Neuroplasticity... Why is it important to Rehabilitation? 

Neuroplasticity is the base of every treatment for a patient who has suffered a neurological event such as a cerebral vascular accident (CVA). It’s the term to describe the ability of the human brain to adapt to environmental pressure, experiences and challenges of daily life. It occurs at many levels from the molecules to the cortical reorganization/remapping aspect of our brain. Learning after a neurological event is dependent upon neural plasticity because large portions of the brain are devoted towards production of skilled movements. We see a clear difference between learning in the intact brain and relearning with an injured brain. In therapy, we are able to take advantage of the previously learned behaviors that may still exist within the residual neural circuits of the damaged brain.

What are the Neuroplasticity Principles and how can they assist you during treatments?

Use it or Lose it

  • If you do not drive specific brain functions, functional loss will occur (Kleim & Jones, 2008).

  • If patients do not focus on using the affected side after a neurological event, they will slowly lose function. For example, if we have a weak arm and do not use it during functional tasks the neuro pathways in our brain will slowly degrade causing the arm to lose all functional mobility.

Use it and improve it

  • Therapy tasks that focus on specific brain task to increase functional improvement (Kleim & Jones, 2008).

  • Patients who have lost function on one side of their body tend to avoid using their affected side due to neglect or to difficult to use. Patients have to be trained to use their affected side to improve its function. One treatment idea that helps focus on this is Constraint-induced movement therapy, because it’s main focus is to force the use of the affected side by restraining the non-affected side.

Specificity

  • Therapy you choose determines the resultant plasticity and function (Kleim & Jones, 2008).

  • The importance of modifying an activity or exercise that produces functional gains in a certain process. For example, using functional electrical stimulation (ESTIM) to produce muscle contraction on an upper extremity that is flaccid from a CVA.

Intensity Matters

  • Induction of plasticity requires the appropriate amount of intensity (Kleim & Jones, 2008).

  • The questions that is always hard to answer is, “How long will this take to get better? How long will I be like this?” We know as clinicians that we are unable to put a date or a time on when a patient with heal from their injury, but what we do know is that if a patient receives intense therapy from the start, they are more likely to increase function. When planning our treatments is looking at the needs of the patient an focusing on each throughout your session. If a patient has low endurance and memory deficits, then perform standing balance exercises with cognitive activities.

Repetitions Matter

  • Plasticity that results in functional change requires repetition (Kleim & Jones, 2008).

  • High repetitions are key to a person’s recovery after a neurological event. Research has showed us over time that a patient that receives a higher dosage during treatment increases function. The key to each treatment when treating a patient with a neurological injury.

Time matters

  • The early recovery starts increases the ability to increase plasticity for functional improvement (Kleim & Jones, 2008).

  • After an injury, our brain is immediately ready to recover and heal itself. The quicker a patient can start with neurological treatment the better the result with be.

Age Matters

  • Plasticity is easily more accessible in younger brains (Kleim & Jones, 2008).

  • The key is to remember that younger brains have the ability to be very adaptable and have high amounts of plasticity, whereas older brains demonstrate a slower rate of adaptability.

Salience Matters

  • The training experience has to be very relevant to facilitate plasticity (Kleim & Jones, 2008).

  • Our treatments have to be engaging and meaningful to our patients or it will not increase the neuroplasticity that we are looking for. For example, we should not be doing cooking task with a patient who has never cooked for themselves. The goal is to be very patient focused and engage patients in meaningful tasks or being able to explain why the treatment with help facilitate independence in what is meaningful for them.

Transference

  • Plasticity in response to a training experience can increase the functional gain of a similar behaviors (Kleim & Jones, 2008).

  • Treatments need to be relatable to real world activities. It needs to have carryover to specific tasks such as dressing, drinking from a cup, etc.

Interference

  • Plasticity in response to a training experience can hinder achievement of similar behaviors (Kleim & Jones, 2008).

  • If patients receive delayed neurological treatment, then they tend to learn compensatory strategies that are not always the best technique. So, we have to help the patient unlearn the new behavior that they have integrated into their daily life.

Neuroplasticity is the primary role when planning treatments for our patients. We have to gain the full picture of our patient and understand what goals they want to achieve.  Allow your patients to help drive the treatments so that they will be more likely to participate which will allow for more functional gains within the body.  

Reference

Kleim, Jeff & Jones, Theresa. (2008). Kleim JA, Jones TAPrinciples of experience-dependent neural plasticity: implications for rehabilitation after brain damage. J Speech Lang Hear Res 51:S225-S239. Journal of speech, language, and hearing research : JSLHR. 51. S225-39. 10.1044/1092-4388(2008/018).

Hannah Cox