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Ten Principles of Neuroplasticity Cheat Sheet (DRAFT) by [deleted]

Ten Principles of Neuroplasticity

This is a draft cheat sheet. It is a work in progress and is not finished yet.


Kleim and Jones* outlined ten principles of neurop­las­ticity that can be helpful to keep in mind in the treatment enviro­nment:

1. "Use It or Lose It"

"­Neural circuits not actively engaged in task perfor­mance for an extended period of time begin to degrad­e." An example of this might be seen in the treatment of a patient who requires g-tube feeding due to an inability to be fed orally. Over time, the circuits respon­sible for the swallowing mechanism may actually begin to degrade due to lack of use. Subseq­uently, when that patient is able to begin to swallow again, they may require additional time and trials to re-est­ablish this process as these circuits may be a bit "­rus­ty."­

2. "Use It and Improve It"

"­Tra­ining that drives a specific brain function can lead to enhanc­ement of that functi­on."­ An example of this can be highli­ghted from the previous discussion of a stroke patient who may have lost use of a particular side of their body and may be neglecting that side or not using it because it is simply too difficult. In the treatment setting, a technique known as constr­ain­t-i­nduced movement therapy (CIMT) can be used to restrain the arm on the non-af­fected side so that the patient is compelled to use their affected limb as much as possible and improve its function.

3. Specif­icity

The nature of the training experience dictates the nature of the plasti­city.
From a treatment standp­oint, specif­icity highlights the importance of tailoring an activity or exercise to produce a result in specific circuitry. For example, as discussed earlier, physical exercise can be utilized to promote vascular growth, if that is your aim. By the same token, exercises and modalities geared toward enhancing swallowing might also be related to the circuitry involved in producing speech, but may not necess­arily generalize to actually producing speech.

4. Repetition Matters

Induction of plasticity requires sufficient repeti­tion.
One of the challenges for therapists in the rehabi­lit­ation enviro­nment can often revolve around being able to quantify how much time or how many sessions of specific therapy a patient needs to recover certain skills. Stakeh­olders, especially insurance repres­ent­atives and the patients themse­lves, want to know, "How long is it going to take to get better­?" The truth is, we don't know these actual numbers, but we do know from research and study, that thousands and tens of thousands of repeti­tions of certain activities are needed to generate these changes. Because of this, it may take utilizing techniques such as combining therapies to provide patients the opport­unities for sufficient repetition of skills.

5. Intensity Matters

Induction of plasticity requires sufficient intensity.
The question of proper therapy intensity follows this concept of repetition as well: " What is the proper dosage of therapy necessary? "How many sessio­ns?­" How long should these sessions be?' Research has also shown us that the more intensive the therapy program, the more likely a person is to achieve results and the more likely these changes are to be maintained over time.

6. Time Matters

Different forms of plasticity occur at different times during recovery.
This principle is based on the idea that after an injury, the brain really wants to recover, so it makes sense that the earlier you provide the opport­unity for recovery through these neurop­lastic changes, the better. This "­early vs. late" approach is especially important to support the beginning treatment before malada­ptive behaviors have a chance to spring up.

7. Salience Matters

The training experience must be suffic­iently salient to induce plasti­city.
What the person takes away from the training experience and what it means to them can affect their recovery. It is important for the therapist to know what is important to the patient, as emotions can modulate the strength of training

8. Age Matters

Traini­ng-­induce plasticity occurs more readily in younger brains.
Younger brains are already more plastic and adaptable to change than older brains, which is important to keep in mind when working with older versus younger patients.

9. Transf­erence or Genera­liz­ation

Plasticity in response to one training experience can enhance acquis­ition of similar behaviors.
In the training process, the therapist needs to have an eye toward how a particular skill or activity can be genera­lized or transf­erred to real world activi­ties, such as increased indepe­ndence in the home enviro­nment.

10. Interf­erence

Plasticity in response to one training experience can impede acquis­ition of similar behaviors.
When patients are actually able to come in for neurol­ogical treatment and that treatment is delayed, they often come in with compen­satory behaviors for skill deficits, having already learned a different way of compen­sating, but which may not be the best way. With this, some of the challenge to learning the best way to regain a skill may involve "­unl­ear­nin­g" some of these previously acquired behaviors.