Posts Tagged Neuroplasticity

[ARTICLE] Increased Sensorimotor Cortex Activation With Decreased Motor Performance During Functional Upper Extremity Tasks Poststroke – Full Text

Abstract

Background and Purpose: Current literature has focused on identifying neuroplastic changes associated with stroke through tasks and in positions that are not representative of functional rehabilitation. Emerging technologies such as functional near-infrared spectroscopy (fNIRS) provide new methods of expanding the area of neuroplasticity within rehabilitation. This study determined the differences in sensorimotor cortex activation during unrestrained reaching and gripping after stroke.

Methods: Eleven individuals with chronic stroke and 11 neurologically healthy individuals completed reaching and gripping tasks under 3 conditions using their (1) stronger, (2) weaker, and (3) both arms together. Performance and sensorimotor cortex activation using fNIRS were collected. Group and arm differences were calculated using mixed analysis of covariance (covariate: age). Pairwise comparisons were used for post hoc analyses. Partial Pearson correlations between performance and activation were assessed for each task, group, and hemisphere.

Results: Larger sensorimotor activations in the ipsilesional hemisphere were found for the stroke compared with healthy group for reaching and gripping conditions despite poorer performance. Significant correlations were observed between gripping performance (with the weaker arm and both arms simultaneously) and sensorimotor activation for the stroke group only.

Discussion and Conclusions: Stroke leads to significantly larger sensorimotor activation during functional reaching and gripping despite poorer performance. This may indicate an increased sense of effort, decreased efficiency, or increased difficulty after stroke. fNIRS can be used for assessing differences in brain activation during movements in functional positions after stroke. This can be a promising tool for investigating possible neuroplastic changes associated with functional rehabilitation interventions in the stroke population.

Video Abstract available for more insights from the authors (see Video Abstract, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A269).

 

INTRODUCTION

Stroke is the leading cause of long-term disability in Canada, with approximately 405 000 Canadians currently living with its long-lasting effects.1 While the site of injury and the specific presentation of symptoms are heterogeneous, up to 70% of these individuals experience upper extremity hemiparesis,2 and even after rehabilitation, greater than 65% of this population have difficulty utilizing their affected limb in activities of daily living.3 Decreased use of the paretic arm can lead to chronic pain and weakness, decreased bone density,4 cerebral cortex changes,5and an overall decrease in quality of life.6 In addition, stroke rehabilitation and continual care are costly for the health care system.7 Therefore, it is important to maximize patient recovery in an effective and efficient manner.

One area that has been highly debated for rehabilitation efficacy is the side of arm training. Numerous reviews have stated conflicting and inconclusive results pertaining to benefits of the paretic (affected) arm or bilateral arm training8–10 and a few studies have recently investigated the effects of the nonparetic (less-affected) arm training.11,12 Investigating how stroke itself affects neural activation during unilateral and bilateral upper extremity activities may help explain the mechanisms underlying such training.

In individuals living with the chronic effects of stroke, nonnormal brain activation is commonly seen with irregular activation in both the ipsi- and contralesional hemispheres during movement. A meta-analysis of 20 studies13 calculated increases in contralesional primary motor cortex, and bilateral premotor and supplementary motor areas with use of the paretic hand compared with healthy individuals. Systematically reviewing 22 functional magnetic resonance imaging (fMRI) and positron emission tomography studies, Buma et al14 reported general initial increases in contra-, ipsi-, and perilesional activation during paretic upper extremity movement in individuals with cortical and subcortical strokes when compared with healthy adults. In addition, as paretic arm performance increased with training, these authors also showed that in many, but not all participants, activation decreased in areas such as the contralesional motor cortex (ie, ipsilateral to the movement arm), which is not typically activated in healthy individuals. Previous reviews have also reported increases in cortical activation of motor supporting areas (bilateral premotor and supplementary motor areas) later in recovery that are associated with greater function,15 although the opposite has also been reported.16

The majority of previously mentioned evidence utilized neuroimaging techniques that require an individual to remain fairly still, especially at the head, and recorded in the supine position. While there are many advantages to these techniques, such as high spatial resolution and penetration depth using fMRI, the functional imaging data acquired from these studies may not be truly indicative of the neural correlates involved during rehabilitation tasks. Thus, assessment of brain activation during upright, unrestrained, functional tasks is needed. Functional near-infrared spectroscopy (fNIRS) is an emerging neuroimaging device that has the capabilities of determining cortical activation while the participant is mobile. Similar to fMRI, fNIRS is an indirect measure of cortical activation that utilizes the neurovascular coupling theory to estimate changes in brain activity.17 Near-infrared light emitted by this device is absorbed by areas high in oxyhemoglobin or deoxyhemoglobin content and is measured through detectors placed on the individual’s head. When an increase in brain activity occurs, a typical overall increase in oxyhemoglobin concentration and a slight decrease in deoxyhemoglobin are observed.17 Due to its portability, fNIRS has been used to investigate cortical activation during various mobile tasks after stroke.18,19 To our knowledge, no work has been done to compare sensorimotor cortex activation of paretic, nonparetic, and bilateral arm movements poststroke using fNIRS.

