In the 2008 National Geographic film Birth of Civilization: The Rise of Man, there is a remarkable depiction of a prehistoric stroke survivor. When I saw this portrayal, I almost fell out of my chair.

For many years I have been writing (there's even a chapter in my book) and speaking about what it would be like to have a stroke in prehistoric times. I contend that prehistoric stroke survivors had two major advantages over stroke survivors today.

First, the prehistoric survivor had a much larger capacity for hard work. Research has shown that stroke survivors who are athletes at any time (not necessarily immediately prior to their stroke) have better outcomes than stroke survivors who were not athletes. It is not exactly clear why this might be. It is hypothesized that ex-athletes may have two things going for them: A hypertrophy of the portion of the motor cortex dedicated to movement, and the fact that the "athlete" is already acclimated to the work that learning movement takes. Prehistoric people were forced, by everyday circumstances, to be athletes.

The second advantage was more basic. Prehistoric stroke survivors would also be compelled to survive more than the stroke. They would have to survive in a harsh environment. How would stroke survivors recover? Their "therapy" would have been ferocious and focused on pursuing food and shelter. Recovery efforts would have been directed by the survival instinct. Nothing would stand in the way of recovery-not embarrassment, nor limited insurance, nor fear of failure. Recovery meant survival. You fail, you die.

Patients Have Active Minds

In Birth of Civilization, the actor depicts dense hemiparesis and aphasia as well as efforts toward recovery. At first he is shunned by his tribe for being "cursed." But he is ultimately adored, respected and vindicated because, while his recovery is a work in progress, his mind is as active as ever. During a long convalescence he makes the connection between seed, soil, water and earth. Thus, agriculture is born.

Many stroke survivors are frustrated that their deficits are seen as a reduction in cognition. Stroke survivors, and other folks with acquired brain injury, score as high on IQ tests after their injury as before. The way much of society perceives aphasia, hemiparesis, balance problems and so on as a reduction in cognitive ability is ignorant but understandable-people often make instant judgments. So this film's fictional tale was a refreshing reminder that, while stroke may be the end of one chapter, it can be the opening of a new one.

For decades researchers have believed recovery can continue years into the chronic stage of stroke. Modern-day stroke survivors have countless assistive devices available, as well as everyday energy-saving technology. These tools may have the paradoxical effect of halting recovery. Hunter-gatherers walked between 5 and 20 miles per day. Modern-day survivors take a car.

'Acting' Out Recovery

Like a nerdy Star Trek aficionado scoffing at someone else's Capt. Kirk outfit, I am a critic of portrayals of stroke survivors. An example of a poor rendition of stroke was Sir Anthony Hopkins' portrayal of Col. William Ludlow in the film Legends of the Fall. A stroke forced one of Ludlow's eye shut, caused a permanent sneer and rapidly grayed his hair. The stroke also somehow keeps him from getting a haircut. In contrast, the depiction in Birth was spot on. From the hemiparetic posturing of the upper extremity (internally rotated and adducted shoulder, flexed elbow, wrist and fingers with the forearm in pronation) to the gait deviations, the depiction was both accurate and convincing.

Perhaps the best way to "act" a disability is to use actors who actually have that disability. Of course, this may not work, given a particular plot. In both Legends and Birth, the characters have strokes in the middle of the film. There is movement to promote the hiring of actors with disabilities in film, TV and theater. "I AM PWD" (www.iampwd.org) is an organization dedicated to promoting both the hiring of actors with disabilities and the accurate depiction of people with disabilities. They have a compelling point; 20 percent of the population in America has some sort of disability but only 2 percent of characters on TV do. This speaks to accuracy, but what of equity? "I AM PWD" suggests that using an able-bodied actor to play someone with a disability is just as ludicrous as using a white actor to play an African American.

For most of us, there is some disability. It may be the migraine headaches we hide from our employers, dyslexia, a fear of crowds or ADHD. But we have a choice that folks with an apparent disability don't have; we can attempt to hide our problem. For people with obvious disabilities, all the world's a stage.

Peter G. Levine is co-director of the Neuromotor Recovery and Rehabilitation Laboratory (rehablab.org) and the author of Stronger After Stroke (Demos Health, 2008). He conducts seminars teaching research-based, neuroplasticity-producing stroke recovery strategies. E-mail him at StrongerAfterStroke@yahoo.com.