Importance of Neuroplasticity in Rehabilitation

Neuro Physiotherapist Presenting Neuroplasticity.

1. Ashik Dhakal (MPT - Neuro) Nava Jiwan Rehabilitation Center (NRC) Neuroplasticity

2. Neuroplasticity What is this ??

3. Introduction Plasticity - the ability to be moulded/shaped Neuroplasticity is ability of the brain to change or rewire throughout the person’s life introduced by -william James (1842-1910) - american psychologist and philosopher

4. Lisa Kreber, Ph.D, Neuroplasticity is the ability of the brain to form and reorganize synaptic connections, especially in response to learning or experience or following injury. Dr. Donald Hebb, a Canadian neuropsychologist, stated, “Neurons that fire together, wire together” Dr. David Perlmutter (neurologist) noted, “Neuroplasticity provides us with a brain that can adapt not only to changes inflicted by damage, but allows adaptation to any and all experiences and changes we may encounter.”

5. Billions ? Really?

6. Complex networks - responsible for brain function

7. Neural darwinism What is pruning then !

8. Principles of neuroplasticity c

9. Diekhoff-Krebs et al 2017 blob:file:///d05dadf7-f690-48d9-a13b-23c6f443e8d4 blob:file:///d05dadf7-f690-48d9-a13b-23c6f443e8d4

10. What to focus on therapy ?

11. 1. Use it or lose it If we not use those neural pathways they die off Re enforcing neural pathways of dailly activities is necessary in rehabilitation Principles of experience-dependent neural plasticity: implications for rehabilitation after brain damage Kleim   1 and Jones . 2008 10 Principles of Neuroplasticity 2. Use it to Improve it When we use it with different functions — different pathways activated (cognitive , physical, speech) — improve those function

12. 3. Specificity Task specific training — generate specific and strong pathways. According to occupation, interest or requirement of the patient. 4. Repetition & 5. Intensity More is better (Chao Han et al 2012) Right amount of therapy in right settings for long enough period of time All medical professional in the hospital to ask pt to try with affected limb as much possible Learning guitar (even more during rehabilitation)

13. 6. Time matters 7. Salience matters Brain makes greater changes in acute stage compared to chronic stages. Learned task Knowing how it helps to obtain certain goals 8. Age matters Kugler et al 2003 2000 pts, 2 age groups < & > 55.

14. Maladptive neuroplasticity ! Foot drop — >hip flexion Observe - train - prevent 9. Transference/Generalization One type of training transfer itself to different activities with similar skills Core stability training — sitting/standing balance, ability to transfer 10. Interference

15. Types of Neuroplastic changes Temporary or short term changes Long lasting changes - Structural - Functional

16. Structural changes Long term changes requires strong or sustained stimulation, such as - growth of new dendritic spines and synaptic connections -formation of new neurons - enlargement of the cortical area associated with increased activity or viceversa

17. Functional changes Neurons adopt new function — when sufficiently stimulated Healthy tissue — take over the function of damaged area during rehabilitation

18. Daniel kish Tactile and auditory stimuli increase metabolic activity in the visual cortex in blind individuals Deaf individuals responds faster and more accurately than normal individuals to moving stimuli in the visual periphery

19. Mechanism of neuroplasticity Accelator (LTP) and brake (LTD)

20. Long term potentiation Ltp occurs at excitatory synapse in: Hippocampus Cortex Amygdala Cerebellum

21. As a treatment tool in stroke patients

22. References Lisa Kreber & Grace ; The interplay between neuropathology and activity based rehabilitation after traumatic brain injury Diekhoff-Krebs 2017; Interindividual differences in motor network connectivity and behavioral response to iTBS in stroke patients Kleim and Jones. 2008; Principles of experience-dependent neural plasticity: implications for rehabilitation after brain damage. Effects of intensity of arm training on hemiplegic upper extremity motor recovery in stroke patients: a randomized controlled trial Memory and Learning: Long-Term Potentiation (LTP) Teaching the blind to navigate the world using tongue clicks: Daniel Kish 2012

23. Let’s Access the power of Neuroplasticity to change our patient’s brain to change their LIFE Thank you