Recovery of function
Dr/ Shimaa A. Essa
Lecturer of physical therapy for neurological &
neurosurgical disorders, King Khaled University
is a process for the acquisition and
modification of movement
The physiological basis of motor learning is
distributed among many brain structures and
processing levels. likewise, the physiological
basis of Recovery of function.
Motor learning depends
on the interaction
between individual, task
Is a general term describing the ability of
Plasticity = Neural modifiability
Plasticity occur in one of two forms:
1) Short-term changes (functional) in the efficiency of
2) Long-term changes (structural) in the organization
and number of connections among neurons.
Recovery of function
Functional changes:- such as unmasking of existing
but weak connections.
Structural changes:- such as remapping of sensory or
also characterized by
changes from short-term
(functional) occur immediately
after injury, to long-term (structural)
Short-term changes Persisting changes
Changes in synaptic
(Number + Organization)
Learning = acquisition of knowledge or skills.
Memory = storage of learning outcome.
a) Short- term memory:- Refers to working memory, which has a
limited capacity for information and lasts only few minutes.
b) Long- term memory:-
Long-term memory is intimately related to the process of learning.
1) Initial stages of long term memory reflects functional changes to
the efficiency of synaptic connections.
2) Later stages of long term memory reflects structural changes in
Are learning and memory localized to a certain area of the brain?
Plasticity and learning
Many factors affect or modify synaptic connections. As for motor
learning the main concern is activity dependent modifications of
Continuous motor activity Modification of synaptic connections
Forms of motor learning
1) Declarative learning = learned motor task needs attention and
consciousness to be carried out.
2) Non-declarative learning = learned task can be performed
automatically without consciousness.
Is when a person can predict
A specific stimulus predicts
A specific response
Habituation Sensitization Procedural learning
Human learn to predict the
out come Of a specific
Predicts a consequence
Non- associative learning
1) Habituation (Desensitization)
- Habituation is related to in
synaptic connectivity between
sensory & motor neurons.
- Short-term habituation = efficiency
of synaptic connections( Amplitude
of Excitatory Post synaptic Potential
- Long-term habituation = structural
changes in synaptic connections.
(They in number)
2) Sensitization (Sensory reeducation)
- Is caused by strengthening of response
to a potentially dangerous stimulus.
- Occurs in form of short and long term
changes as in habituation.
- Short term changes
# Improve mobilization of
- Long term changes
3) Growth of New synapses.
(They in number)
3) Procedural learning
Is a more complex form of non-declarative learning. It includes
learning and execution of motor and non-declarative cognitive
s k i l l s . I t o c c u r s t h r o u g h t r i a l - a n d - e r r o r p r a c t i c e .
**what is The neural system underlying procedural (implicit)
1) Frontal lobe ( Sensorimotor cortex).
2) Basal ganglia (Tail of Cuadate nucleus).
3) Parital lobe. 4) Cerebellum ( adaptation).
**what is The neural system underlying (explicit) learning?
1) Frontal brain areas (supplementary motor area, prefrontal cortex).
2) Head of cuadate nucleus.
3) Hippocampus. 4) other medial temporal lobe structures.
Motor cortex contributes to procedural
learning, and the shift from implicit to explicit
Sensorimotor cortex has a role in motor
learning , its damage doesn't cause loss of already
learned skills but only slows down the learning of
NEW motor skills.
Plasticity and declarative (explicit form of learning)
Declarative learning requires Attention & Consciousness.
Procedural learning is expressed through improvement of performance of
a learned task, while Declarative learning may be expressed in a form
other than the learned task.
In humans, lesions in the temporal lobe of cortex and hippocampus may
interfere with the lay down of declarative memory,
Hippocampus is critical for declarative learning.
Motor learning includes both simple forms ( classical & operant
conditioning), and more complex forms (procedural & declarative
learning) involving acquisition of skilled movements.
Early induced plasticity & Recovery of function
Early transient events that depress brain functions:
1- Edema of 2 forms:-
a) Local = next to the primary injury site, lead to compression of
axons and physiological neuronal block. (reduction of edema
restore a portion of functional loss).
b) Remote = not part of primary injury and causes depression of
2- Diaschisis:- is a transient CNS disorder involving loss of
function in a structurally intact brain area. Caused by
reduction of brain blood flow or metabolism.
Intracellular response to injury:-
Formation and regeneration of synapses (synaptogenesis)
Early recovery is due to:- Resolution of temporary
factors interfering with neural function ( edema & diaschisis).
Late recovery is due to:- Plastic changes involving,
Synaptic modulation and Cortical reorganization.
1) Immediate changes
(a) Immediate reorganization
Through unmasking of
from neighboring areas
(b) a longer-term changes
Through neighboring inputs
from the areas take over
the parts of the map that
were previously occupied
by the destroyed cells
2) The important effect of Experience and
Training in shaping the cortical map.
Thus , if we leave patients without
rehabilitation training for many weeks
or months, their brains will show
changes in organization , reflecting
Proper training appears to make
a difference no matter when it’s
given. Since the brain continues
to be plastic through out our