Nppcity

Neuroplasticity
Dr. Michael P. Gillespie
Neuroplasticity
Neuroplasticity is the ability of the brain to
change, for better or for worse, throughout the
individuals life span.
It involves forming neuronal connections in
response to information derived from experiences
in the environment, sensory stimulation, and
normal development (Doidge, 2007; Merzenich,
2001; Nudo, 2008).
Neuroplasticity
Neuroplasticity refers to the moldable structure of
the brain and nerves that results from changes in
neural pathways and synapses. These changes
stem from changes in behavior, environment,
neural processes as well as changes from bodily
injury.
The brain does change throughout life.
Neuroplasticity
Girl Living With Half Her Brain

http://www.youtube.com/watch?v=2MKNsI5CWoU
Positive Outcomes of
Neuroplasticity
New skills
Better cognition
More efficient communication between sensory and motor pathways
Improved function of the aging brain
Slowing down pathological processes
Promoting recovery of sensory losses
Improved motor control
Improved memory
(Mahncke, Bronstone & Merzenich, 2006; Mahucke & Merzenich, 2006;
Nudo 2007; Stein & Hoffman, 2003).
Negative Outcomes of
Neuroplasticity
Decline in brain function
Altered motor control
Impaired performance of activities of daily living
Amplified perception of pain
Neuroplasticity
http://www.youtube.com/watch?v=iAzmyB9PFt4
Structural Changes in the

Brain
Synaptic plasticity
Synaptogenesis
Neuronal migration
Neurogenesis
Neural cell death
10
Synaptic Plasticity
Synaptic plasticity refers to changes in the
strength of connections between synapses.
Long-term potentiation (LTP)
Long-term depression (LTD)
Changes in the number of receptors for specific
neurotransmitters
Up-regulation
Down-regulation
Changes in which proteins are expressed inside the

cell
11
Neuroplasticity Brain
Remodeling
Steps to remodel the brain based upon
experiences:
1. Repetition
2. Correct fundamentals
3. Authentic environment
12
Neuroplasticity Brain
Remodeling
http://www.youtube.com/watch?v=VvZ9ofM7Go&feature=related
Synaptogenesis & Synaptic

Pruning
The creation and removal of entire groups of
synapses.
This builds and destroys connections between
neurons respectively.
13
14
Neuronal Migration
Neuronal migration is a process whereby neurons
extend from their place of birth to connect to far
reaching areas of the brain.
15
Neurogenesis
Neurogenesis is the creation of new neurons.
It largely occurs in the developing brain.
Limited neurogenesis occurs in the adult brain.
16
Neural Cell Death

Neurons die.
This can happen from either damage, overexcitation, or disease.
Natural programmed cell death including
apoptosis also occurs.
17
Functional Reorganization
As the brain develops, certain areas of the brain
become specialized for specific tasks.
If your experience changes dramatically or parts
of the brain are damaged, areas previously
specialized for a certain function can take on the
work of other areas.
18
Brain Functions / Brain

Regions
Contrary to common
understanding, brain
functions are not strictly
confined to specific fixed
locations as identified in
this picture.
19
Previously Held Beliefs

Brain functions were confined to specific fixed
locations of brain tissue.
Brain structure is relatively immutable after a
critical period during early childhood.
* New research reveals that many aspects of the
brain remain plastic in adulthood. *
20
Levels of Neuroplasticity
Cellular changes (result of learning)
Cortical remapping (response to injury)
21
Synaptic Pruning
Synaptic pruning is a neurological regulatory process
that facilitates a change in neural structure by
reducing the overall number of neurons and
synapses.
The resulting synaptic connections are more efficient.
Pruning is believed to represent the learning process.
Synapses that are frequently used have strong
connections whereas those that are rarely used are
eliminated.
Neurons that fire together, wire together. Neurons
that fire apart, wire apart.
Synaptogenesis / Synaptic
Pruning
http://www.youtube.com/watch?
v=tJ93qXXYRpU&feature=related
22
23
Cortical Maps
Sensory information from certain parts of the body
projects to specific regions of the cerebral cortex.
As a result of this somatotrophic organization of
sensory inputs to the cortex, cortical
representation of the body resembles a map (or a
homonculus).
24
The Learning Brain

v=cgLYkV689s4&feature=related
25
Homunculus
26
Removing Sensory Inputs

If a cortical map is derived of sensory input, the
adjacent segments it will become activated by
adjacent sensory inputs.
Merzenichs 1984 study involved the mapping of owl
monkey hands before and after amputation of the third
digit.
Before amputation, there were five distinct areas
corresponding to each individual digit.
After amputation of the third digit, the area of the cortical
map formerly occupied by the third digit was invaded by
the previously adjacent second and fourth digit zones.
Only the regions bordering a certain area will invade it
will alter the cortical map.
27
Sensory Site Activation

