This document discusses neuroplasticity and its applications in neurophysiotherapy. It defines neuroplasticity as the ability of the central nervous system to change and adapt in response to environmental cues, experience, behavior, injury, or disease. The document outlines different types of neuroplasticity including synaptic plasticity, neurogenesis, neuronal migration, and functional changes. It also discusses principles of experience-dependent neural plasticity such as repetition, intensity, time, specificity, transfer, and interference. Neuroplasticity can have both positive and negative effects in clinical practice.

1. Neuroplasticity: Applications
in Neurophysiotherapy
Dr. Vipinnath E.N.(PT)
MPT, PG Dip MT, CMP.
Associate Professor & Head of Dept. (Neurophysiotherapy)
Alva’s College of Physiotherapy and Research Centre, Moodbidri, Karnataka

2. Plastic
• Plastic : easily shaped or moulded
(Greek “Plastos”)

3. Plasticity
• Plasticity is the ability to be moulded

4. Neural Plasticity/ Neuroplasticity
• Neuroplasticity is the ability of the central nervous
system (CNS) to change and adapt in response to
• Environmental cues
• Experience
• Behavior
• Injury or
• Disease.
(Ludlow et.al. 2008)

5. History
• 1800s – Focal areas in adult brain
• William James (1842-1910)
• American Philosopher and Psychologist
• “Organic matters, especially nervous tissues,
seem to be endowed with a very extraordinary
degree of plasticity of this sort ...” (Principles of
Psychology, 1890)
William James

6. History Contd…
• Until 1960s the idea of “malleability” of adult
brain was overwhelmed
• This had a very negative impact on the field of
Neurorehabilitation
• In 1967, Paul Bach-y-Rita MD, published a
research article about sensory plasticity
• Rehabilitated his father from stroke and was
able to go hiking
(Bach-y-Rita P, 2003)

7. How do Neuroplasticity occur?
• from a change in function within a particular neural substrate in the
CNS through alterations in
• synaptic strength
• neuronal excitability
• neurogenesis or cell death.
(Brosh & Barkai, 2008)

8. Types of Neuroplasticity
Structural Neuroplasticity
• Synaptic plasticity
• Synaptogenesis
• Synaptic Pruning
• Neuronal migration
• Neurogenesis
• Neuronal cell death
Functional Neuroplasticity
• Homologous area adaptation
• Cross-modal reassignment
• Map expansion
• Compensatory masquerade
(Demarin V., Morovic S. & Bene R. 2014, Grafman J. & Litvan I. 1999)

9. Synaptic Plasticity
Two types
• Potentiation
• Depression

10. Synaptogenesis
• Formation of new synapses
• Sprouting

11. Synaptic Pruning
• Selective degeneration of axons

12. Neurogenesis
• Occurs through the division of
neural stem cells and maturation
into neural progenitor cells, which
then migrate and mature into
neurons.
• thought to be restricted to
embryonic development, then
ceasing post-natally
• Adult neurogenesis has
unexpectedly been detected to
occur throughout the lifetime of
various mammalian brain in,
particularly in the hippocampus
(Gage F.H. 2019)

13. Neuronal Migration
• position determines a neuron’s
function
• from the site of neuronal birth to the
target location
• during the embryonic period, after
birth till adulthood
(Ghashghaei HT, Lai C. & Anton E.S. 2008)

14. Neuronal Cell Death
• Type 1: Seen in developmental
neuroplasticity (Apoptosis)
• Type 2: Seen in degenerative
conditions
• Type 3: Seen in inflammatory
conditions
(Yuan J., Lipinski M. and Degterev A. 2003, Chi H., Chang H.-Y. and Sang T.-K., 2018)

15. Homologous area adaptation
• The assumption of a particular
cognitive process by a
homologous region in the
opposite hemisphere.
• Results difficulties in dual tasking
(Grafman J. & Litvan I. 1999)

16. Cross-modal reassignment
• Occurs when structures
previously devoted to processing
a particular kind of sensory input
now accept input from a new
sensory modality.
• Auditory and Visual cueing
improves performance using this
kind of neuroplasticity
(Grafman J. & Litvan I. 1999)

17. Map expansion
• Enlargement of a functional
brain region on the basis of
performance.
• Expansion of cortical
representation due to improved
skills
• Eg. A manual therapist’s finger
representation
(Grafman J. & Litvan I. 1999)

18. Compensatory Masquerade
• Compensatory masquerade is a
novel allocation of a particular
cognitive process to perform a
task.
• Formation of alternate pathways
to perform a lost function
• Pathological Gaits
(Grafman J. & Litvan I. 1999)

19. Neuroplasticity: Clinical Picture

20. Negative Side of Plasticity
• Decline in brain function
• Altered motor control
• Impaired performance of activities of daily living
• Increased perception of pain
• Learned non-use
• Phantom limb
(Mahncke, Bronstone & Merzenich 2006; Nudo RJ.2007; Stein & Hoffman, 2003)

21. Positive Side of Plasticity
• The ability to learn New Skills
• More efficient communication between sensory and motor pathways
• Improved function of the aging brain
• Slowing down pathological processes
• Promoting recovery of sensory losses
• Improved motor control
• Improved memory
(Mahncke, Bronstone & Merzenich, 2006; Nudo 2007; Stein & Hoffman, 2003)

22. Principles of
Experience Dependent
Neural Plasticity

23. 1. Use it or Lose it
• Failure to drive specific brain
functions can lead to functional
degradation
• Learned non-use
• Continue the training, to stay
functionally independent
(Kleim & Jones, 2008)

24. 2. Use It and Improve It
• Training that drives a specific
brain function can lead to an
enhancement of that function
• The skills acquired through
training, should be put to daily
life situations and improved
(Kleim & Jones, 2008)

25. 3. Specificity
• The nature of the
training experience
dictates the nature of
the plasticity
• Train for the specific
function in specific
context
(Kleim & Jones, 2008)
Can strength training improve skilled activities of daily living?

