Posts Tagged Neuroplasticity

[ARTICLE] Functional electrical stimulation therapy for restoration of motor function after spinal cord injury and stroke: a review – Full Text


Functional electrical stimulation is a technique to produce functional movements after paralysis. Electrical discharges are applied to a person’s muscles making them contract in a sequence that allows performing tasks such as grasping a key, holding a toothbrush, standing, and walking. The technology was developed in the sixties, during which initial clinical use started, emphasizing its potential as an assistive device. Since then, functional electrical stimulation has evolved into an important therapeutic intervention that clinicians can use to help individuals who have had a stroke or a spinal cord injury regain their ability to stand, walk, reach, and grasp. With an expected growth in the aging population, it is likely that this technology will undergo important changes to increase its efficacy as well as its widespread adoption. We present here a series of functional electrical stimulation systems to illustrate the fundamentals of the technology and its applications. Most of the concepts continue to be in use today by modern day devices. A brief description of the potential future of the technology is presented, including its integration with brain–computer interfaces and wearable (garment) technology.


Losing the ability to move voluntarily can have devastating consequences for the independence and quality of life of a person. Stroke and spinal cord injury (SCI) are two important causes of paralysis which affect thousands of individuals around the world. Extraordinary efforts have been made in an attempt to mitigate the effects of paralysis. In recent years, rehabilitation of voluntary movement has been enriched by the constant integration of new neurophysiological knowledge about the mechanisms behind motor function recovery. One central concept that has improved neurorehabilitation significantly is neuroplasticity, the ability of the central nervous system to reorganize itself during the acquisition, retention, and consolidation of motor skills [1]. In this document, we present one of the interventions that has flourished as a consequence of our increased understanding of the plasticity of the nervous system: functional electrical stimulation therapy or FEST. The document, which is not a systematic review, is intended to describe early work that played an important historical role in the development of this field, while providing a general understanding of the technology and applications that continue to be used today. Readers interested in systematic reviews of functional electrical simulation (FES) are directed to other sources (e.g., [2,3,4]).[…]


Textile-based neuroprostheses. a Finger extension produced using a shirt designed for implementing a neuroprosthesis for reaching and grasping. The garment includes rectangular areas (dark grey patches) made of conductive yarn that function as electrodes. b Forward reaching. Details can be found in [65]

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[ARTICLE] Non-Immersive Virtual Reality for Post-Stroke Upper Extremity Rehabilitation: A Small Cohort Randomized Trial – Full Text


Immersive and non-immersive virtual reality (NIVR) technology can supplement and improve standard physiotherapy and neurorehabilitation in post-stroke patients. We aimed to use MIRA software to investigate the efficiency of specific NIVR therapy as a standalone intervention, versus standardized physiotherapy for upper extremity rehabilitation in patients post-stroke. Fifty-five inpatients were randomized to control groups (applying standard physiotherapy and dexterity exercises) and experimental groups (applying NIVR and dexterity exercises). The two groups were subdivided into subacute (<six months post-stroke) and chronic (>six months to four years post-stroke survival patients). The following standardized tests were applied at baseline and after two weeks post-therapy: Fugl–Meyer Assessment for Upper Extremity (FMUE), the Modified Rankin Scale (MRS), Functional Independence Measure (FIM), Active Range of Motion (AROM), Manual Muscle Testing (MMT), Modified Ashworth Scale (MAS), and Functional Reach Test (FRT). The Kruskal–Wallis test was used to determine if there were significant differences between the groups, followed with pairwise comparisons. The Wilcoxon Signed-Rank test was used to determine the significance of pre to post-therapy changes. The Wilcoxon Signed-Rank test showed significant differences in all four groups regarding MMT, FMUE, and FIM assessments pre- and post-therapy, while for AROM, only experimental groups registered significant differences. Independent Kruskal–Wallis results showed that the subacute experimental group outcomes were statistically significant regarding the assessments, especially in comparison with the control groups. The results suggest that NIVR rehabilitation is efficient to be administered to post-stroke patients, and the study design can be used for a further trial, in the perspective that NIVR therapy can be more efficient than standard physiotherapy within the first six months post-stroke.

