I initially wrot this to a young survivor friend of mine named Kim who was worried about her lack of return in her face. Kim also is recovering from a left hemiparesis but she's ambulating well with a leg brace and cane and even has some arm and hand movement. She was worried that her face wasn't progressing like the rest of her affected parts . I wrote this to her because I think all of us should be aware of plateau phases in recovery. They can make one feel like it's over but if you know about them you cn keep going an really heed all of the 'don't give up messages " you get from various peopl, invluding me. Never give up !

Hi Kim,

After we were texting back and forth the other day I thought about something I probably should hve told you about a long time ago....It may or may not affect you but here goes. In recovery just about everyone will experience recovery plateaus. That's where you're doing your therapy faihfully. You're doing ll of your home excercises but still nothing changes. You see no improvement. (

Im not sure and I cannot prove it but I think that is the time that the brain is actually rewiring itself. Our therapy and excercises make the neurons of the brain reach out to make new connections, bypassing the damaged areas and dead neurons, but the actual making of these new connections and the strengthening of them is what I think is going on in the plateau. It's an important thing to know about because it can lead a survivor to think that their recovery is over because nothing is changing outwardly and they see no imporovements in their abilities despite all their efforts. I first read about this phenomenon in the book Stronger After Stroke. It was a good thing I read about it too because I was in a 4 month long plateau phase. I was at a point where I started to think, "maybe ythis is as good as I'll get...?" but the plateu ended and new subtle improvements continue to be made. Early recovery comes a lot easier than late recovery but as long as you knkow that your efforts are literally changing your brain and that takes time you shouldm't get discouraged. In the beinning of our recovery we make achievements swiftly like how I walked my first steps a week after the strokewhen initially I couldn't even sit up. That was a huge early gain. All of my gains since then have been much smaller but they're still coming so I can dea with small as long as they're still ppositive ).Immediately after stroke we all get brain swelling the swelling or edema is primarily in the stroked/deadarea but it can disrupt neighboring tissue that did't actually strokeby compressing it. Well, when that swelling goes down, which takes days, we see lots of return of function and that easy early returnit can set us up to feel like recovery wont be so bad.... It can give one thoughts like, "I used to be able to relearn things quickly but now a few moinths outfrom the stroke, im trying and nothing's happening... ". that is the plateau. your facial recovery might be in such a period and I point this out to let you kow that plateau's end. No one knows how long a plateau will last but we do know that they end.My longest plateau lasted aoutt 4 months. It was a rough 4 months because I had been trying to move my ankle daily with no apparent success an zero mvemenyt. After that 4 month period I was again trying to move my ankle and then voila! it moved.It was just a tiny weak movement butth same thing happened with my wrist. I had been trying t move it dail for months and I got othing then... it moved just a small bit but enough to let me knoe my recovey hand't ended it hd just plateaud for a while That let me know my plateau was ending and that my recovery would continue. I hope this makes sense. I dont know if I would have kept at it if I hadn't read about recovery plateau's in that book. I was like, "come on... I've been trying to lift my foot for months and got nothing and then one day it moved and I breathed the biggest sigh of relief.

I think the plateau's are a cruel joke and though I cant provre it I'll bet that thyey are why some ppl don't recover well. I think they get into a plateau BUT they don't know about this phenomenon so they just JUST ASSUMe Tthey're NOT GOING TO GET ANY BETTER SO THEY stop trying whih of coursemeans they wont get any better but the people that know about this hidden snare can just keep trying anyway and they are the ones thatt make fantastic life-long recoveries. There's something to be said for simple stubborn pigheadedness. So, the moral of my story is no matter how little results you see just keep trying, you're changing your brain, you just can't see the results o those changes yet but they too will come bt only i you prersist/ stay strong. I know this work is hard. Im still typing 1 handed but Im not giving up. Spread the word. Everybody should know about plataeau's so they don't give up on their reoveries.Stay strong and just keep trying survivors ) As always all my best wishes for your full recovey, good health and patience for the meantime )