If you do not know how the brain makes and replaces habits, you will waste a lot of therapy time and get less than optimal results. When a baby with a damaged brain starts to move against gravity, the parts of the brain that are currently working control the movement. For example, in a baby with a right-sided hemiplegia, the left arm and hand start to bring the hand to the mouth, while the right side either cannot move or it moves badly. At this stage, some of the brain is permanently damaged and other parts are in a process of active recovery. The baby uses whatever is able to work and over time, she wires in an abnormal movement pattern.

Practiced Movements Wire into the Brain and Become Habits
It is easier for the brain to perform a wired–in habit than it is to learn a new way of moving. Anyone who has taken up a new sport, tried to play a musical instrument or learned to drive a car will remember how very difficult it was to learn new ways of moving your body. Remember the feeling of abject terror as you first tried to make a left-hand turn in a car across traffic. Now exactly the same movements require some concentration but they are easy and practiced. The key movements of driving a car have become well-ingrained habits, so ingrained that you often don’t pay any attention to your driving until you suddenly realize your habit has been driving you over the well known path to your home.

Brain and Body Habits are Energy Efficient
Whatever you do, you learn to do better and habits are much less effort. A child who has learned to walk with one of the characteristic movement patterns of cerebral palsy, developed this abnormal walking habit early in life. The habit was laid down in the brain when it was in the process of recovery. We assume that significant recovery after brain damage takes 3 to 4 years. By that age, the young child’s brain has recovered to whatever extent it can and other parts of the brain have matured and become functional. This means that new skills can be learned with a new brain.

Early Skills are Habits: Later Learned Skills Demonstrate Recovery
What this means is that in the early years, we have to all work together to keep the child’s movement patterns as normal as possible. This often involves spasticity management, braces and/or splints, compressive garments and even surgery in addition to working with skilled physical and occupational therapists. The goal is to minimize the development of maladaptive habits. If the child has already developed an abnormal movement pattern, the goal shifts to inhibiting or diminishing the use of the early learned abnormal habit while teaching new, more adaptive habits to replace the old.

This link is to a 2 minute You Tube video animation by Sentis that explains how the brain creates and changes habits. It is the best explanation of a difficult concept that I have ever seen.

Watch it a few times and even show it to older children and teenagers. Discuss it with any athletes or coaches you know. The concept of replacing a bad habit with a better habit is not new…it just has not been widely applied to children and adults with early learned movement patterns.


Coaches and Sports Therapists Know that Habits can be Replaced

Early Praise for The Boy Who Could Run But Not Walk: Understanding Neuroplasticity in the Child’s Brain

“An amazing book that proves habit hides recovery. It can be done; it doesn’t matter what the disability. A good therapist, parent or a sports coach can train a patient like an athlete – to achieve an optimal level of performance.”
Karen Orlando, BSc, PT, Owner ProCare Rehabilitation in Toronto. Member of the Canadian Olympic and Paralympic Medical Teams

Next week, I will start a series of blogs that will explore how you can uncover brain recovery hidden by maladaptive habits. As ever, I welcome your comments and questions.



  1. How about a child with CP and seizures can they’re brains rewired even if the seizures are not under control. This is my son’s case and despite having daily seizures he still manages to learn and remember. Just curious if he has reached his max or is there still more potential for him.

    • That is a tough question. The fact that he is learning and can remember tells you that his brain is wiring in new information. But continuous seizures will limit it.Ultimately gaining control of the seizures is as much an art as science. I always recommend a consult with a seizure specialist if you are not gaining control of them. There are medications, surgery and even implanted seizure pacemakers that can be of help. The key is to have him evaluated to see if any might be of help.Many seizures thought to be refractory can be helped. Discuss this with your healthcare team. I wish you the best of luck with it.

  2. I love your book as it gives us hope. But I am not sure how to identify if the therapy we are doing for a 5 month old is the best method. Can you give me guidance how to prevent the bad habits in the first place?

    • Thank you for your comment Suzanne. I am glad you have found my book useful. There are a lot of ideas for you in Chapter 11 – What To Do In The First 4 Years – and in an excellent blog on Love That Max that is reproduced on my media page of the website.http://www.karenpapemd.com/media/ The key to preventing maladaptive habits is to make sure you are linked uyp with a good therapist and an early intervention program.Keeping the body in alignment is the first and most important goals. Until the child gains in strength, various external supports are usually needed.This blog post is useful as well. Hope this helps, Karen

Comments are closed.