1. Introduction

Stroke Alliance for Europe states that “every 20 s, someone in Europe has a stroke”, while in the United States, “someone has a stroke every 40 s” a leading cause of significant long-term disabilities [1,2]. According to a European Union (EU) report, Romania has the lowest annual healthcare expenditure per capita (€1029 in 2015, compared to the EU average of €2884). The highest risk factors of a stroke are smoking and alcohol drinking, with males accounting for more than 50% of those impacted. Additionally, the level of education influences both lifestyle and life expectancy, with the Romanian life expectancy being among the lowest in the EU (75.3 years in Romania versus 80.9 years in the EU, in 2015). Moreover, there were 61,552 stroke cases in Romania in 2015 and forecasts state that this number will increase by 24% until 2035 [3,4].Worldwide, the population faces high incidence rates of stroke and post-stroke sequelae with an increased need for neurorehabilitation services. In Europe, it is estimated that the number of annual stroke events will increase from 613,148 registered in 2015 to 819,771 in 2035, an increase of 34%. Considering that post-stroke survival rates have improved; estimations predict that the number of people living with strokes in Europe will grow from 3,718,785 in 2015 to 4,631,050 in 2035 [1].Stroke complications can be long-lasting; thus, at 15-years post-stroke, two-thirds of survivors live with a disability, nearly two of five suffer from depression, and more than a quarter have cognitive impairment [5]. Post-stroke disability significantly contributes to the increasing use of long-term medical care resources, thus highlighting that efficient rehabilitation can cut costs in the healthcare system [6] whereas telerehabilitation is still in the early phase of utilization in developing countries.Furthermore, international guidelines for stroke rehabilitation include physiotherapy techniques and methods for the recovery of the swallowing function and the urinary and bowel continence. These techniques and methods are also recommended for the improvement/prevention of shoulder pain, joint misalignments, and limb deviations caused by post-stroke spasticity, also used for secondary prevention of falling, as well as for enhancing the ability to perform self-care and daily living activities. Recovery from post-stroke impairments is facilitated, on the one hand, by increasing the motor function and, on the other hand, by improving the functionality of the limbs and body as a whole functional unit. In order to retrieve functional capacity, the existing guidelines recommend the use of intensive, repetitive training, improvement of functional mobility, use of orthoses, performing specific activities of daily living (ADLs) practiced repeatedly, progressive and bilateral training of the upper limb, the use of virtual reality and assisted robotic therapy, and the use of strength training exercises [7,8,9].The use of virtual reality technology as an adjunct or substitute for traditional physiotherapy has been studied and proved to be effective in improving patients’ functional rehabilitation. However, as regards strokes, some systematic reviews suggest that virtual reality (VR) has not brought more benefits to patients compared to standard physiotherapy alone, while other research advocates for specific VR training as a therapy with a better outcome compared to conventional physiotherapy in the rehabilitation of stroke survivors [10,11,12,13,14].Research on neuroplasticity and learning or relearning abilities shows that there are several principles of motor learning, including multisensory stimulation, explicit feedback, knowledge of results, and motor imagery. These principles, notably explicit feedback and multisensory stimulation, are found in the VR technology used for neuromotor rehabilitation. Accordingly, VR therapy becomes an alternative to classical physiotherapy, as it develops neuroplasticity. So, novel enriched environments are preferred in the context of current rehabilitation methods since guidelines do not provide an accurate record of evidence inferred from the specialized literature about motor skill learning. This evidence is essential in identifying practical methods and applications that could shape future approaches to neuromotor relearning. Furthermore, in animal research, it has been shown that aerobic exercise and environmental enrichment have pleiotropic actions that influence the occurrence of molecular changes associated with stroke and subsequent spontaneous recovery. These aspects may argue in favor of the efficient use of VR in motor and functional recovery after a stroke, by stimulating neuroplasticity [15,16].Over the past ten years, research and literature reviews regarding the use of VR in post-stroke recovery have been homogeneous. Many approaches have focused on the use of VR as adjunct therapy alongside standard physiotherapy, and in some studies, non-dedicated VR technologies have been used, for medical purposes, in the motor rehabilitation of post-stroke patients [17,18]. Previous research on NIVR and immersive VR-based activities suggests that these interventions improve upper extremity rehabilitation after a stroke by providing motivating environments, stimulating extrinsic feedback, or simulating gameplay to facilitate recovery. Besides non-immersive VR therapy use in post-stroke patient’s rehabilitation, immersive VR therapy is used but requires more space and is more expensive, compared to NVIR. Robotic therapy is gaining more ground in neuro-motor rehabilitation, but the costs are very high, and in the case of exoskeletons, complex technology requires a long period of time for physiotherapists to acquire skills in the use of equipment. Currently, research has shown that VR positively influences the recovery of the upper extremity in post-stroke patients, as an adjunct therapy, by using dedicated and non-dedicated technologies [19,20]. The VR action on upper extremity post-stroke rehabilitation, using dedicated NVIR technology as a standalone therapy has not yet been determined at a staged level according to the post-stroke phases. The present study aims to investigate the efficiency of a dedicated NIVR system used in the rehabilitation of patients with subacute and chronic stroke, on upper extremity functionality and motor function. The research was done through specific VR training that incorporates real-time 3D motion capture and built-in visual feedback which provide functional exercises designed to train and regain the neuromotor functions of the upper extremity.Our main goal was to evaluate the efficiency of the proposed protocol, by using staged, specific, and customized NIVR therapy on three levels of difficulty and by using specific exergames according to patient’s capacity, and adjusted by the level of difficulty, compared to standard physiotherapy. Besides, we were looking for differences in post-stroke clinical and functional status in the use of VR that improve or negatively influence the functional outcomes of the upper extremity when exposed to VR-based therapy compared to standard physiotherapy. […]

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[WEB PAGE] The Ultimate Guide to Stroke Exercises

Functional recovery is possible, even years after a stroke. Learn how to harness neuroplasticity through repetitive exercise, and the all-around health benefits of staying active after stroke or brain injury.

By JUNE LEE, 21 SEP 2020 

The Ultimate Guide to Stroke Exercises

Having a stroke is a mentally and physically taxing experience. According to the World Health Organization (WHO), 15 million people suffer from stroke worldwide each year. Of these, 5 million people die, and many survivors are left permanently disabled.

Stroke survivors may lose physical abilities and cognitive skills or undergo behavioral changes because strokes cause temporary or permanent damage to the brain areas that control those functions.

