Mr.

Phinoj K Abraham (MOTh)

Assistant Professor,
SRM College of Occupational Therapy
 (plastos) - ‚capable of being molded’

Neuroplasticity:
‘the ability of the CNS to remodel itself’
Neuroplasticity is how we adapt to changing
conditions, learn new facts, and develop new
skills.

It is constantly occurring; the brain is always

changing (Mark Hallet 2005)
Neuroplasticity
Historical Background

Two Current Concepts

Importance in Rehabilitation

Role of Occupational Therapist

Related Research
Until 1970 : brain structure is relatively immutable in
adulthood.

In the 1960s,
Paul Bach-y-Rita - electrically stimulated chair with 400
vibrating stimulators for congenitally blind.

He Concluded, “We see with our brains, not with our eyes.”
Doidge, Norman (2007)
A tragic stroke that left his 68 year old father paralyzed
inspired Bach-y-Rita to study brain rehabilitation
His brother – a physician- rehabilitated him and he recovered
well

He believed that ‘Under conditions of interest, such as that

of competition, the resulting movement may be much more
efficiently carried out than in the dull, routine training in the
laboratory’
(Franz, 1921, pg.93)
David Hubel and Torsten Wiesel:
Study with kittens

The experiment involved sewing one eye shut and

recording the cortical brain maps

the portion of the kitten’s brain associated with the shut

eye was not idle, as expected. Instead, it processed visual
information from the open eye.

“… as though the brain didn’t want to waste any ‘cortical

real estate’ and had found a way to rewire itself.”
Jenkins & Merzenich (1987) removed monkey’s 1 Peripheral
Nerve , later found that adjacent neurons had started to
respond to the palm.
(Ramachandran V 1992).
“if someone were to lose their right
hand in an accident, they may then have
the feelings of a phantom limb because
the areas in the somatosensory cortex
that are near to the ones of the hand
(the arm and face) will take over (or
"remap") this cortical region that no
longer has input”
Enhancement of existing Formation of new
connections connections

Very active
A very research
active area;
research concepts
area; areare
concepts continually being
continully updated
being updated
 Type Mechanism Duration

1. Enhancement of existing connections

A. Synapse development Physiological ms-1 to hours

B. Synapse strengthening Biochemical hours to days

2. Formation of new connections

A. Unmasking Physiological minutes to days
B. Sprouting Structural days to months
1. Enhancement of existing connections

Increased use of a synapse in existing

pathways e.g. learning a new task

Or alternative pathways following

damage

Opposite: dendrite atrophy

Increased
afferent input +
+ New synapses
evolve leading to
+
increased
excitation
Ragert et al., 2004
Effectiveness of a synapse can be increased for at least 3
durations:
1. Seconds and minutes (short-term memory)
2. Hours and days (intermediate-term memory)
3. Months and years (long-term memory)

Such changes can take place at

three cellular locations:
1. Presynaptic terminal
2. Postsynaptic membrane
3. Postsynaptic nucleus
Kidd et al., 1992
 Two point discrimination threshold in
pianists index finger

Ragert et al., 2004

R L

Comparison of musicians to non-musicians

Findings were long-lasting piano practising resulted in lower spatial
discrimination thresholds in the index finger of piano players in
comparison to non-musicians.
This decrease in threshold was related to the number of hours
practised per day (>3 hours), not to the number of years they had
been playing
2) Formation of new connections

Unmasking of pre-existing pathways

Sprouting of new pathways

Possible reasons why some synapses could
be ‘silent’
Inhibited by dominant pathways
Too little transmitter
Too few receptors
Don’t fire with other inputs
 Parallel pathway; neurons
with a comparable role

Dominant pathway Subservient pathway

+ +
Lesion to
Subservient pathway is
dominant
unmasked
pathway

+
+

Activity is
continued
despite
lesion
Cell body Sprouting occurs
following damage or
denervation to the
Axon
nervous system and
is the growth of new
axons from cell
bodies forming new
pathways
 INJURY
Following
denervation, neurotro
phic factors or nerve
growth factors are lesion
released, they are
polypeptides capable Nerve
Growth
of promoting Factor
neuronal survival. (NGF)
 INJURY
The release of
nerve growth Neurite induced
factors to sprout by
NGF
stimulates
lesion
neurites or new
axons to sprout
and look for NGF
the source of
the NGF
 Injury results in
cell death

Cell is re-innervated
from alternative
stimulus

Sprouting may be a means of recovery; it may also produce

unwanted effects For example spinal cord injury patients may
experience strange sensations.
 1. Strengthen and develop
normal synapses

OT’st need to 2. Guide axonal sprouting

3. Facilitate unmasking of
alternative or previously
subservient pathways
Provide positive sensory input
i.e. “appropriate handling”

Facilitate “functional”
movement

Provide treatment at
“optimum” time

Education
 NEGATIVE POSITIVE PLASTICITY
PLASTICITY
Stimulation Disuse/ unskilled Intensive, skilled
Quality of Noisy. nonspecific Appropriate / specific
sensory
input
Modulation Not challenging Novel &
Challenging
Outcome Negative behaviors Positive behaviors
Mirror Therapy for patients with stroke & Amputation
Ramachandran, Rogers-Ramachandran & Cobb 1995

Hypothesis
Every time the patient attempted to move the paralyzed limb, they
received sensory feedback (through vision and proprioception) that
the limb did not move.
This feedback stamped itself into the brain circuit (Hebbian Learning)
So even when the limb was no longer present, the brain had learned
that the limb (and subsequent phantom) was paralyzed.
Often a phantom limb is painful because it is felt to be stuck in an
uncomfortable or unnatural position, and the patient feels they
cannot move it.
Mirror Box
To retrain the brain, and thereby
eliminate the learned paralysis

The patient places the good limb into

one side, and the stump into the
other

It appears as if the phantom limb is

also moving
to unclench it from potentially
painful positions.
(Ramachandran, Rogers-Ramachandran & Cobb 1995)
Ex.
“Examining the Neuroscience Evidence for Sensory-
Driven Neuroplasticity: Implications for Sensory-
Based Occupational Therapy for Children and
Adolescents”
Shelly J. Lane and Roseann C. Schaaf
American Journal of Occupational Therapy
May/June 2010 vol. 64 no. 3 375-390
Neuroplasticity is the focus of a growing body of
research with significant implications for neuro-
rehabilitation.

Neuroplasticity - while not a concept unique to

OT - holds tremendous application for neuro-
rehabilitation provided by OTs.
Bibliography
Neurological Rehabilitation – Umphred Darcy 4th edition
Physiological basis of Rehabilitation
Journals
Mirror therapy improves hand function in subacute stroke: a
randomized controlled trial. Arch Phys Med Rehabil. 2008
Mar;89(3):393-8.
Guest Editorial - Neuroplasticity and rehabilitation assesssed from
www.rehab.research.va.gov/jour/05/42/4/pdf/hallet.pdf retrieved on 3-
03-12
Net References
http://en.wikipedia.org/wiki/Neuroplasticity retrieved on 3-03-12
http://en.wikipedia.org/wiki/Mirror_box retrieved on 3-03-12
http://en.wikipedia.org/wiki/Hebbian_learning retrieved on 3-03-12