Moving Forward Without Looking Back: Neuroplasticity and Hope

“When will our lives be back to normal?”

This is probably the most common question I receive from patients and their families.  I usually dodge it:  Instead, I estimate the timeline for reaching the patient’s goals and establishing a daily communication (or eating/swallowing) routine.  Because honestly, what is “normal”?

This isn’t a pithy rhetorical question.  Does “normal” mean following an established pattern with the resources you have?  That can start during the recovery process, although there may be great suffering in it.  Does “normal” mean a predictable life with no obstacles?  I can confidently say that will never happen.  What was expected yesterday may not be expected today.  Yet this clinging, this preference for the past over the future, is common.  We long for the security of the known.

How can we shift our expectations to allow for the changes that are happening in our lives?  How do I, as a therapist, talk about moving forward with my patients—and with myself?

A new diagnosis can be both empowering and frightening.  There’s no going back now.  Even a very successful recovery from an injury or meeting missed developmental milestones doesn’t erase the past.  The patient and their family have to establish a new routine, a new “normal”.  It may closely resemble the previous “normal”—and yet, it may not.  Either way, time continues.  It’s easier to paddle downstream than to try to return to where we were before.  Even in science fiction, revisiting the past isn’t the same as experiencing it for the first time (think:  Groundhog Day; Cause and Effect, Star Trek TNG).  So instead of looking back, we have to look forward.

In looking forward, there is strangeness and perhaps some suffering—but there is also much hope.  The brain has the amazing ability to grow and change with our circumstances—even with a cognitive and/or communication disorder.  Sometimes lost or missed skills can be recovered.  And if not, there are alternative routes:  the brain can create new neural pathways, ways to “work around” skills that just don’t seem to come naturally.  Therapists refer to these abilities of the brain as neuroplasticity.

How does this happen?  The brain learns via repeated exposure.  This is true for “neurotypicals”, for patients with developmental differences, patients with acquired brain injuries and strokes, and patients with dementia.  Learning happens best with repetition.  Certain patterns of neurons fire in response to certain input.  The more times the input is presented, the more times the neurons fire in that pattern, and that “pathway” in the brain is strengthened.  Seldom-used patterns are not strengthened and may be forgotten.  Repetition is key.  With repetition, our brains (and our hearts) can learn how to navigate a new "normal".

Neuroplasticity means the brain can change and adapt to new circumstances.  Neuroplasticity means gently saying ‘goodbye’ to yesterday and embracing today and tomorrow for the possibilities they bring.

Letting go of the past and changing the way we imagine the future can be very difficult and painful.  It's important to let ourselves feel the pain of it.  So if you or a loved one are receiving therapy now, or if you find yourself in a new situation after a dramatic life change, I encourage you to grieve the past, and as you grieve, hold on to the hope that the present is not permanent—and that there is hope in the future.