But here is the good news: the brain is able to recover after stroke, whether initially or months to years later. While short-term recovery after stroke (called spontaneous recovery) is limited to the first six months, long-term functional recovery can occur at any point thereafter. Stroke survivors who continue to engage their affected side in daily activity and exercise can capitalize on functional recovery potential throughout their stroke journey.

The Importance of Stroke Exercise for Rehabilitation and Recovery

The brain is capable of rewiring and repairing itself even if its cells are damaged. The undamaged parts step in to perform the tasks that the damaged parts were performing. This phenomenon (called neuroplasticity) allows stroke survivors to regain lost movement and function. The key to neuroplasticity is the consistent performance of repetitive tasks so that the brain can relearn how to perform these tasks through different neural pathways.

In simpler words, stroke exercise is one of the most effective means by which stroke patients can heal themselves, get stronger, improve the quality of their lives, and maximize their recovery from stroke. Because lifestyle factors like being overweight and having high blood pressure are a common cause of stroke, daily exercise becomes even more important in reducing the risk for recurrent stroke and other complications.

No matter the severity of the stroke, survivors can improve their quality of life through healthy lifestyle changes and engagement in restorative activities. Whether implementing big changes or small ones, the key to meaningful functional recovery is engaging in your post-stroke routine changes consistently.

The Physical and Mental Health Benefits of Stroke Recovery Exercises

Let’s look at some of the important physical and mental health benefits of engaging in stroke rehabilitation exercises. Post-stroke exercise is shown to produce many positive outcomes, which may include:

Physical benefits

  1. Speeds up all-round stroke recovery
  2. Recovers strength
  3. Improves endurance
  4. Increases walking speed
  5. Improves balance
  6. Boosts the ability to perform daily routine activities
  7. Prevents the recurrence of strokes.

Mental benefits

  1. Reduces depression and enhances mood
  2. Boosts brain health
  3. Relieves stress
  4. Helps in increasing a sense of self-worth and self-reliance that can decrease after a stroke
  5. Gives patients a sense of purpose and a goal to work towards.

Exercises to help Patients in Stroke Recovery at Home

The positive effects of post-stroke exercise are undeniable. However, when setting up an exercise routine as a stroke survivor, it is important to incorporate both cardiovascular fitness and muscle strengthening to ensure the most effective outcomes.

Stroke exercises are always safer to do with a loved one or caregiver around. However, if that is not possible, patients can modify an exercise program to ensure safe performance. For instance, completing exercises from sitting as opposed to standing to avoid loss of balance. It is also wise to consult a doctor or a therapist should any uncertainties about any of the stroke exercises arise or if you have any other underlying health condition.

Cardiovascular Fitness

Aerobic exercise is fundamental to building a healthy heart, improving endurance, and maintaining healthy lungs. Cardiovascular exercise can also improve the sensory perception and motor skills of stroke survivors. Walking outside or on a treadmill, stationary cycling, recumbent cross training and many other forms of exercise that get your heart pumping are extremely beneficial for stroke recovery.

Stroke survivors must get at least 20-60 minutes of light to moderate aerobic exercise (50 to 80% of your maximum heart rate) 3 to 7 days a week to improve the chances of stroke recovery. Patients can choose to do aerobic exercise at one go or in smaller sessions during the day.

Resistance Exercises for Strengthening Muscles

Resistance training or muscle strength training plays a crucial role in post-stroke recovery, as it helps to recover physical strength, stamina, stability, and improve range of motion.

Here are some commonly prescribed exercises for stroke recovery at home:

1. Wrist Curls

Equipment: A stable chair with armrests (preferably padded), light weights, or any household object which can provide some resistance and is easy to grip.

How To Do It: Sit up straight on the chair. Place your arms on the rests with your palms facing upward. Let your wrists dangle over the edge of the armrests. Grasp the weights firmly and comfortably, and with slow controlled movements, bend your wrist up towards your forearm and back down again (only your wrists should be moving).

Benefits: Wrist curls are isolated movements that build forearm strength, improve range of motion, and enhance gripping ability.

2. Wrist and Hand Stretch

Equipment: Stable chair with armrests.

How To Do It: With your arms facing downward and your wrists dangling over the edge of the armrest, drop your hand down and use your other hand to gently lift your wrist up and down and side to side.

Benefits: This simple movement stretches the ligaments in the wrist and forearms to maintain range of motion.

Modification: If you add a weight while completing this exercise, you are completing a reverse wrist curl, strengthening the muscles on the opposite side of your forearm.

3. Shoulder Openers

Equipment: Light weights or any light object that can be gripped easily and will provide some resistance.

How To Do It: Grasping your weights (make fists with your fingers facing inwards), hold your arms at your sides, and bend your elbows 90 degrees. With slow controlled movements, move your fists outwards while keeping your arms in position at your sides (like you are opening a door). Bring your arms back to your starting stance. (Can be performed both sitting or standing).

Benefits: This exercise improves range of motion and strength in the shoulders.

4. Table Towel Slide

Equipment: Folded Towel and table.

How To Do It: Place the towel in front of you. With your weaker hand on the towel and your stronger hand on top of it, slide the towel away and towards you (using your stronger hand to guide and push). Apart from going back and forth, you could also go clock and counter-clockwise, forming circles on the table.

Benefits: Stretches and strengthens shoulder and arm muscles and promotes neuroplasticity through improved arm coordination.

5. Trunk Bends

Equipment: A stable chair.

