I initially wroet 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 t realized as I had been trying to guide her throug this recovery process there was something I never told or warned her abu so I wrote the following email .I'm reblogging it here becaus I think not everybody is aware of what I discuss but we all should be for very good reasons.All of us survivors should be ware of plateau phases in recovery. they can make one feel like it's over but ifyou 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, Doing all your excercies but still nothing changes. you see no improvement.

Im not sure and I cannot prove it but I think the plateau period 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 having just read about this phenomena I thought..."maybe I'm in a plateau...? I'd better keep trying, just in case ) Well, Im glad I kept trying )My plateu ended and its end was heralded bnew subtle improvements. Early recovery comes a lot easier than late recovery but as long as you kow that your efforts are literally changing your brain and that takes time you shouldm't get discouraged.( I know that's easy to say, I get discouraged to but I refuse to stop tryng) In the beinning of our recovery we make achievements swiftly like how I walked my first steps a week after the stroke when initially I couldn't even sit up. That was aHUGE early gain. ) All of my gains since then have been much smaller but they're still comingI 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 stroke by compressing it. Well, when that swelling goes down, which takes days to weeks, we see lots of return of function and that easy early return it 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 about 4 months. It was a rough 4 months because I had been trying to move my ankle daily with no apparent success an zero movemen t. I was about ready to give up but then... After that 4 month period I was again trying to move my ankle and voila! it moved.It was just a tiny weak movement butth same thing happened with my wrist. I had been trying t move it daily for months and I got nothing then... it moved, like my ankle it was just a small bit of weak movement but it was enough to let me know my recovey hand't ended it had 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. and that's why I'm telling you now Kim, hanh in there Ihad been thinking, "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 prove it I'll bet that thyey are why some ppl don't recover fully. 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 course means they wont get any better but the people that know about this hidden snare can just keep trying anyway and they are the ones that 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 of those changes yet but they too will come but only if you prersistand keep at it. stay strong! I know this work is hard, fustrating and heart breaking . I can't count the number of times I cried while staring down at my toes trying to get them to move but like my wrist and ankle I know someday they will move if I keep sending my brain the 'requests'. Im still typing 1 handed but Im not giving up. Spread the word. Everybody should know about plateau'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 )