Therefore, the primary purpose of this study was to investigate differences in cortical brain activation during performance of upper extremity activities in an upright position after stroke and in neurologically healthy individuals. Based on the current evidence, we hypothesized that greater sensorimotor cortex activation would be observed in the stroke group compared with the neurologically healthy group, particularly when using the weaker arm. For our secondary measures, we hypothesize that (1) individuals in the stroke group will perform worse than the control group when using their weaker arm and (2) cortical activation in the contralateral hemisphere (eg, ipsilesional hemisphere during paretic arm movements) will positively correlate with task performance.[…]

Continue —->  Increased Sensorimotor Cortex Activation With Decreased Moto… : Journal of Neurologic Physical Therapy

Figure 1
(A) Schematic of the environmental setup for the reaching task. Two adjacent Box and Block sets were placed in front of the participant. The left box was for the left hand and the right box was for the right hand. Arrows indicate the movement of the blocks from the box closest to the participant to the box further in front of the participant. (B) Schematic of the optode placements with reference to the international 10/10 system. Source probes are indicated by black circles and detector probes are indicated by gray circles.
Source
Increased Sensorimotor Cortex Activation With Decreased Motor Performance During Functional Upper Extremity Tasks Poststroke
Journal of Neurologic Physical Therapy43(3):141-150, July 2019.

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[NEWS] Robotic Rehab Aims for the Home Market in Q3

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MotusNova

Motus Nova is expanding its list of partner hospitals and clinics using its FDA-approved robotic stroke therapy system. It also plans to introduce its system to the consumer market for home use in Q3 2019.

Twenty-five hospitals in the Atlanta area within Emory Healthcare, the Grady Health System, and the Wellstar Health System are now using the Motus Nova rehabilitation therapy system, which is designed to use Artificial Intelligence (AI) to accelerate recovery from neurological injuries such as strokes.

The system features a Hand Mentor and Foot Mentor, which are sleeve-like robots that fit over a stroke survivor’s impaired hand or foot. Equipped with an active-assist air muscle and a suite of sensors and accelerometers, they provide clinically appropriate assistance and resistance while individual’s perform the needed therapeutic exercises.

A touchscreen console provides goal-directed biofeedback through interactive games—which Motus Nova calls “theratainment”—that make the tedious process of neuro rehab engaging and fun.

“It’s a system that has proven to be a valuable partner to stroke therapy professionals, where it complements skilled clinical care by augmenting the repetitive rehabilitation requirements of stroke recovery and freeing the clinician to do more nuanced care and assessment,” says Nick Housley, director of clinical research for Atlanta-based Motus Nova, in a media release.

“And while we continue to fill orders for the system to support therapy in the clinic and hospital, we also are looking to use our system to fill the gap patients often experience in receiving the needed therapy once they go home.”

Clinical studies show that neuroplasticity begins after approximately many 10’s to 100’s of hours of active guided rehab. The healing process can take months or years, and sometimes the individuals might never fully recover. Yet the typical regimen for stroke survivors is only two to three hours of outpatient therapy per week for a period of three to four months.

“These constraints were instituted by the Centers for Medicare & Medicaid Services (CMS) in determining Medicare reimbursement without a full understanding of the appropriate dosing required for stroke recovery, and many private insurers have adopted the policy, as well,” states David Wu, Motus Nova’s CEO.

Motus Nova plans to offer a more practical model, the release continues.

“By making the system available for home use at a reasonable weekly rate as long as the patient needs it, the individual can perform therapy anytime,” Wu adds. “A higher dosage of therapy can be achieved without the inconvenience of scheduling appointments with therapists or traveling to and from a clinic, and without the high cost of going to an outpatient center every time the individual wants to do therapy.”

While the system gathers data about individual performance, AI tailors the regimen to maximize user gains, discover new approaches, minimize side effects and help the stroke survivor realize his or her full potential more quickly.