How To Do It: Sit on the edge of your chair with your feet planted slightly apart but firmly on the ground. Bend forward as far as you can, and try to reach your ankles or the floor between your legs. Then use your core muscles for sitting back up as straight as you can.

Benefits: Improves core strength and helps with weight shifting.

6. Knee Rotations

Equipment: Firm, flat surfaces such as a bed or a mat.

How To Do It: Lie on your back and rest your hands by your sides. Bend your knees with your feet flat on the floor. Keeping your knees together, drop them, slowly, to the left then, bring them back to the center. Then drop them to the right and back to the center.

Benefits: Improves core, back strength, coordination, and balance.

7. Hip Abduction

Equipment: Stable chair.

How To Do It: Sit up straight on the edge of your chair. Gently tighten your abs and straighten one knee. With your toes pointed to the ceiling, slowly move your foot out to the side. Return to the starting stance, then repeat on the other side. You can decrease the intensity by lying down and performing this exercise or make it more difficult by attempting this from standing, if you are capable.

Benefits: Strengthens hips, core, leg, back, and improves coordination and stability.

8. Standing Knee Raises

Equipment: A firm surface to hold on to.

How To Do it: Stand with your back straight and hold on to a firm surface. Shifting your weight to one leg, bring the other leg up in front of you while bending your knee to a 90-degree angle. Hold for a few seconds and resume the starting position. Then switch legs.

Benefits: Strengthens upper and lower abs, hips, and back. It also helps with posture, balance, and coordination.

9. Sit to Stands

Equipment: Stable chair.

How To Do it: Sit up tall in your chair with your knees bent (90 degrees). Place your feet firmly on the floor shoulder-width apart. Slowly rise to a standing position while ensuring that your knees never cross the tips of your toes. Sit back down slowly and in a controlled manner. To make it less intense, use your arms for support, and to make it more difficult, cross your arms on your chest.

Benefits: Strengthens core and upper thigh muscles, improves weight shifting and balance.

10. Hip Thrusts

Equipment: A flat, firm surface like a bed or a mat.

How To Do it: Lie on your back with your feet flat on the ground and knees bent. Place your arms by your sides, palms down. Gently contract your abs and squeeze your glutes (backside muscles) to lift your hips and make a bridge. Hold on this position for a few seconds and lower to the starting stance. You can make it easier by straightening your legs and placing a rolled-up towel under your knees, then squeezing and lifting your hips. You could also make it more intense by lifting one foot at a time while holding the bridge.

Benefits: It boosts the strength of the core, glutes, lower back muscles, and muscles that support the spine.

Frequency and Intensity of Stroke Exercises

Stroke exercise is most beneficial if done consistently and repetitively. It is always best to consult your medical team about the type and frequency of exercises that are optimal for your unique situation. Do not risk your safety by attempting things that you are unsure about.

As a guideline, resistance exercises should be done 3-5 times a week. 2-3 sets of 12-15 repetitions (of each exercise) should be completed to achieve noticeable results. A survivor who is new to exercise post-stroke exercises may have to work up to the ideal frequency of exercise over time.

Stroke exercise should never cause pain. Pain may indicate that you are causing new or lasting damage to your muscles and joints. If your exercises produce a burning, shooting, or otherwise uncomfortable sensation, stop immediately and modify the activity (ex. reduce weight, perform the exercise within a smaller range of motion). If it is not possible to perform the activity without pain, remove it from your program and ask your doctor.


A stroke results in drastic and sudden changes in life that can leave survivors struggling physically, socially, and emotionally. However, proper stroke exercise is the path to reclaiming the body, mind, and quality of life. With determination and hard work, there is light at the end of the tunnel and a more promising future ahead.

For more information, support, or to know more about the latest developments in stroke recovery, give us a call at (888) 623-8984 or email at


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[Abstract] The medical avatar and its role in neurorehabilitation and neuroplasticity: A review


BACKGROUND:One of the most interesting emerging medical devices is the medical avatar – a digital representation of the patient that can be used toward myriad ends, the full potential of which remains to be explored. Medical avatars have been instantiated as telemedical tools used to establish a representation of the patient in tele-space, upon which data about the patient’s health can be represented and goals and progress can be visually tracked. Manipulation of the medical avatar has also been explored as a means of increasing motivation and inducing neural plasticity.

OBJECTIVE:The article reviews the literature on body representation, simulation, and action-observation and explores how these components of neurorehabilitation are engaged by an avatar-based self-representation.

METHODS:Through a review of the literature on body representation, simulation, and action-observation and a review of how these components of neurorehabilitation can be engaged and manipulated with an avatar, the neuroplastic potential of the medical avatar is explored. Literature on the use of the medical avatar for neurorehabilitation is also reviewed.

RESULTS:This review demonstrates that the medical avatar has vast potentialities in neurorehabilitation and that further research on its use and effect is needed.


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[ARTICLE] Depression impedes neuroplasticity and quality of life after stroke – Full Text


Background and Purpose Depression following a stroke/poststroke depression (PSD) has been newly recognized as one of the most common complications after stroke. PSD may affect neuroplasticity and quality of life. The purpose of present study was to find out effects of depression on functional recovery, quality of life and neuroplasticity in patients with acute stroke. 

