Neuroplasticity and recovery

If you or a loved one had a stroke or other 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?

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 regenerate damaged nerve cells, also known as neurons, to help you regain lost function, both mentally and physically. “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 the brain has been injured or damaged in some way, including from a stroke or traumatic brain injury. It is the concept that different areas of the brain control different functions. If the brain is damaged in one area, another area can take up that function. 
• Structural plasticity is the brain’s ability to physically remodel by growing new connections between nerves cells and even growing new nerve cells.

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 “Principle of Psychology,” in 1890.  More than 100 years later, researchers developed the 10 principles of neuroplasticity. These principles now serve as the basis for recovery after a brain injury. They are:

1. Use it or lose it. Every ability and action is connected to a neurocircuit in your brain. If they are not practiced or used, they will weaken, and you’ll lose your ability to perform those tasks.
2. Use it and improve it. Practice drives your brain function to improve over time. 
3. Specificity. The brain forms specific new circuits in response to new tasks, so if you want to get better at walking, Rudloe said, you should start walking.
4. Repetition. If you want to create a change in your brain, you must practice and repeat.
5. Intensity. If it’s not intense enough, your brain function is not going to improve.
6. Timing. Thesooner you begin rehabilitation after a stroke or brain injury, the better.
7. Salience. The activities and therapy you perform need to be important to you. For example, if you want to return to gardening, your recovery should include gardening or activities that simulate it.
8. Age. The older you are, the more difficult it is for your brain to repair itself, but that doesn’t mean improvements and recovery are not possible.
9. Transference. Learning one skill or activity can transfer to another. “That means doing stairs could also help improve your walking,” Rudloe said. “Learning in one area can influence another.”
10. Interference. On the other hand, learning a new skill could also set you back or interfere in another area.

   

Rehabilitation after stroke or brain injury

As a physical therapist in the inpatient rehabilitation setting, Rudloe said the principles of neuroplasticity are an integral part of the care plan when it comes to treating 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 the inpatient rehabilitation setting, individuals 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.” The therapy you receive in an inpatient rehabilitation hospital like Encompass Health may include speech, occupational and physical therapies that are customized to your lifestyle and goals prior to your injury or illness.  Your goals in inpatient rehabilitation will not only include practicing everyday activities like eating, dressing and walking, but can also incorporate hobbies and other activities the you enjoy, 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. He came to Encompass Health Tallahassee 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.”