“By optimizing factors such as frequency, intensity, difficulty, encouragement, and motivation, the AI system builds a personalized medicine plan uniquely tailored to each individual user of the system,” Housley comments.

“Our system is durable, too, proven in clinical trials to deliver an engaging physical therapy experience over thousands of repetitions. We look forward to making it available on a much wider scale in the coming months.”

[Source(s): Motus Nova, PR Newswire]

 

via Robotic Rehab Aims for the Home Market in Q3 – Rehab Managment

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[REVIEW ARTICLE] Robot-Assisted Therapy in Upper Extremity Hemiparesis: Overview of an Evidence-Based Approach – Full Text

Robot-mediated therapy is an innovative form of rehabilitation that enables highly repetitive, intensive, adaptive, and quantifiable physical training. It has been increasingly used to restore loss of motor function, mainly in stroke survivors suffering from an upper limb paresis. Multiple studies collated in a growing number of review articles showed the positive effects on motor impairment, less clearly on functional limitations. After describing the current status of robotic therapy after upper limb paresis due to stroke, this overview addresses basic principles related to robotic therapy applied to upper limb paresis. We demonstrate how this innovation is an evidence-based approach in that it meets both the improved clinical and more fundamental knowledge-base about regaining effective motor function after stroke and the need of more objective, flexible and controlled therapeutic paradigms.

Introduction

Robot-mediated rehabilitation is an innovative exercise-based therapy using robotic devices that enable the implementation of highly repetitive, intensive, adaptive, and quantifiable physical training. Since the first clinical studies with the MIT-Manus robot (1), robotic applications have been increasingly used to restore loss of motor function, mainly in stroke survivors suffering from an upper limb paresis but also in cerebral palsy (2), multiple sclerosis (3), spinal cord injury (4), and other disease types. Thus, multiple studies suggested that robot-assisted training, integrated into a multidisciplinary program, resulted in an additional reduction of motor impairments in comparison to usual care alone in different stages of stroke recovery: namely, acute (57), subacute (18), and chronic phases after the stroke onset (911). Typically, patients engaged in the robotic therapy showed an impairment reduction of 5 points or more in the Fugl-Meyer assessment as compared to usual care. Of notice, rehabilitation studies conducted during the chronic stroke phase suggest that a 5-point differential represents the minimum clinically important difference (MCID), i.e., the magnitude of change that is necessary to produce real-world benefits for patients (12). These results were collated in multiple review articles and meta-analyses (1317). In contrast, the advantage of robotic training over usual care in terms of functional benefit is less clear, but there are recent results that suggest how best to organize training to achieve superior results in terms of both impairment and function (18). Indeed, the use of the robotic tool has allowed us the parse and study the ingredients that should form an efficacious and efficient rehabilitation program. The aim of this paper is to provide a general overview of the current state of robotic training in upper limb rehabilitation after stroke, to analyze the rationale behind its use, and to discuss our working model on how to more effectively employ robotics to promote motor recovery after stroke.

Upper Extremity Robotic Therapy: Current Status

Robotic systems used in the field of neurorehabilitation can be organized under two basic categories: exoskeleton and end-effector type robots. Exoskeleton robotic systems allow us to accurately determine the kinematic configuration of human joints, while end-effector type robots exert forces only in the most distal part of the affected limb. A growing number of commercial robotic devices have been developed employing either configuration. Examples of exoskeleton type include the Armeo®Spring, Armeo®Power, and Myomo® and of end-effector type include the InMotion™, Burt®, Kinarm™ and REAplan®. Both categories enable the implementation of intensive training and there are many other devices in different stages of development or commercialization (1920).

The last decade has seen an exponential growth in both the number of devices as well as clinical trials. The results coalesced in a set of systematic reviews, meta-analyses (1317) and guidelines such as those published by the American Heart Association and the Veterans Administration (AHA and VA) (21). There is a clear consensus that upper limb therapy using robotic devices over 30–60-min sessions, is safe despite the larger number of movement repetitions (14).

This technic is feasible and showed a high rate of eligibility; in the VA ROBOTICS (911) study, nearly two thirds of interviewed stroke survivors were enrolled in the study. As a comparison the EXCITE cohort of constraint-induced movement therapy enrolled only 6% of the screened patients participated (22). On that issue, it is relevant to notice the admission criteria of both chronic stroke studies. ROBOTICS enrolled subjects with Fugl-Meyer assessment (FMA) of 38 or lower (out of 66) while EXCITE typically enrolled subjects with an FMA of 42 or higher. Duret and colleagues demonstrated that the target population, based on motor impairments, seems to be broader in the robotic intervention which includes patients with severe motor impairments, a group that typically has not seen much benefit from usual care (23). Indeed, Duret found that more severely impaired patients benefited more from robot-assisted training and that co-factors such as age, aphasia, and neglect had no impact on the amount of repetitive movements performed and were not contraindicated. Furthermore, all patients enrolled in robotic training were satisfied with the intervention. This result is consistent with the literature (24).