Methods: A total of 76 cases were recruited for the study and out of which 44 were available for the analysis after six months. Patients were divided into three groups according to severity of depression: Group A (without depression), Group B (mild-to-moderate depression), and Group C (severe depression) on the basis of Patient Health Questionnaire-9 (PHQ-9) scale scores. All patients were assessed for depression by PHQ-9, and for quality of life by Stroke Specific Quality of Life (SSQOL) scale. Neuroplasticity was assessed by measuring levels of serum brain-derived neurotrophic factor. 

Results: Quality of life was observed to be significantly affected by depression (P ≤ 0.05). The most commonly affected characteristics were energy, family roles, mobility, self-care, social roles, upper extremity function, and work productivity. Serum BDNF levels were also affected significantly by depression (P ≤ 0.05). 

Conclusion: PSD is a serious complication, affecting quality of life and neuroplasticity (BDNF) in patients. Decreased neuroplasticity further may affect functional improvement.


Despite decrease in stroke mortality rate, there has been increase in the stroke survivors with residual disability and impairment. This has grown interest in the factors that can affect recovery from stroke and quality of life.[1] Depression after stroke or poststroke depression (PSD) is one of the factors that can negatively influence the functional outcome after stroke but is often ignored. With a possible role also in cognitive status and survival, it is an obvious source of suffering for patients and caregivers.[2] PSD may impede rehabilitation, recovery, quality of life, and caregiver’s health.[3],[4],[5],[6] Depression after stroke, though recognized for more than a century, had never received the attention that has been devoted to other stroke complications, such as motor impairment, language problems, or cognitive deficits.[7] PSD not only leads to poor involvement in rehabilitation and delays functional recovery but results in limited social activity and increased disability.[8],[9] Moreover, 12.3–73.2% of stroke survivors suffer from concurrent depression and anxiety which further delays recovery from stroke.[10],[11],[12]

The prevalence of PSD (13.7–31.1%) is four times higher than the likelihood of having depression in the general population without comorbid physical disease. When physical recovery is the main focus of treatment, occurrence of depression and anxiety can be overlooked in the early stage of stroke recovery.[8],[13] Consequently, depression and anxiety are usually diagnosed poorly and inadequately treated.[8],[14] Recognizing these symptoms is difficult because they often overlap with stroke-related impairments.[11],[14]

Based on the literature, the most consistent factors associated with PSD are severe stroke and physical disability.[15] Close relationship between PSD and neurological deficits suggests that PSD may be a psychological, reactive depressive symptom associated with sudden functional deficits.[16],[17] When there are prolonged functional deficits, subsequent familial and social issues may perpetuate PSD.[18] Several clinical studies on major depressive disorder (MDD) have shown that blood–brain-derived neurotrophic factor (BDNF) is associated with depression response. BDNF is a neurotrophin related to neuronal survival, synaptic signaling, and synaptic consolidation.[19] Several studies have been performed assessing BDNF levels in MDD and showing important correlations between MDD and BDNF levels.[20]

Studies regarding the PSD and its impact on neuroplasticity and quality of life are still lacking. The current study was designed to assess patients for depression (by Patient Health Questionnaire-9 [PHQ-9]), levels of serum brain-derived neurotrophic factor (S. BDNF), and their impact on quality of life (by Stroke Specific Quality of Life Scale [SSQOL]) in patients with stroke.[…]

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[Editorial] Functional Adult Neurogenesis – Neuroscience

Editorial on the Research Topic
Functional Adult Neurogenesis

In the adult brains of most mammalian species, new neurons are continuously generated from neural stem/progenitor cells in discrete regions, such as the subgranular zone (SGZ) in the hippocampal dentate gyrus and the subventricular zone (SVZ) along the lateral cerebral ventricles. This process is generally termed adult neurogenesis, which is important for the survival of an individual in the natural environment. Accumulating studies have shown that the continuous adding of new neurons to the adult brain plays essential roles in relevant brain functions, such as spatial and fear memories, pattern separation, stress resilience, etc. Abnormalities in the generation or integration of new neurons are often associated with a various of disorders, such as mental disorders, stress disorders, epilepsy, etc. On the other hand, adult neurogenesis is regulated by a combination of molecular, cellular and circuitry mechanisms. This Research Topic collected several interesting and exciting new findings in the field of adult neurogenesis, regarding its functional implications.

During the development of newborn neurons in the adult brain, the initial morphogenic stage is critical for the survival, development, and functional integration of these newborn neurons. Ahamad et al. investigated the regulation of early morphogenesis of newborn neurons by a cellular metabolism-linked gene, Four and a half LIM domain 2 (FHL2). By using engineered viral vectors for genetic manipulation of FHL2 in the adult-born dentate granule neurons, they found that overexpression of FHL2 during early DGC development resulted in marked sprouting and branching of dendrites, while silencing of FHL2 increased dendritic length. These results suggest that FHL2 is an important regulator of early dendritic morphogenesis in adult-born dentate granule neurons, thus providing evidence for potential biological relevance of FHL2 in brain development and functions.

Tonic and phasic GABA signals regulate the development and integration of newborn neurons. Due to high level of ionic cotransporter NKCC1 expression in early-stage young neurons, GABAergic inputs initially provide depolarizing signals. As new neurons develop, accompanied by increasing expression of KCC2 and decreasing expression of NKCC1, GABA responses transit to hyperpolarizing signals. Gómez-Correa and Zepeda chronically administrated NKCC1 blocker bumetanide to young-adult rats, and found that the number of DCX-positive young neurons decreased, associated with altered morphological development of these newborn neurons. However, the animals’ behavior was not affected in contextual fear conditioning and open field tests.

