Neural plasticity refers to the brain's ability to change and adapt in response to experience. It involves changes in synaptic connections from short-term changes in efficiency to long-term structural changes. There is a continuum from short-term to long-term learning and neural changes that underpins recovery from injury. Principles of neuroplasticity that guide clinical practice include repetition, intensity, salience, age appropriateness, patient expectation, transference, interference, fun, feedback, and environment to facilitate optimal learning and recovery through experience-driven plastic changes in the brain.

1. Neural Plasticity
Dr. Shweta Kotwani; Pediatric Physical Therapist
BPTh (MUHS); MPT (Neuro,MUHS); LASHS-U.K. Fellowship Dip.(Peds.Rehab.; Clinical Neuro.Sc.)

2. Plasticity or Neural Modifiability
• A continuum from short-term changes in the efficiency or strength of
synaptic connections, to long-term structural changes in the
organization and number of connections among neurons.
• Parallel continuum of learning- gradual shift from short-term to long-
term learning.

3. Continuum of neural modifiability leads to
long-term modification of behavior.
Persisting changes
Persisting changes
Changes in synaptic
connections
Long-term changes
(structural changes)
Changes in
synaptic
efficiency
Short-term
changes
Neural-modifiability
Parallel continuum of learning
Fig 1- Gradual shift from short-term to long term learning is reflected in a move along the continuum of neural
modifiability. Short-term changes, associated with an increased synaptic efficiency, persist and gradually give way to
structural changes, the underpinning of long-term learning.

4. Clinical Application
• Like learning, recovery of function can also be characterized by a
continuum of changes from short-term functional changes that occur
immediately following injury (existing weak synaptic connections), to
long-term structural changes such as remapping of the sensory or
motor cortex.

5. Neuroplasticity Principles to guide Clinical
Practice
1. Use it or lose it- Stay active and keep challenging learning. Failure
to regularly engage specific general brain functions can lead to
functional degradation.
2. Use it and improve it- Engaging in training behaviors that drive
specific brain functions can lead to an enhancement of the
function. Setting clear goals and objectives for retraining.
3. Be specific- Training experience must match the desired outcome;
nature of neural plasticity is dictated by the nature of training.

6. 4. Repetition is essential-
• Learning requires repetition progressed in difficulty and spaced over
time.
• Creating learning activities that are goal-directed, repetitive,
progressed in difficulty, increased in variety and depth, spaced over
time, rewarded and complemented with feedback on accuracy.
• Avoiding activities that stimulate repetition of abnormal movements.
5. Intensity matters-
• Plasticity changes require a sufficient training intensity to ensure
durability of pathways.
• Making the stimulus strength adequate for detection and appropriate
to avoid abnormal behaviors.

7. 6. Salience is important-
• The training must be salient and match the outcome behavior desired
and the goals of the individual.
• Integrating training behaviors into meaningful functional activities.
7. Age must be addressed- Training induced plasticity occurs most readily
in a young brain, but neural adaptation continues across the life span
with learning based training. Training must be age appropriate.
8. Patient expectation- Patient expectation can facilitate the outcomes of
training; patients who expect to get better can enhance their learning.
Strengthening positive responses with meaningful rewards.

8. 9. Transference-
• Plasticity in response to one training experience can also enhance the
acquisition of similar behaviors and adaptation in other experiences
and other parts of the body.
• Eg. Making it difficult to use the unaffected side.
10. Interference-
• Plastic changes after one training experience may interfere with the
acquisition of similar systems.
• Matching training behaviors with progression of healing and recovery
as well as development.
11. Fun- Learning is greatest when it is associated with discovery and
fun.

9. 12. Reward or feedback-
• Feedback allows modification of training behaviors, correcting errors
and improving accuracy of learning.
• Maintaining high levels of attention and cognitive function within the
context of all daily activities; avoiding habitual unattended behaviors.
13. Environment- Performing training activities in different postural
orientations and different environments, which facilitate the best
performance.
14. Helping Others- Maintaining the fitness of the brain is best when
individuals look beyond themselves to help and involve others.

10. References
• Umphred’s Neurological Rehabilitation; Sixth Edition; Darcy A.
Umphred, Rolando T. Lazaro, Margaret L. Roller, gordon U. Burton.

11. • THANK YOU