The main outcome result is that robotic therapy led to significantly more improvement in impairment as compared to conventional usual care, but only slightly more on motor function of the limb segments targeted by the robotic device (16). For example, Bertani et al. (15) and Zhang et al. (17) found that robotic training was more effective in reducing motor impairment than conventional usual care therapy in patients with chronic stroke, and further meta-analyses suggested that using robotic therapy as an adjunct to conventional usual care treatment is more effective than robotic training alone (1317). Other examples of disproven beliefs: many rehabilitation professionals mistakenly expected significant increase of muscle hyperactivity and shoulder pain due to the intensive training. Most studies showed just the opposite, i.e., that intensive robotic training was associated with tone reduction as compared to the usual care groups (92526). These results are shattering the resistance to the widespread adoption of robotic therapy as a therapeutic modality post-stroke.

That said, not all is rosy. Superior changes in functional outcomes were more controversial until the very last years as most studies and reviews concluded that robotic therapy did not improve activities of daily living beyond traditional care. One first step was reached in 2015 with Mehrholz et al. (14), who found that robotic therapy can provide more functional benefits when compared to other interventions however with a quality of evidence low to very low. 2018 may have seen a decisive step in favor of robotic as the latest meta-analysis conducted by Mehrholz et al. (27) concluded that robot-assisted arm training may improve activities of daily living in the acute phase after stroke with a high quality of evidence However, the results must be interpreted with caution because of the high variability in trial designs as evidenced by the multicenter study (28) in which robotic rehabilitation using the Armeo®Spring, a non-motorized device, was compared to self-management with negative results on motor impairments and potential functional benefits in the robotic group.

The Robot Assisted Training for the Upper Limb after Stroke (RATULS) study (29) might clarify things and put everyone in agreement on the topic. Of notice, RATULS goes beyond the Veterans Administration ROBOTICS with chronic stroke or the French REM_AVC study with subacute stroke. RATULS included 770 stroke patients and covered all stroke phases, from acute to chronic, and it included a positive meaningful control in addition to usual care.[…]

 

Continue —->  Frontiers | Robot-Assisted Therapy in Upper Extremity Hemiparesis: Overview of an Evidence-Based Approach | Neurology

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[NEWS] Stroke: Rewiring eye-brain connection may restore vision

Many people who have a stroke also experience vision impairment as a result. New groundbreaking research looks at the mechanisms that play a role in this damage and shows that it may be reversible.

a person's eye looking up

New research may offer people who have lost some of their vision due to a stroke renewed hope that they may regain it.

A stroke can affect different parts of the brain. When it occurs in the primary visual cortex, which is the region of the brain that processes visual information, the lack of oxygenated blood can mean that the neurons (brain cells) active in that region incur damage.

In turn, this will affect people’s ability to see, and they may experience various degrees of vision loss. While some people who experience vision loss after a stroke may spontaneously regain their sight, most individuals do not.

So far, specialists have believed that damage to the primary visual cortex neurons causes a set of cells in the eye’s retina called “retinal ganglion cells” to become atrophied, meaning that they lose their ability to function.

When retinal ganglion cells become atrophied, it is highly unlikely that a person will ever recover sight in the affected area.

However, a new study, the findings of which appear in the journal Proceedings of the Royal Society B, has uncovered more information about the brain damage mechanisms relating to impaired eyesight.

“The integration of a number of cortical regions of the brain is necessary in order for visual information to be translated into a coherent visual representation of the world,” explains study co-author Dr. Bogachan Sahin, Ph.D., who is an assistant professor at the University of Rochester Medical Center in New York.

“And while the stroke may have disrupted the transmission of information from the visual center of the brain to higher order areas,” he adds, “these findings suggest that when the primary visual processing center of the brain remains intact and active, clinical approaches that harness the brain’s plasticity could lead to vision recovery.”

Therapies should ‘encourage neuroplasticity’

In the new study, the researchers worked with 15 participants who were receiving care at Strong Memorial and Rochester General Hospital for vision damage resulting from a stroke.