Sensory sites that are activated in an attended
operant behavior increase their cortical representation
(Merzenich and William Kenkins (1990)).
When a stimulus is cognitively associated with
reinforcement, its cortical representation is
strengthened and enlarged (Merzenich and DT Blake
(2002, 2005, 2006).
Cortical representations can increase two to threefold
in 1-2 days at the time in which a new sensory motor
behavior is first acquired and changes are largely
finished within a few weeks.
28
Phantom Limbs
Phantom limbs are experienced by people who
have undergone amputations.
Cortical reorganization appears to play an
important role in phantom limb sensation.
Mirror box therapy developed by Vilayanur
Ramachandran has shown great promise in
treating phantom limb pain.
29
Phantom Limb Pain
30
Mirror Box
A diagrammatic
explanation of the mirror
box. The patient places the
good limb into one side of
the box (in this case the
right hand) and the
amputated limb into the
other side. Due to the
mirror, the patient sees a
reflection of the good hand
where the missing limb
would be (indicated in
lower contrast). The
patient thus receives
artificial visual feedback
that the "resurrected" limb
is now moving when they
move the good hand.
31
Mirror Visualization Therapy

v=Pe8Y3YETnuY&feature=relmfu
v=hMBA15Hu35M&feature=related
32
Spatial Coupling
Marian Michielsen suggested that
Ramachandrans Mirror Box therapy worked by
enhancing spatial coupling between limbs.
33
Treatment of Brain Damage

Brain activity associated with a given function can
move to a different location.
This concept allows for the treatment of acquired
brain injury.
The adult brain is not hard-wired with fixed
neuronal circuits.
Cortical and subcortical rewiring of neuronal
circuits happens in response to training and in
response to injury.
34
Neurogenesis
Neurogenesis is the process by which neurons are
generated from neural stem cells.
Recent studies show that neurogenesis occurs in
the adult mammalian brain and can persist well
into old age.
This appears to occur in the hippocampus, olfactory
bulb, and cerebellum.
In the rest of the brain, neurons can dies, but cannot
be recreated.
Rehabilitation Techniques
That Precipitate Cortical
Reorganization
Constraint-induced movement therapy
Functional electrical stimulation
Treadmill training with body weight support
Virtual reality therapy
35
Constraint-induced Movement
Therapy (CIMT)
This therapy improves upper extremity function in
stroke victims and other victims with central nervous
system damage.
The purpose is to combine restraint of the unaffected
limb and intensive use of the affected limb.
Types of restraints:
Sling
Triangular bandage
Splint
Half glove
Mitt
36
Therapy (CIMT)
The use of the affected limb is called shaping.
Training typically involves restraining the unaffcted
limb and using the affected limb for 90% of waking
hours.
Receiving CIMT early (3-9 months post-stroke) results
in greater functional gains than receiving delayed
treatment (15-21 months post-stroke).
Factors for success of CIMT
Concentrated and repetitive practice of the affected limb.
The unaffected limb must be constrained 90% of the
waking hours.
37
Therapy (CIMT)
38
Therapy (CIMT)
http://www.youtube.com/watch?v=MMTh2hWvB2g
39
40
Functional Electrical
Stimulation
Functional electrical stimulation uses electrical
currents to activate nerves innervating extremities
affected by paralysis resulting from spinal cord
injury, head injury, stroke, and other neurological
disorders.
Sometimes it is referred to as Neuromuscular
electrical stimulation (NMES).
41
Functional Electrical
Stimulation
Contralaterally Controlled
Functional Electrical Stimulation
Stroke Therapy
http://www.youtube.com/watch?v=boz0HQXQhKg
42
43
Treatment of Learning
Difficulties
Michael Merzenich developed a series of plasticity
based computer programs known as Fast ForWord.
The programs consist of seven brain exercises to
help with the language and learning deficits of
dyslexia.
The software also improved cognitive function in
adults with age related cognitive decline (ARCD).
44
Chronic Pain
Some people suffer chronic pain at sites that were
previously injured, but are currently healthy.
Chronic pain happens as a result of maladaptive
reorganization of the nervous system both
peripherally and centrally.
During the period of tissue damage, prolonged
nociceptive input from the periphery to the central
nervous system results in somatotopic
organization and central sensitization.
45
Meditation
Meditation has been linked to cortical thickness and the
density of gray matter.
Richard Davidson performed experiments with H.H. the
Dalai Lama to examine the effects of mediation on the
brain.
Long term and short term practice of meditation resulted
in different levels of activity in brain regions associated
with qualities such as attention, anxiety, depression,
fear, and anger.
Mediation also demonstrated an effect on the ability of
the body to heal itself.
Changes in the physical structure of the brain appear to
be responsible for these differences.
46
Exercise Induced
Neuroplasticity
All forms of exercise appear to produce neuronal
changes in the brain; however, different forms of
exercise produce changes in different brain
regions.
More demanding forms of exercise seem to
promote change in more diverse areas of the
brain.
Neuroplasticity & Occupational

