Brief Answer:
No way to know for sure...important thing is that it seems to be working!

Detailed Answer:
Good afternoon and once again welcome to our forum. I'm not entirely understanding how your right knee is "helping" your left hand pick up things...unless you are using the knee to scoop or shovel things toward the open/outstretched left hand and then, grasping the object in order to bring it up to a higher level and place it somewhere, etc. Perhaps, it would help me understand your physical situation if you could describe for me exactly what is functioning normally vs. what was affected by the accident and in what way there is still dysfunctionality.

However, to try and answer the question as directly as possible I must say that unfortunately, there's no way to be able to distinguish the 2 things you're talking about in terms of regenerating new pathways of neuronal connections between cortex and muscle(s) being activated vs. trying to re-establish old connections. It entirely depends upon which direction would be the path of "least resistance" and how much damage was done to the original pathway. The phenomenon of Wallerian Degeneration states that when nerve body damage occurs that everything distal (i.e. going away from the cell body) to the point of death or damage tends to degenerate and not only is that particular locus or group of nerves damaged but also all of the nerves DOWNSTREAM from that point in line with the target organ will begin failing and dieing BACK due to lack of electrical stimulation. If Wallerian Degeneration occurs which usually happens on the order of months to years from the time of an insult then, the chance of regenerating that same pathway is felt to be extremely unlikely. In fact, what more likely takes place over time is that there is Wallerian Degeneration that occurs which will cause a dieing back of nerves and tracts of nerves to a point where scarring or gliosis will take place. Once this occurs then, the RE-establishment of electrical activity in that same circuit is believed to be impossible.

Therefore, new pathways must be sought in order to produce both motor as well as sensory innervations. The establishing of these new pathways may not be topographically very different from the original tracts and in some cases may run virtually "alongside" a tract that has always from Wallerian Degeneration but that entirely depends upon how much SLACK a set of neurons or tract of neurons is with respective to accepting an additional load or distribution to either muscles or for transmitting IN to the brain/spinal cord for sensation.

Training and physical therapy are geared toward helping the patient perform repetitive and stereotyped activities...even sensory stimulations...which tend to cause "electrical activity to traverse the same set of tracts/nerves over and over until a circuit can be completed. This can take months or years.

I have not much of an explanation as to why singing may have improved...and with being a violinist you may wonder why I don't know much about that....except to say that whenever my emotions drive the music forward...I too feel that my playing is on a higher and more moving level....perhaps?

All the best my dear and I continue to applaud your efforts and not giving up or giving in and expecting just a bit more from your body at all times. You Go Girl! LOL.....

Be well......

If I've provided useful and helpful information to your questions could you do me a huge favor by CLOSING THE QUERY and be sure to include some fine words of feedback along with a 5 STAR rating? Again, many thanks for submitting your inquiry and please let me know how things turn out.

Do not forget to contact me in the future at: www.bit.ly/drdariushsaghafi for additional questions, comments, or concerns having to do with this topic or others.

This query has utilized a total of 30 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.

---

Brief Answer:
Thank you for the details of your accident and rehabilitation

Detailed Answer:
I concur with your therapist's point of view on doing strengthening exercises as a way of reducing pain as you are now using the right knee in a different way than what it has been used to doing. Recall, I am a neurologist by trade and therefore, my knowledge of orthopedics is somewhat limited, however, it is quite true that once a joint or limb becomes "used" to performing in a particular way...and especially if that "way" represents a limitation to what would be considered normal RANGE OF MOTION of the joint or limb then, what I refer to as "usage memory" sets in....many may interchangeably use the word "arthritis" but it's not always really inflammation of a joint but rather a particular usage habit that begins changing anatomic and physiologic parameters of the tendons, ligaments, and muscle activations which over time become habituated. When a change occurs such as what you're describing then, pain and discomfort sets in...a form of remdeling may be what's necessary to reduce this discomfort and train the joint to move and function differently.

I would add that in addition to strengthening types of exercises for the right knee a suggestion of AQUATHERAPY either in conjunction with those exercises or in addition to would be potentially beneficial. One particular water exercise that is a favorite of mine and patients is WATER JOGGING. This is a great way for most patients to stretch and range the joint in question without the detrimental effects of gravity on land. It is also a good way of strengthening quadriceps and hamstrings that are useful in stabilizing knee joint function again, without a lot of pain and resistance which can be negative on a joint when trying to remold its function.

I wish you the best as you continue to explore new ways to continue to come back from that accident and enjoy your life's activities to the fullest.

Cheers to you as well.

This query has utilized a total of 45 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.

---