26. 4. Repetition Matters
• Induction of plasticity requires
sufficient repetition
• Acute stage: 5-10mins (Total 20
Repetitions in 3 or 4 sets)
• Skill development: 2000 to 3000 reps
• Max 300 reps in an hour
• At least 100 reps for Upper limb/day
• Resisted exercises: 30 repetitions
• Use optimum number of repetitions,
muscles and other tissues should not
get injured
(Kleim & Jones, 2008)

27. 5. Intensity Matters
• Induction of plasticity requires
sufficient training intensity
• The more the intensity, the more
and long-term, the plastic
changes
• Take into account of the
patient’s exercise capacity and
decide the intensity (70-85% of
maximum heart rate or 60-80%
of Heart Rate Reserve)
• Look beyond nervous system
(Kleim & Jones, 2008)
http://www.neuropt.org/practice-resources/locomotor

28. 6. Time Matters
• Different forms of plasticity occur at
different times during training.
• during motor skill training, gene
expression precedes synapse formation
• a 5-week period of rehabilitation initiated
30 days after cerebral infarcts was far less
effective in improving functional outcome
and in promoting growth of cortical
dendrites than the same regimen initiated
5 days post infarct. (Biernaskie,
Chernenko, & Corbett 2004)
• The earlier the better.
(Kleim & Jones, 2008)

29. 7. Salience
• The training experience must be sufficiently salient to induce
plasticity
• the function, which is important to the patient is easily learned
• motivation and attention are essential to promote engagement in the
task
• Give positive feedback and reward points for accomplishments of
tasks
(Kleim & Jones, 2008)

30. 8. Age Matters
• The effects of brain damage vary
with developmental age
• Training-induced plasticity
occurs more readily in younger
brains
• Difficult to train very young and
very aged
• Aged brain suffers cognitive
decline and plastic changes are
less profound and slow
(Kleim & Jones, 2008)

31. 9. Transference
• Plasticity in response to one
training experience can enhance
the acquisition of similar
behaviors
• In Clinic, focus on training
functions that can be transferred
as ADLs at home
(Kleim & Jones, 2008)

32. 10. Interference
• Plasticity in response to one experience can interfere with the
acquisition of other behaviors.
• E.g. Learned non-use
• Development of compensatory behaviors after brain damage
interfere with rehabilitation
• Prevent compensatory movements that are not useful
(Kleim & Jones, 2008)

33. To Sum up….
• Continue the training, to stay functionally independent
• The skills acquired through training, should be put to daily life situations
and improved
• Train for the specific function
• Use optimum number of repetitions
• Training programme should be according to the patient’s capability
• Start training at the earliest
• The function, which is important to the patient is easily learned. Always
motivate the patient and give positive feedback or reward points
• Training-induced plasticity occurs more readily in younger brains
• In clinic, focus on training functions that can be transferred as ADLs at
home
• Prevent compensatory movements and behaviours that are not useful

34. Thank You

35. References
• Ludlow, C. L., Hoit, J., Kent, R., Ramig, L. O., Shrivastav, R., Strand, E., ... &
Sapienza, C. M. (2008). Translating principles of neural plasticity into
research on speech motor control recovery and rehabilitation. Journal of
Speech, Language, and Hearing Research.
• Bach-y-Rita, P. (2003). Late postacute neurologic rehabilitation:
Neuroscience, engineering, and clinical programs. Archives of physical
medicine and rehabilitation, 84(8), 1100-1108.
• Brosh I, Barkai E. Learning-induced long-term synaptic modifications in the
olfactory cortex. Curr Neurovasc Res 2004;1(4):389–395. [PubMed:
16181087]
• Demarin, V., & MOROVIĆ, S. (2014). Neuroplasticity. Periodicum
Biologorum, 116(2), 209-211.

36. • Grafman, J., & Litvan, I. (1999). Evidence for four forms of
neuroplasticity. In Neuronal plasticity: Building a bridge from the
laboratory to the clinic (pp. 131-139). Springer, Berlin, Heidelberg.
• Gage, F. H. (2019). Adult neurogenesis in mammals. Science,
364(6443), 827-828.
• Ghashghaei, H. T., Lai, C., & Anton, E. S. (2007). Neuronal migration in
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141-151.
• Yuan, J., Lipinski, M., & Degterev, A. (2003). Diversity in the
mechanisms of neuronal cell death. Neuron, 40(2), 401-413.
• Chi, H., Chang, H. Y., & Sang, T. K. (2018). Neuronal cell death
mechanisms in major neurodegenerative diseases. International
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37. • Mahncke, H. W., Bronstone, A., & Merzenich, M. M. (2006). Brain
plasticity and functional losses in the aged: scientific bases for a novel
intervention. Progress in brain research, 157, 81-109.
• Nudo, R. J. (2007). Postinfarct cortical plasticity and behavioral
recovery. Stroke, 38(2), 840-845.
• Stein, D. G., & Hoffman, S. W. (2003). Concepts of CNS plasticity in the
context of brain damage and repair. The Journal of head trauma
rehabilitation, 18(4), 317-341.
• Kleim, J. A., & Jones, T. A. (2008). Principles of experience-dependent
neural plasticity: implications for rehabilitation after brain damage.
Journal of speech, language, and hearing research.