During a stroke, parts of the brain lose blood flow—and without oxygen, some cells die. So when patients hear that the brain can rewire and recover after such an injury, it often feels hard to believe. But that’s where neuroplasticity comes in. Let’s break it down.
Neuroplasticity is defined as the ability of the nervous system to change its activity in response to stimuli by reorganizing its structure, functions, or connections after injuries, such as a stroke or traumatic brain injury.
Neuroplasticity is powered by a complex web of mechanisms and theories—far too rich to unpack in one sitting. So for all you neuroanatomy junkies, we’ll save that deep dive for a future blog.
Before we get started, here are a few terms that might be helpful to know:
Neurons: These are the cells that make up your nervous system, including your brain and spinal cord.
Synapses: This is the point of communication between a neuron and its target, which could be another neuron, muscle cell, or gland cell.
Now onto the fun stuff. Neuroplasticity doesn’t happen by chance—it follows patterns we can understand and influence. There are 10 key principles that guide how the brain rewires, adapts, and recovers. Let’s walk through them together and explore how each one shapes the way we heal and learn.
Use It and Improve It
Our brain’s connections thrive on activity. When synapses are regularly stimulated—through movement, thought, or experience—they grow stronger and more efficient.
Example: In therapy, we sometimes design tasks that force use of the weaker limb—helping the brain strengthen the neural pathways that control it.
Use It or Lose It
If synapses are not stimulated, the brain begins to clear them away, like pruning unused branches to make room for growth.
Example: After a stroke, avoiding use of the weak arm can cause the brain to weaken or remove the connections that control it—making recovery even harder.
Specificity Matters
It is important to practice the specific task you want to improve.
Example: If your goal is to improve the speed of your walking, the best way for us to do this is to practice fast walking!
Repetition Matters
Repetition strengthens the brain’s wiring—each time we practice a skill, the neural pathway becomes clearer, faster, and more automatic.
Example: This is why your therapist sends you home with an exercise program – because practicing a skill one time a week is not going to be enough to make meaningful change!
Intensity Matters
To truly strengthen neural pathways, skill practice needs to be intense, focused, and repeated. That’s how the brain gets the message: “This matters—build it stronger.”
Example: Good physical therapy isn’t easy—it challenges both body and mind. It should feel like a workout, because real progress takes effort, repetition, and intensity
Time Matters
While physical therapy can lead to meaningful progress even years after a stroke, the first 3–6 months are considered a critical window—when the brain is especially responsive to rehab and recovery efforts
Example: That’s why many stroke survivors begin their recovery in an inpatient rehab facility—where they receive intensive, focused therapy designed to jumpstart healing and restore function.
Salience Matters
In order to promote neuroplasticity, the activity being practiced must be important to the patient.
Example: If a patient’s goal is to get on and off the floor to play with their dog, practicing that specific movement becomes deeply meaningful. That emotional connection makes the brain pay closer attention—boosting motivation and increasing the chances of lasting neural change.
Age Matters
Younger brains tend to adapt more quickly, making bigger changes in synaptic connections during intensive therapy. But neuroplasticity isn’t just for the young—older brains can still rewire, relearn, and recover with the right stimulation and support.
Transference
Neuroplasticity that results from the practice of one skill can also activate nearby pathways for similar skills.
Example: Let’s say that one of your goals is to be able to grab and drink from a cup and we practice this skill often during therapy. Over time, that skill doesn’t just improve in the clinic—it starts to transfer to other real-life tasks, like reaching for a phone, a doorknob, or a light switch.
Interference
Sometimes, existing synaptic connections can get in the way of learning new skills—making it harder for the brain to adapt and rewire. Neuroplasticity isn’t just about building new pathways; it’s also about overcoming old ones that no longer serve us.
Example: When patients delay participation in skilled, intensive therapy, compensatory strategies often develop to help them manage daily tasks. While these workarounds can be helpful short-term, they may reinforce inefficient movement patterns—making it harder for the brain to relearn optimal skills and slowing recovery.
Why does this all matter?
These concepts might feel overwhelming at first—and could even make you question your current recovery path. The good news? A skilled physical therapist is your neuroplasticity guide. They’ll design a treatment plan that weaves these principles into every step, helping your brain rewire with purpose and precision.