The participants agreed to take tests assessing their eyesight. They also had MRI scans to monitor their brain activity and an additional test that looked at the state of the retinal ganglion cells.

First, the investigators found that the health and survival of the retinal ganglion cells were highly dependent on activity in the associated primary visual area. Thus, the retinal cells connected to inactive brain areas would atrophy.

At the same time, however, the team surprisingly noted that some retinal cells in the eyes of people who had experienced vision impairment were still healthy and functional, even though the person had lost sight in that part of the eye.

This finding, the researchers explain, indicates that those healthy eye cells remained connected to fully active brain cells in the visual cortex. However, the neurons failed to correctly interpret the visual information that they received from the corresponding retinal ganglion cells, so the stimuli did not “translate” into sight.

“These findings suggest a treatment protocol that involves a visual field test and an eye exam to identify discordance between the visual deficit and retinal ganglion cell degeneration,” notes the study’s first author Dr. Colleen Schneider.

“This could identify areas of vision with intact connections between the eyes and the brain, and this information could be used to target visual retraining therapies to regions of the blind field of vision that are most likely to recover,” Dr. Schneider adds.

In the future, the researchers hope that their current discovery will allow specialists to fine-tune current therapeutic approaches or develop better strategies that will stimulate the damaged brain-eye connections to “rewire” correctly.

“This study breaks new ground by describing the cascade of processes that occur after a stroke in the visual center of the brain and how this ultimately leads to changes in the retina,” says senior author Brad Mahon, Ph.D.

By more precisely understanding which connections between the eye and brain remain intact after a stroke, we can begin to explore therapies that encourage neuroplasticity with the ultimate goal of restoring more vision in more patients.”

Brad Mahon, Ph.D.

via Stroke: Rewiring eye-brain connection may restore vision

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[Abstract] Optimizing Hand Rehabilitation Post-Stroke Using Interactive Virtual Environments

The main goal of this project is to refine and optimize elements of the virtual reality-based training paradigms to enhance neuroplasticity and maximize recovery of function in the hemiplegic hand of patients who had a stroke.

PIs, Sergei Adamovich, Alma Merians, Eugene Tunik, A.M. Barrett

This application seeks funding to continue our on-going investigation into the effects of intensive, high dosage task and impairment based training of the hemiparetic hand, using haptic robots integrated with complex gaming and virtual reality simulations. A growing body of work suggests that there is a time-limited period of post-ischemic heightened neuronal plasticity during which intensive training may optimally affect the recovery of gross motor skills, indicating that the timing of rehabilitation is as important as the dosing. However, recent literature indicates a controversy regarding both the value of intensive, high dosage as well as the optimal timing for therapy in the first two months after stroke. Our study is designed to empirically investigate this controversy. Furthermore, current service delivery models in the United States limit treatment time and length of hospital stay during this period. In order to facilitate timely discharge from the acute care hospital or the acute rehabilitation setting, the initial priority for rehabilitation is independence in transfers and ambulation. This has negatively impacted the provision of intensive hand and upper extremity therapy during this period of heightened neuroplasticity. It is evident that providing additional, intensive therapy during the acute rehabilitation stay is more complicated to implement and difficult for patients to tolerate, than initiating it in the outpatient setting, immediately after discharge. Our pilot data show that we are able to integrate intensive, targeted hand therapy into the routine of an acute rehabilitation setting. Our system has been specifically designed to deliver hand training when motion and strength are limited. The system uses adaptive algorithms to drive individual finger movement, gain adaptation and workspace modification to increase finger range of motion, and haptic and visual feedback from mirrored movements to reinforce motor networks in the lesioned hemisphere. We will translate the extensive experience gained in our previous studies on patients in the chronic phase, to investigate the effects of this type of intervention on recovery and function of the hand, when the training is initiated within early period of heightened plasticity. We will integrate the behavioral, the kinematic/kinetic and neurophysiological aspects of recovery to determine: 1) whether early intensive training focusing on the hand will result in a more functional hemiparetic arm; (2) whether it is necessary to initiate intensive hand therapy during the very early inpatient rehabilitation phase or will comparable outcomes be achieved if the therapy is initiated right after discharge, in the outpatient period; and 3) whether the effect of the early intervention observed at 6 months post stroke can be predicted by the cortical reorganization evaluated immediately after the therapy. This proposal will fill a critical gap in the literature and make a significant advancement in the investigation of putative interventions for recovery of hand function in patients post-stroke. Currently relatively little is known about the effect of very intensive, progressive VR/robotics training in the acute early period (5-30 days) post-stroke. This proposal can move us past a critical barrier to the development of more effective approaches in stroke rehabilitation targeted at the hand and arm.

via Hand Rehabilitation Post Stroke

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[BLOG POST] 7 principles of neuroscience every coach and therapist should know – Your Brain Health

What does neuroscience have to do with coaching and therapy?