Evidence has shown that neurogenesis declines in the aging brain. Some of the most interesting questions arising from this observation are, how adult neurogenesis is affected by the microenvironment in the aging brain, and how adult neurogenesis may benefit the physiological functions of the aging brain. Trinchero et al. provided two studies related to adult neurogenesis in the aging brain. Their first study used whole-cell recordings in developing granule cells to characterize the time course of functional integration of adult-born granule neurons in aging mice, and found a later onset of functional excitatory synaptogenesis in aging mice than in young adult mice. Enriched environment significantly facilitated functional integration of newborn neurons in aging mice, indicating an experience-dependent structural plasticity and functional integration of newborn neurons in the aging brain. A second study from the same group showed long-term exercise accelerated the development of adult-generated dentate granule neurons. The accumulation of rapidly integrated newborn neurons generated under exercise are likely beneficial to hippocampus-dependent cognitive functions, possibly rejuvenating the hippocampal neural network in aging animals. These observations highlight how physical exercise could be a beneficial intervention to improve cognition in aging.

Early life stress affects the development of hippocampal neural circuits and postnatal behaviors. In a study by Daun et al., the authors utilized a maternal and social deprivation (MSD) model to investigate the effects of early life stress on neural stem cells and neurogenesis in the adult brain. They found that early life MSD enhanced neurogenesis not only in the dentate gyrus of the hippocampus, but also in the amygdala, such that the animals exposed to early life MSD exhibited a reduction in amygdala/hippocampus-dependent fear memory. This suggests that early life stress during a stress-hyporesponsive period may benefit the resilience to stress in adulthood.

Schizophrenia is a complex and serious mental disorder, and patients with schizophrenia are characterized by psychological hallucinations, deregulated emotionality, and cognitive impairment. Evidence indicated that postnatal neurogenesis in the hippocampus is profoundly impaired in schizophrenic individuals. As an extension of embryonic and early postnatal neurogenesis, adult neurogenesis in the hippocampus is susceptible to factors that are related to schizophrenia. Previous studies have shown that deficiency in schizophrenia-risk gene DISC1 results in deficits in the development of newborn neurons in the dentate gyrus and aberrant adult neurogenesis. Sheu et al. used a rodent model of schizophrenia through maternal immune activation of poly (I:C) injection, and found a delayed onset of schizophrenia-like pathology and the severity of the symptoms positively correlated with the aberrant dendritic phenotypes preferentially at 9-week-old of age for the animals. Temporal suppression of aberrant neurogenesis during such critical time period ameliorated the emergence of schizophrenia-like symptoms. These findings strongly suggest the aberrant dendritic growth of postnatal neurogenesis during a critical time window of development is essential for the pathophysiological progression of schizophrenia-like symptoms.

Resent observations have indicated that mating behavior may affect neurogenesis in the adult brain. In a study by Portillo et al., the authors investigated the effect of paced mating on adult neurogenesis in the olfactory bulb in female rats. They observed a significant increase in the percentage of new neurons in the granular and glomerular layers of the accessory olfactory bulb and granular layer of the main olfactory bulb in females that mated in four sessions, which paced sexual interaction, suggesting that repeated paced mating increases the percentage of new neurons that survive in the olfactory bulb of female rats.

The study of adult neurogenesis after injuries that affected the central nervous system has led to interesting observations suggesting that utilizing newly generated new neurons after injury may provide potential novel strategies for the functional recovery of impaired regions. The endogenous spinal cord ependymal cells, which form the central canal, represent a repair cell source in treating spinal cord injury. A study from Wang et al. showed that BAF45D, a member of the Brg1/Brm-associated factor (BAF) chromatin remodeling complex, is expressed in spinal cord ependymal cells, neurons, and oligodendrocytes but not astrocytes in rat spinal cord. After injury, the structure of central canal was disrupted and the BAF45D-positive spinal cord ependymal cell-derivatives were decreased. This study further highlighted the decreased expression of BAF45D in spinal cord ependymal cells in injured spinal cord, and the potential role of BAF45D downregulation in development of neuronal lesion after spinal cord injury. Their findings provided further understanding of the structural and biological roles of BAF45D in spinal cord ependymal cells after injury, and provided a potential target for spinal cord injury therapy via the manipulation of spinal cord ependymal cells.

Altogether, the articles included in this special Research Topic have identified novel mechanisms underlying the regulation of the generation, development, integration, and functions of newborn neurons in a variety of areas in the adult central nervous system, and provide meaningful insights for our understanding of functional neurogenesis in the adult nervous system.


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[BLOG POST] What is Neuroplasticity? A Psychologist Explains [+14 Exercises]

What is Neuroplasticity? Definition + 14 Brain Plasticity Exercises

Our brains are truly amazing, aren’t they?

Have you ever watched one of those specials on someone who experienced an amazing, unexpected recovery after a traumatic brain injury, stroke, or other brain damage? Some of those stories seem like the only explanation is magic.

Although it certainly seems inexplicable, scientists have been hard at work studying exactly these cases over the last several decades, and have found the explanation behind the magic: neuroplasticity.

Before you read on, we thought you might like to download our 3 Positive Psychology Exercises for free. These science-based exercises will explore fundamental aspects of positive psychology including strengths, values and self-compassion and will give you the tools to enhance the wellbeing of your clients, students or employees.

