hands is extremely requiring of the brain. In other words: hand training is also qualified brain training.

But playing the guitar (or any musicianship) is not only about strength and precision of the hands, it also involves hearing and things such as he musical sense of balance and harmony. It goes far beyond pure motor ability. I have always claimed that motorically advanced musicianship can be the most efficient and best overall training of the brain that exists. It also develops self-discipline and other related qualities. All children, also those not aspiring to professional musicianship, should learn adequately to play at least one motorically qualified acoustic instrument as part of their general education.

Indeed, when this musician should train his hands after the stroke, he became increasingly aware of the factors of good, efficient practice. He devoted himself to method to a level far beyond his pre-stroke practising.

Let's take a look at his method. Its principles are general and can be applied to any systematic training.

He took it from this German book by Karl Leimer and Walter Gieseking. It is aiming at piano practice but can be applied to any instrument or to almost any activity.

The method emphasise that one should practise slowly and thoroughly with total attention to exact details, such as rhythm, fingering, etc. One should play short pieces with absolute concentration. Acknowledging the fact that total concentration can be held only 20-30 minutes, one should never practise sessions longer than that.

Here I want to put the finger on two often overseen details.

One is that if you cannot play a piece slowly and right, you can never play it fast and right. Perhaps, in some instances, you can play so fast that people cannot discern your errors, but that doesn't make it right. Learn to play slowly and right and when you can do that you can gradually increase the speed until you reach the final tempo of that specific piece. The same applies to, for instance, calligraphy, drawing, playing chess or football, driving a car, almost everything. Learn to do it slowly and right before you try to do it fast.

The other is that it is meaningless to practise anything more than about 30 minutes at a time. What's more than that is a waste of time and will not increase your ability at all. No matter what it is... musicianship, (hand-)writing, drawing, playing football, driving a car, learning language (or any subject) … you mention it! The mind cannot fully focus on one and the same thing a longer time than that. Repeated short sessions are more efficient than one long session. However, you rest from one thing when you are doing something else, so the optimal is to change activity every half hour or so. (Of course the exact length of an optimal session depends on the nature of the activity. The half-hour limit applies to activities requiring full concentration. The less concentration something requires, the longer the session can be.)

But back to the stroke patient. By persistent practice day after day, month after month, year after year, my friend regained much of the motor ability of his right hand, and, I suspect, many other brain functions as well.

(This text is based on material previously published in Meriondho Leo.)

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