Short answer: EVERYTHING!

If you’re a coach or therapist, your job is to facilitate change in your client’s

  • thinking (beliefs and attitudes)
  • emotions (more mindfulness and resilience)
  • behaviour (new healthy habits).

Coaching builds the mental skills needed to support lasting change. Skills such as:

  • mindfulness
  • self-awareness
  • motivation
  • resilience
  • optimism
  • critical thinking
  • stress management

Health and wellness coaching, in particular, are emerging as powerful interventions to help people initiate and maintain sustainable change.

And we have academic research to support this claim: check out a list of RCTs in table 2 of this paper).

How can neuroscience more deeply inform coaching and therapy?

Back in the mid-1990s when I was an undergrad, the core text of my neuroscience curriculum was ‘Principles of Neural Science’ by Eric Kandel, James Schwartz and Thomas Jessell. Kandel won the 2000 Nobel Prize in Physiology or Medicine for his research on memory storage in neurons.

A few years before his Nobel, Kandel wrote a paper A new intellectual framework for psychiatry’. The paper explained how neuroscience can provide a new view of mental health and wellbeing.

Based on Kandel’s paper, researchers at the Yale School of Medicine proposed seven principles of brain-based therapy for psychiatrists, psychologists and therapists. The principles have been translated intopractical applications for health & wellness, business, and life coaches. 

One fundamental principle is,

“All mental processes, even the most complex psychological processes, derive from the operation of the brain.”

And another is:

“Insofar as psychotherapy or counseling is effective . . . it presumably does so through learning, by producing changes in gene expression that alter the strength of synaptic connections.”

That is, human interactions and experience influence how the brain works.

This concept of brain change is now well established in neuroscience and is often referred to as neuroplasticity. Ample neuroscience research supports the idea that our brains remain adaptable (or plastic) throughout our lifespan.

Here is a summary of Kandel, Cappas and colleagues thoughts on how neuroscience can be applied to therapy and coaching…

Seven principles of neuroscience every coach should know.

1. Both nature and nurture win.

Both genetics and the environment interact in the brain to shape our brains and influence behaviour.

Therapy or coaching can be thought of as a strategic and purposeful ‘environmental tool’ to facilitate change and may be an effective means of shaping neural pathways.

2.  Experiences transform the brain.

The areas of our brain associated with emotions and memories such as the pre-frontal cortex, the amygdala, and the hippocampus are not hard-wired (they are ‘plastic’).

Research suggests each of us constructs emotions from a diversity of sources: our physiological state, by our reactions to the ‘outside’ environment, experiences and learning, and our culture and upbringing.

3.  Memories are imperfect.

Our memories are never a perfect account of what happened. Memories are re-written each time when we recall them depending on how, when and where we retrieve the memory.

For example, a question, photograph or a particular scent can interact with a memory resulting in it being modified as it is recalled.

With increasing life experience we weave narratives into their memories.  Autobiographical memories that tell the story of our lives are always undergoing revision precisely because our sense of self is too.

Consciously or not, we use imagination to reinvent our past, and with it, our present and future.

4. Emotion underlies memory formation.

Memories and emotions are interconnected neural processes.

The amygdala, which plays a role in emotional arousal, mediate neurotransmitters essential for memory consolidation. Emotional arousal has the capacity to activate the amygdala, which in turn modulates the storage of memory.

 

5. Relationships are the foundation for change 

Relationships in childhood AND adulthood have the power to elicit positive change.

Sometimes it takes the love, care or attention of just one person to help another change for the better.

The therapeutic relationship has the capacity to help clients modify neural systems and enhance emotional regulation.

6. Imagining and doing are the same to the brain.

Mental imagery or visualisation not only activates the same brain regions as the actual behaviour but also can speed up the learning of a new skill.

Envisioning a different life may as successfully invoke change as the actual experience.

7. We don’t always know what our brain is ‘thinking’.

Unconscious processes exert great influence on our thoughts, feelings, and actions.

The brain can process nonverbal and unconscious information, and information processed unconsciously can still influence therapeutic and other relationships. It’s possible to react to unconscious perceptions without consciously understanding the reaction.