You can download the free PDF here.

What is the Meaning of Neuroplasticity?

Neuroplasticity refers to the brain’s ability to adapt. Or, as Dr. Campbell puts it:

“It refers to the physiological changes in the brain that happen as the result of our interactions with our environment. From the time the brain begins to develop in utero until the day we die, the connections among the cells in our brains reorganize in response to our changing needs. This dynamic process allows us to learn from and adapt to different experiences” – Celeste Campbell (n.d.).

Our brains are truly extraordinary; unlike computers, which are built to certain specifications and receive software updates periodically, our brains can actually receive hardware updates in addition to software updates. Different pathways form and fall dormant, are created and are discarded, according to our experiences.

When we learn something new, we create new connections between our neurons. We rewire our brains to adapt to new circumstances. This happens on a daily basis, but it’s also something that we can encourage and stimulate.[…]

Continue —-> What is Neuroplasticity? A Psychologist Explains [+14 Exercises]

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[VIDEO] THE BRAIN DISCOVERY SERIES Issue 4: What to do when chaos in the brain occurs? — Dr. Kester J Nedd

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After injury to the brain- what happens to you and to your brain? I detailed this process on my latest Instagram post (and in the image below/to the right), but the big question remains of what should one do when injury happens and chaos in the brain takes over?

In this video blog, I identify and describe the steps that should be taken when this chaos occurs


2. Restore

3. Compensate

followed by how the Brain Hierarchical Evaluation and Treatment (BHET) Method is used to achieve them.

Since the BHET Method’s main focus is understanding the levels of disorganization and the degree of disruption of brain cycles, this approach allows us to predict outcomes and offer appropriate restorative treatments.

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The brain has over one hundred billion nerve cells that communicate through over one thousand trillion connections

These connections are the command center for what we do, feel, and for just about everything that makes us who we are.

Just imagine what happens when these connections get messed up and break.

via THE BRAIN DISCOVERY SERIES Issue 4: What to do when chaos in the brain occurs? — Dr. Kester J Nedd


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[VIDEO] THE BRAIN DISCOVERY SERIES Issue 3: The Healing Brain — Dr. Kester J Nedd

Changes occur every second in this world- and our body and brain are no exception to this. From the moment we are conceived to when we die, adaption takes place. In our brain, the key driver of this change is neuroplasticity. Neuroplasticity has to do with how we restore the brain to maintain function following an injury, how we organize and develop the brain’s structure and physiology, and how we preserve our brain connections as we age.

In this video, Ellie and I discuss this neuroplasticity and how it heals the brain!

Adaptation is necessary for our growth, our survival, and our healing. Thankfully, the brain uses neuroplasticity for just that.

via THE BRAIN DISCOVERY SERIES Issue 3: The Healing Brain — Dr. Kester J Nedd

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[BLOG POST] Rehab with Real-World Objects for Improved Hand Use After Stroke

If you’ve been through stroke rehabilitation, chances are that you’re familiar with the phrase, “use it or lose it”. Your therapist likely told you this while explaining the principle of neuroplasticity, the brain’s potential to reorganize after damage to regain lost functions. Hopefully “use it or lose it” has helped you remember to engage your weaker arm throughout the day in order for it to make progress!

Here’s another catchy rehab phrase for your repertoire: “you gain what you train”. Research shows that practicing arm movements related to daily living goals may be more effective at improving arm function than standard, non-goal-directed arm exercise. Basically, if you want to be able to hold eating utensils or write with your affected arm, you’re better served by putting a fork or a pen to use than you are by lifting a dumbbell or pinching putty.

“You gain what you train” seems obvious, right? So, why belabor the point? Because many stroke survivors are not practicing real-world skills with their affected arm on their own time. Learning a new skill requires hours of practice and thousands of repetitions. Stroke survivors must ensure they are dedicating sufficient time at home to addressing their specific arm use goals in order to improve.

Think about your current post-stroke home exercise program. Does it go beyond basic stretching and strengthening? If not, consider incorporating task-specific training into your routine to maximize arm and hand function.


Task-specific training overview

What is task-specific training (TST)?

Task-specific training is a therapy technique focusing on improving function of a hemiplegic (weakened) arm through repeated activity practice. Just like how you learned to tie your shoes or ride a bike, TST requires consistent performance of the component steps of a task to help the brain re-learn the big-picture skill.

Task-specific training activities for the post-stroke hemiplegic arm incorporate a real-world object and involve the following four steps:

  • Reaching for the object
  • Grasping the object
  • Moving or manipulating the object
  • Releasing the object

Ideally, a participant will repeat this sequence many times over multiple sessions to show skill improvement. Research studies generally indicate that more repetitions and a greater frequency of training are better.

Who can do TST?

Stroke survivors with sufficient movement to repeatedly reach for an object, hold on to it, and release it using their affected arm are good candidates for TST.

Anyone with activity restrictions on their affected side, or those who experience pain when using their affected side should consult with their medical team before attempting TST.


How to do task-specific training at home:

First, think about what you would like to be able to do better using your affected arm and hand. Ideally, TST goal activities should be centered around a task that has clear and consistent steps and also involves an object. Although that might sound complicated, there are countless TST possibilities available in your home using your everyday belongings! Any of the following ideas make for great TST goals:

  • Using a cup, fork, or spoon
  • Brushing your hair
  • Pulling your pants up
  • Turning a book page
  • Opening a door handle
  • Writing your signature
  • Putting coins into a piggy bank
  • Hammering a nail
  • Putting laundry into a basket

TST skills can also involve your other hand. Consider using your affected hand in the dominant role of a two-handed task, while letting your stronger hand play the role of helper or stabilizer.

