Neuroplasticity and recovery are closely connected. Neuroplasticity is the brain’s ability to change, adapt and form new connections. This process plays an important role in recovery after a stroke or brain injury, helping people regain physical and cognitive abilities through rehabilitation.
If you or a loved one had a stroke or brain injury, you may wonder how and if the brain can repair itself. The answer is yes, it can, and the process is called neuroplasticity.
It’s happening in the brain throughout your lifetime as you learn new information and activities. It’s also crucial during recovery after a traumatic or non-traumatic injury to the central nervous system, including the brain and spine.
“Basically, I like to think of the words neuro and plastic,” said Alissa Rudloe, a physical therapist at Encompass Health Rehabilitation Hospital of Tallahassee. “Plastic can change, but it takes a stimulus. It has to go under heat for the stability of the structure to change. Then you have neuro, which is related to the brain. The brain and nervous system have to have some stimuli to change and reorganize.”
What is neuroplasticity and how does it support recovery?
Neuroplasticity is the brain’s ability to reorganize and adapt its structure and function so you can learn and retain new information. After an injury or illness that affects the brain or spinal cord, neuroplasticity can help the brain with new neural connections and, in some cases, regenerate nerve cells (neurons). This process supports the recovery of both mental and physical abilities.
“It’s like building new road maps and connections,” Rudloe said. “If a road is damaged, we repair or build new ones. Think of the brain reorganizing and making new connections in response to damage.”
Types of neuroplasticity
There are two basic types of neuroplasticity: functional and structural.
- Functional plasticity: Occurs when one area of the brain takes over function after an injury, such as a stroke or traumatic brain injury.
- Structural plasticity: Refers to the brain’s ability to physically remodel by forming new connections between nerve cells and, in some cases, creating new nerve cells.
The 10 principles of neuroplasticity
The concept of neuroplasticity is nothing new. The first theory about its role in recovery was published by William James in “The Principles of Psychology” in 1890.
More than 100 years later, researchers developed 10 principles of neuroplasticity. These principles now serve as the foundation for recovery after a brain injury.
- Use it or lose it. Every ability and action is connected to a neurocircuit in your brain. If it is not practiced, it will weaken.
- Use it and improve it. Practice helps brain function improve over time.
- Specificity. The brain forms new circuits in response to new tasks. If you want to get better at walking, Rudloe said, you should start walking.
- Repetition. Creating change in your brain requires repeated practice.
- Intensity. Therapy must be challenging enough to drive improvement.
- Timing. Starting rehabilitation as soon as possible after a stroke or brain injury leads to better outcomes.
- Salience. Activities and therapy must be meaningful to you. If you want to return to gardening, therapy should include movements related to gardening.
- Age. Recovery may take longer with age, but improvement is still possible.
- Transference. Learning one skill can improve another. “That means doing stairs could also help improve your walking,” Rudloe said.
- Interference. Learning a new skill may sometimes temporarily interfere with progress in another area.
Rehabilitation after a stroke or brain injury
As a physical therapist in the inpatient rehabilitation setting, Rudloe said the principles of neuroplasticity guide treatment for individuals recovering from stroke or other brain-related injuries, even those that are considered degenerative.
“If you have a degenerative disease like Parkinson’s, it’s important to keep up with therapy,” she said. “We try to educate these individuals when they leave the hospital that they’re not done with therapy. They need to keep on exercising. It goes back to that use it or lose it rule.”
In inpatient rehabilitation, individuals typically receive therapy for three hours a day, five days a week. “I tell people you don’t want to go to a nursing home after a stroke because it’s not going to be intense enough,” Rudloe said. “You’ll maybe get one hour a day. That’s what’s so good about Encompass Health. You’re going to get three hours a day, and it’s going to create plasticity in the brain. Your therapists are going to make it intense enough.”
Therapy at an inpatient rehabilitation hospital like Encompass Health may include speech, occupational and physical therapies that are customized to your lifestyle prior to your injury or illness. Goals in inpatient rehabilitation often include practicing everyday activities like eating, dressing and walking. They can also include hobbies, such as golf, playing with grandchildren or caring for a pet.
Neuroplasticity in action
Rudloe recalls a former patient of hers who had an incomplete spinal cord injury who came to inpatient rehabilitation with the goal of walking again.
“Every day we were doing gait training with him,” she said. “We would get him on our harness system and get him standing. We were putting weight on his legs and getting his legs moving on the treadmill. Now, he’s home and walking with a rollator. That’s amazing.”
Stories like this show how neuroplasticity and recovery work together. With the right therapy, repetition and support, the brain can continue to adapt and help people regain independence and quality of life.