 

via 7 principles of neuroscience every coach and therapist should know – Your Brain Health

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[Abstract] High-Intensity Interval Training After Stroke: An Opportunity to Promote Functional Recovery, Cardiovascular Health, and Neuroplasticity.

Abstract

INTRODUCTION:

Stroke is the leading cause of adult disability. Individuals poststroke possess less than half of the cardiorespiratory fitness (CRF) as their nonstroke counterparts, leading to inactivity, deconditioning, and an increased risk of cardiovascular events. Preserving cardiovascular health is critical to lower stroke risk; however, stroke rehabilitation typically provides limited opportunity for cardiovascular exercise. Optimal cardiovascular training parameters to maximize recovery in stroke survivors also remains unknown. While stroke rehabilitation recommendations suggest the use of moderate-intensity continuous exercise (MICE) to improve CRF, neither is it routinely implemented in clinical practice, nor is the intensity always sufficient to elicit a training effect. High-intensity interval training (HIIT) has emerged as a potentially effective alternative that encompasses brief high-intensity bursts of exercise interspersed with bouts of recovery, aiming to maximize cardiovascular exercise intensity in a time-efficient manner. HIIT may provide an alternative exercise intervention and invoke more pronounced benefits poststroke.

OBJECTIVES:

To provide an updated review of HIIT poststroke through ( a) synthesizing current evidence; ( b) proposing preliminary considerations of HIIT parameters to optimize benefit; ( c) discussing potential mechanisms underlying changes in function, cardiovascular health, and neuroplasticity following HIIT; and ( d) discussing clinical implications and directions for future research.

RESULTS:

Preliminary evidence from 10 studies report HIIT-associated improvements in functional, cardiovascular, and neuroplastic outcomes poststroke; however, optimal HIIT parameters remain unknown.

CONCLUSION:

Larger randomized controlled trials are necessary to establish ( a) effectiveness, safety, and optimal training parameters within more heterogeneous poststroke populations; (b) potential mechanisms of HIIT-associated improvements; and ( c) adherence and psychosocial outcomes.

 

via High-Intensity Interval Training After Stroke: An Opportunity to Promote Functional Recovery, Cardiovascular Health, and Neuroplasticity. – PubMed – NCBI

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[Abstract] Evidence for Training-Dependent Structural Neuroplasticity in Brain-Injured Patients: A Critical Review

Acquired brain injury (ABI) is associated with a range of cognitive and motor deficits, and poses a significant personal, societal, and economic burden. Rehabilitation programs are available that target motor skills or cognitive functioning. In this review, we summarize the existing evidence that training may enhance structural neuroplasticity in patients with ABI, as assessed using structural magnetic resonance imaging (MRI)–based techniques that probe microstructure or morphology. Twenty-five research articles met key inclusion criteria. Most trials measured relevant outcomes and had treatment benefits that would justify the risk of potential harm. The rehabilitation program included a variety of task-oriented movement exercises (such as facilitation therapy, postural control training), neurorehabilitation techniques (such as constraint-induced movement therapy) or computer-assisted training programs (eg, Cogmed program). The reviewed studies describe regional alterations in white matter architecture and/or gray matter volume with training. Only weak-to-moderate correlations were observed between improved behavioral function and structural changes. While structural MRI is a powerful tool for detection of longitudinal structural changes, specific measures about the underlying biological mechanisms are lacking. Continued work in this field may potentially see structural MRI metrics used as biomarkers to help guide treatment at the individual patient level.

via Evidence for Training-Dependent Structural Neuroplasticity in Brain-Injured Patients: A Critical Review – Karen Caeyenberghs, Adam Clemente, Phoebe Imms, Gary Egan, Darren R. Hocking, Alexander Leemans, Claudia Metzler-Baddeley, Derek K. Jones, Peter H. Wilson, 2018

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[WEB SITE] Technology helps stroke patients get moving again

Electronic devices are helping stroke patients walk and move their hands again.
Provided

Electronic devices are helping stroke patients walk and move their hands again.

This may bode well for the 20 percent of survivors that have foot drop, and 87 percent of stroke survivors that have lost the use of their hands.

When a person has a stroke, multiple sclerosis or brain injury, most of the neurons that help signal muscles to move are broken. This keeps the brain from being able to send signals to certain muscle groups telling them to move.

A stroke, for example, can destroy millions of brain cells that you need to tie your shoes, pick up a grandchild or reach into your closet. To gain lost function, rehabilitation used to focus on teaching patients how to compensate for their physical deficits.