  • Fastening buttons or zippers
  • Tying shoelaces
  • Opening containers
  • Pouring liquid from one container into another
  • Putting credit cards into a wallet
  • Wringing out a wet washcloth
  • Putting a stamp on an envelope
  • Folding laundry into halves or quarters

Because TST involves repeating the steps of an activity using your affected arm, we need to think about how to measure performance. Completing a reach/grasp/manipulate/release sequence is considered one repetition of a task. The goal of TST is to complete as many repetitions as possible. View the examples of measuring one repetition from the TST tasks on our list above:

Note: The affected arm starts and ends in the same position relative to the task object/s (e.g. on the tabletop next to the object)
Using a spoon: Pick up the spoon from the tabletop, bring it up to your mouth, put it back on the tabletop, return hand to starting position
Writing your signature: Pick up the pen from the tabletop, bring it to paper to write your full name, put the pen back on the tabletop, return hand to starting position

Note: For a two-handed task, you may choose to repeatedly pick up the stabilized object using your unaffected hand, or hold it throughout the task
Putting credit cards into a wallet: One repetition = pick up credit card from tabletop, insert and remove credit card from wallet (held by unaffected hand), place credit card on tabletop, return hand to starting position

After you have defined your activity and what a repetition looks like, you’re ready to go. You may choose to practice one activity in a TST session, or, for a longer session, you may pick two or three goal areas.


How much and how often should I do TST?

Studies show that between one and five repetitions of a task per minute may be ideal to promote improved arm function. Gauge your performance by performing a 15-minute TST test. Have a helper time the number of repetitions you can do during this period. If you have achieved between 15 and 100 repetitions, you’re in the TST sweet spot: continue practicing the skill! If you are over 100 repetitions, it is time to make the task more difficult by add more complex elements (e.g. using heavier objects, attempting the task from standing as opposed to sitting). If that is not possible, try practicing a different, harder skill.

Research has also demonstrated that completing 60 minutes of task-specific training four times per week can produce significant arm function improvements. This is an amount that you may have to build up to. If one hour seems daunting, try to ease into TST practice by attempting increasingly longer intervals (e.g. aim for 5 more minutes of TST each time).

What if I can’t do task-specific training?

Survivors who have some but not all required arm functions to perform TST may choose to perform a modified version incorporating the elements within their capabilities. For instance, TST might consist of repeatedly reaching to tap an object with the hand as opposed to grasping and releasing it.

If you have minimal to no movement in your affected arm, you will not be able to perform TST. However, your affected side can and should still play a role in your daily living tasks. Use your stronger side to place your affected arm within your field of vision during tabletop tasks. If you are doing a two-handed task, use the stronger arm to place the weaker arm to hold or stabilize objects. Even though doing this is not TST, you are still promoting function of your affected side while preventing learned non-use.

Do I have to do task-specific training after stroke?

TST is just one tool in your upper extremity stroke rehab toolbox. There are several other evidence-supported activities that may improve arm and hand function. Some people may not be able to perform TST without the guidance of a therapist, while others may not be motivated by the intervention. If you have questions on how to perform TST at home or whether it is the right option for you, consult with your therapy team.


The bottom line: practice means progress

We’ll conclude with one final catchy rehab phrase: “practice means progress”. Needless to say, improving weakened arm function after a stroke can be a long and sometimes frustrating ordeal. However, additional keys to success are right in front of you in the forms of your daily tasks and personal belongings. With practice and repetition, your goals are within reach!


French B, Thomas LH, Coupe J, McMahon NE, Connell L, Harrison J, et al.. Repetitive task training for improving functional ability after stroke.Cochrane Database Syst Rev. 2016; 2016:CD006073. doi: 10.1002/14651858.CD006073.pub3.

Hatem SM, Saussez G, Della Faille M, et al. Rehabilitation of Motor Function after Stroke: A Multiple Systematic Review Focused on Techniques to Stimulate Upper Extremity Recovery. Front Hum Neurosci. 2016;10:442. Published 2016 Sep 13. doi:10.3389/fnhum.2016.00442

Lang, Catherine E. PT, PhD; MacDonald, Jillian R.; Gnip, Christopher DPT Counting Repetitions: An Observational Study of Outpatient Therapy for People with Hemiparesis Post-Stroke, Journal of Neurologic Physical Therapy: March 2007 – Volume 31 – Issue 1 – p 3-10 doi: 10.1097/01.NPT.0000260568.31746.34

Waddell, K. J., Strube, M. J., Bailey, R. R., Klaesner, J. W., Birkenmeier, R. L., Dromerick, A. W., & Lang, C. E. (2017). Does Task-Specific Training Improve Upper Limb Performance in Daily Life Poststroke? Neurorehabilitation and Neural Repair, 31(3), 290–300.

Waddell KJ, Birkenmeier RL, Moore JL, Hornby TG, Lang CE. Feasibility of high-repetition, task-specific training for individuals with upper-extremity paresis. Am J Occup Ther. 2014;68(4):444-453. doi:10.5014/ajot.2014.011619

via Rehab with Real-World Objects for Improved Hand Use After Stroke

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