Gainesville. Orlando

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Stephany Charles
6 years ago
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1 Gainesville Orlando

4 PLASTICITY AND REHABILITATION An end to nihilism

5 BIO Chair and Professor, Department of Communicative Disorders, University of Florida In position of needing to generate my salary As researcher and clinician Scientist at the Brain Rehabilitation Research Center

6 THAT LAST IS IMPORTANT Our reason for being as researchers is to study treatments We do so with a group of SLPS, PTs, OTs, neuropsychologists, and neurologists

7 OUR BELIEF Treatment done according to principles influences the brain and behavior Doing nothing can have disastrous consequences The rehabilitationists major duty is to develop the best possible behavioral treatments

8 THE REASON The best biomedical advances will have muted effects without behavioral treatments Rehabilitationists can see themselves as teachers of cells Whether those cells are imported or specially activated

9 MY COLLABORATORS Dr. Leslie Gonzalez-Rothi Dr Steve Nadeau Dr Bruce Crosson Dr. Diane Kendall Dr. Steve Kautz

10 OUTLINE OF PRESENTATION Plasticity defined Principles guiding rehabilitation Examples primarily from swallowing where much of the seminal work has been done in bulbar and language function Defining treatment effects

11 PLASTICITY DEFINED Flexibility of neural substrates so that alteration to support function is possible Or, Filipek (2000). Brain s ability to recover function that was lost as result of insult. Thus we talk of neuroplastic changes in the anatomy and physiology of intact cortical and subcortical tissues (Nudo et al. 2000)

12 REFERENCES ON PLASTICITY Levin, Grafman (2000). Cerebral Reorganization of Function after Brain Damage. Oxford: Oxford University Press. Kolb (1995). Brain Plasticity and Behavior. Mahwah, NJ: Erlbaum. Dobkin. The Clinical Science of Neurologic Rehabilitation. Oxford, 2003.

13 CRITICAL REHAB NOTION Plastic change does not occur completely on their own The guiding notions of this presentation PLASTICITY IS USE/EXPERIENCE DEPENDENT ALL USE/EXPERIENCE IS NOT EQUAL

14 CONSIDER THESE STATEMENTS The cortex can preferentially allocate area to represent the particular peripheral in put sources that are proportionally most used The rules governing this cortical representational plasticity following manipulation of inputs, including learning, are increasingly well-understood Buonomano & Merzenich,Annual Review of Neuroscience, 1998, 21:

15 HEBB S RATS His rats allow us to think about one more important notion He took half his rats home to live in the house with the family Then he compared the learning of those and the rats maintained in cages in the lab The learning of the home rats was superior

16 THE LESSON Environmental enrichment can increase plasticity Experience or use dependent plasticity can be increased by: The right training A generally enriched environment

17 CAJAL S FOLLY

18 TWO MISTAKES Women have no place in science The adult brain is immutable

19 OPTIMISM During the past two decades, experimental studies in animals and neurophysiological and neuroimaging studies in humans have demonstrated that the adult brain maintains the ability to reorganize throughout life Butefisch. The Neuroscientist, 2004, 10:

22 PRINCIPLES I need to thank Jeffrey Klime and Theresa Jones for these 10 principles can govern how we think about use dependent plasticity Will list each and draw an example or two from a variety of literatures

23 ONE: USE IT OR LOSE IT The brain is precious real estate As Kleim and Jones say, failure to drive specific brain functions through training can lead to the degeneration of that function And to the assumption of its neural substrate by some other function One of the powerful motivators of rehab

24 EXAMPLE Tape the fingers of braille readers and the finger differentiation disappears

25 TWO: USE IT AND IMPROVE IT Training enhances function whether in development or in rehabilitation There is no behavior change without brain change

26 EXAMPLES Constrain induced movement therapy Weight-supported gait training Lee Silverman Voice Therapy Program

27 THREE: PLASTICITY IS EXPERIENCE SPECIFIC One gets better at doing what one practices Cortical and subcortical regions are expanded predictably Leads many researchers to argue for skill rather than use dependent plasticity

28 CONSIDER CORTICAL SWALLOWING AREAS We know that electrical stimulation of the pharynx improves swallowing function and expands the pharyngeal representation in cortex

29 Cortical Areas of Representation

30 LESSONS Training needs to be specific to the function being improved Examples of this principles abuse abound in speech rehab We have people sticking out their tongues as far as they can Yet no speech or swallow activity requires that movement

31 FOUR: REPETITION MATTERS Once is not enough How many times is not yet clear for many behaviors But once or twice weekly treatments are likely to be feckless CIMT, depending on protocol, is hours per day

32 FIVE: INTENSITY MATTERS Intensity admits to multiple definitions I am using it to refer to effort or load Simply moving does not improve performance Moving with steadily increasing accuracy (skill) or effort or load will

33 SIX: TIME MATTERS the young brain is more plastic than the old But the old is not immutable Age should not be a factor in the decision to treat

34 SEVEN: SALIENCE MATTERS By this I mean purpose Reaching for a purpose is different from simply reaching Salience is especially important in communication therapy

35 EIGHT: TIME MATTERS Different forms of plasticity occur at different times during training Even the placebo effect is accompanied by changes in brain Early effects may be result of unmasking Later from changes at the synapse Consider mechanisms of plasticity briefly

36 MECHANISMS OF PLASTICITY Unmasking Vicariation Synaptogenesis

37 UNMASKING The mechanism of using previously existing connections In other words other ways of supporting the activity are revealed when a lesion occurs May explain some reasonably rapid changes in behavior after insult For example ipsilateral fibers, while less numerous may support function impaired by loss of contralateral fibers

38 VICARIATION Mobilization of a region connected to the damaged substrate (Benton and Tranel, 2000). Can be adjacent, homologous on the other side of the brain, or at a distance as in the subcortical region in the case of cerebral injury Probably associated with later plastic change, however

39 EXPERIMENTAL ISSUE Whether reasonably quick improvement is a function of this mechanism or of unmasking Or whether experience (treatment) is necessary

40 SYNAPTOGENESIS Growth of new connections Almost inevitably is experience or use dependent Almost inevitably requires extensive, intensive stimulation

41 ONE MORE NOTION Excitotoxic effects of exercise in animals have been documented Extreme exercise can extend the ischemic lesion in experimentally lesioned mice However absence of activity can extend this period of vulnerability So the right amount of exercise acutely may be key

42 A USEFUL REFERENCE Kozlowski et al.journal of Neuroscience. 1996, 16:

43 NINE: TRANSFERENCE As Kleim and Jones say, Plasticity that occurs in response to one training experience can enhance the acquisition of similar behaviors This is in part basis for generalization which is orderly

44 TEN: INTERFERENCE Again, according to them, Plasticity that occurs in response to on training experience can interfere with the acquisition of other behaviors May be in part the explanation for treatment induced perseveration

45 THE GOOD NEWS Plasticity even in the adult, damaged brain is possible Cynicism about rehab is totally unjustified The cynic can only be at home in Jurassic Park But it does not occur maximally in the absence of systematic, goal directed stimulation (therapy)

Utilizing Principles of Neuroplasticity to Guide Language Rehabilitation. Peter Meulenbroek, MA CCC-SLP University of Wisconsin-Madison

Utilizing Principles of Neuroplasticity to Guide Language Rehabilitation Peter Meulenbroek, MA CCC-SLP University of Wisconsin-Madison 1. Outline Assumptions Outline of Talk 2. Outline Principles of Neurological