Therapy
Learning and memory are the result of experience
driven alterations of the synaptic structures of
neurons.
Occupational Therapy practitioners set up the
circumstances and situations that modify the
environment and the degree of challenge for a skill set
(just the right challenge) that creates an adaptive
response that originates at the cellular and molecular
level (McCormack, 2009).
Neuroplasticity reflects the brains ability to grow and
change into old age as long as it is engaged in
meaningful occupations. This is the basis of
occupational therapy (Christiansen & Baum, 2005).
47
48
Types of Neuroplasticity
Practice-Dependent Plasticity
Competitive Plasticity
Positive Plasticity
Negative Plasticity
49
Practice-Dependent Plasticity
A person performs a task repeatedly to learn or relearn a skills set.
The neurons that fire together, wire together
(Hebbs concept).
http://www.youtube.com/watch?v=5iyodWeFkLE
You can incorporate constraint induced OT as well
to force neurons to fire together and unmask
latent neurons to activate those neuronal
pathways.
50
Competitive Plasticity
Use or disuse of a neuronal pathway will lead to
natural selection of the pathways utilized.
Use it or lose it
The cerebral cortex is constantly remodeling itself
according to influences from the environment
(Bear et al, 2007; Mahncke, Bronstone et al,
2006).
51
Positive Plasticity
Compensatory changes occuring at the cellular
and molecular levels (dendritic sprouting).
Temporal changes (speed of action potentials).
Release of neuromodulators.
Influence of second messengers (i.e. producing
new postsynaptic membrane receptors).
Formation of alternative pathways that make new
functional connections in the cortex and tract
systems.
52
Dendritic Sprouting
53
Neurite Outgrowth
v=n_9YTeEHp1E&feature=related
54
Negative Plasticity
Negative plasticity occurs when dendritic sprouting and
proliferation of postsynaptic membrane receptors
results in excessive production of excitatory impulses
producing hypertonicity in muscles.
Good motivation and attention release
neuromodulators (dopamine and acetylcholine) that
promote faster synapses and positive changes in
cortical mapping.
Poor motivation and lack of effort produces weak
synaptic connections and synapses that are slower.
These neurons sometimes undergo apoptosis.
Neurons that fire out of sync, fail to link (Bear et al.,
2007; Fillipi, 2002; Woolf & Salter, 2000).
55
Secondary Neural Pathways

After a lesion in the central nervous system, the
usual neuronal pathways are blocked or destroyed.
We can develop secondary neuronal pathways to
send neuronal signals around the blockage.
We say that secondary neuronal pathways become
unmasked and get stronger with use.
This is analogous to a bridge going out. We can
take secondary roads. This path may take longer,
but shorter paths will be found.
56
Compensation
If a person loses one sensory modality, other senses can
compensate and take over.
Teaching ways to adapt, modify, or change the method to
perform the task.
This may involve modifying the environment.
It may involve training the family members or caregivers to
assist.
Compensation involves the brains ability to recruit other
neurons in other regions of the nervous system. It is a
form of neuroplasticity and not just a way to modify or
adapt.
57
Neuroplasticity in Pain
Syndromes
Neuropathic pain and pain hypersensitivity are
examples of negative plasticity.
Activation of nociceptive pathways is the response
of the system to repeated stimuli.
Neuroplasticity in Repetitive
Strain Injuries
Complex bio-psychosocial responses can cause
undesirable outcomes in localized injuries (Nudo, 2007).
Therefore, it is necessary to treat the whole person.
OT practitioners should stimulate practice-dependent
plasticity by facilitating adaptive responses that engage
the cerebral cortex.
Mental rehearsals and guided imagery techniques
release neuromodulators such as dopamine,
norepinephrine, and acetylcholine.
These neuromodulators influence neuroplasticity and
the formation of new cortical maps.
58
59
Mechanisms of
Neuroplasticity
1. Diaschisis neuronal structures that are anatomically
connected to a lesion or region damaged by stroke
undergo reduced blood supply and metabolism.
2. Behavioral compensation occupational therapy
directs the individuals interaction with the environment
to utilize viable neurons surrounding the area of the
lesion in order to reorganize their capacity to
compensate for damaged neurons.
3. Adaptive plasticity dendritic growth and angiogenesis
occurs near the damaged areas. Dendritic growth is an
adaptive response to substitute for the lost function.
This is a critical time of OT intervention.
Positive plasticity happens through use or doing.
Negative plasticity happens through disuse or doing little.
60
OT in Cognitive Rehabilitation
Cognitive impairments are an example of negative
plasticity that affects mood and the ability to
problem solve. This in turn can reduce motivation.
Interventions used in occupational therapy that
stimulate change and repetition are important in
strengthening connections between neurons
(Meintzschel & Ziemann, 2006).
If the practitioner uses a novel stimulus, it should be
followed immediately by some reward or
reinforcement. It should be repeated again and
again to drive synaptic change.
61
Compensatory Cognitive
Strategies
Changes in environmental structure and support.
Visual aids.
Checklists.
Step-by-step instructions.
Remedial cognitive interventions include repetitively practicing
tasks that require specific cognitive functions and challenges.
Video games
Virtual reality
Neurofeedback training
Brain-computer interface technology can deliver repetition,

challenge, and motivation rapidly and consistently.
62
Neurofeedback Training
http://www.youtube.com/watch?v=GJRWYxEEFv0
63
Brain Computer Interface

http://www.youtube.com/watch?v=ZwuMg0FsKzs

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