Today, research shows that neural plasticity (the ability of the brain to repair itself) can be applied effectively for improved outcomes and enhanced functional abilities.

To do this successfully, the central nervous system must seek other neural pathways and find new connections that bypass the damaged areas. With a little help from functional electrical stimulation (FES), which is low energy electrical pulses, the process to find the new connections is a bit easier.

New electrical orthotics target muscles with FES and can help accelerate muscle-nerve recovery. The electronic orthosis and its control unit transmit synchronized electric pulses to the peripheral nerves through electrodes built into the orthosis — these pulses are driven in precise sequence and accurately activate five muscles in the forearm.

“Muscles relearn when electrical stimulation provides feedback to the brain that can facilitate neuro re-education and promote neuroplasticity, which is the ability of the central nervous system to remodel itself,” says physical therapist Imelda Ungos, director of rehabilitation for Melbourne Terrace, a facility that specializes in the active and aging population. “And patients can learn a better way to function just by having new input, regardless of age.”

Ungos reports that the ultimate goal with this method of therapy is to restore voluntary movement. Patients with a history of brain lesions, such as stroke conditions and movement disorders, may have the most to gain with the neuro-orthotics and the rehab to learn how to use them.

“The latest therapy equipment from Bioness can drive the brain to new connections, and newer technology and techniques encourage the neuronal changes necessary for improved function,” says Ungos. “This kind of therapy is very specialized, and we’re the only sub-acute facility in the Space Coast area with the Bioness FES technologies,” says Ungos.

For improved hand function, the orthosis fits to the forearm and wrist, and communicates wirelessly with the control unit. Inside the orthosis, electrodes deliver mild pulses to stimulate muscle contraction.

The level of stimulation can be adjusted toward each function. With an intuitive interface, clinicians are better able to help their patients obtain simple control of desired hand activation.

The wireless device is portable and allows for quick detection of the best electrode position for each individual. A control unit enables easy programming of functional modes and training regimens.

For patients with poor safety and balance due to foot drop, which is the inability to lift the foot during walking, there’s an electronic orthosis that fits below the knee. The unit has stimulating electrodes placed over the correct nerve and fits below the knee. A heel sensor sends a muscle-contracting signal during the correct step phase to enable the foot to lift.

After the initial custom fitting of the orthosis, patients can enhance their abilities to perform daily activities, and the carry-over results from continued use will improve voluntary movement.

Ungos adds that the other benefits of interacting with the device include a reduction in muscle spasm, an increase in range of motion, and improved blood circulation. “That all goes towards retarding disuse atrophy,” she says.

“Efforts must be directed towards preventing complications and learning how to use affected limb along with active rehabilitation… especially when the use is started early in post stroke rehabilitation,” says online Bioness reports from Harold Weingarden, MD, Director of Rehabilitation Day Hospital Sheba Medical Center in Israel.

“An early start to rehab gives patients hope of what is possible in terms of present and future improvement,” says Ungos. She adds that the devices allow patients to move in more natural ways.

Feeling “normal” again can improve mood, function, and quality of life.

For more information, call Melbourne Terrace Rehabilitation Center at 321-725-3990. They offer comprehensive rehabilitative outpatient and inpatient services for short or long term care located at 251 East Florida Ave., Melbourne, FL 32901

via Technology helps stroke patients get moving again

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[Infographic] This nifty infographic is a great introduction to neuroplasticity and cognitive therapy

It’s startling to think about how we’ve got a spaceship billions of miles away rendezvousing with Pluto, yet here on Earth there are major aspects of our own anatomy that we’re almost completely ignorant about. We’ve climbed Everest, sent men to the moon, and invented the Internet — but we still don’t know how our brains work. The positive outlook is that many health, science, and research specialists believe we’re on the precipice of some major neuroscientific breakthroughs.

One example of a recent discovery with major implications is our further understanding of neuroplasticity. Simply put, we used to think our brain was what it was — unchangeable, unalterable. We were stuck with what nature gave us. In actuality, our brains are like plastic. We can alter neurochemistry to change beliefs, thoughts processes, emotions, etc. You are the architect of your brain. You also have the power to act against dangerous impulses such as addiction. The therapeutic possibilities here are endless.

Below, broken up into two parts, is a terrific infographic detailing the essence of what we know about neuroplasticity and how it works. It was created by the folks at Alta Mira, a San Francisco-area rehabilitation and recovery center.

Part One

Part Two

Want a high-res, unedited version of the image above? Your wish is my command.

via This nifty infographic is a great introduction to neuroplasticity and cognitive therapy | Big Think

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