SCI & Understanding Neuroplasticity

SCI & Understanding Neuroplasticity

Posted by AskNurseLinda on Jun 8, 2015 10:57 am

NeuroplasticityNeuroplasticity is a word that is used frequently when discussing the nervous system especially in terms of recovery. It stems from the words "neuro" meaning pertaining to the nervous system and "plastic" meaning moldable. It is a term that has been created to note the ability of the nervous system to adapt to change from life experiences to recovery for nervous system injury. Nervous system function is an extremely complex process that is not fully understood. But scientists are attempting to unravel the mystery in hope of finding treatments for restoration and recovery. This is a very simplistic review to understand neuroplasticity as it is a word you will be hearing frequently.

The nervous system, up until the 1980's was thought to be set. It used to be understood that nervous system processes happened in a certain way and only that way. This is simply not the case. The nervous system, whether discussing the brain or spinal cord, is finding new pathways when a typical route for messages to and from the body is interrupted. We know typical routes for messages can be identified or mapped. However, it has been demonstrated that alternative message routes and interpretations can be developed. This is what is happening in referred and neuropathic pain, the message is attempted to be sent in another route. Occasionally, a new route will be defined by the nervous system, this is called, "remapping".

There are four types of neuroplasticity processes. Homologous area adaption is switching an activity from a non-functioning or weak area to a like area in the brain. This is what often happens with children with neurological issues which is why they typically recover more quickly than adults. Compensatory neuroplasticity is the nervous system finding another route for message transmission. Cross-modal neuroplasticity is the use of nervous transmission in areas that have not been utilized previously. Map expansion is the creation of function in one part of the nervous system taking over other functions. The map expansion neuroplasticity is the most often cited neuroplasticity process for functional recovery but all four processes are being researched. These are four ways the body tries to find solutions to nervous system recovery. All four ways (and perhaps more) are attempted.

We have all heard the expression that we are born with a finite number of brain cells and that is all we will ever have. Actually, current evidence has demonstrated that humans are creating new nerve cells, making new nerve connections and remyelinating or reinsulating existing damaged nerve cells. All of this is part of the process of recovery of the nervous system.

The process of patterned activity was used by Sister Kenney in her renowned treatment of polio in the mid 1900's. We know, today, that the body below a spinal cord injury or after a stroke, still is capable of function but the messages to perform activities do not get through. Therefore, if the brain thinks about a certain activity and the body is put through the function of that activity, the messages are sent to the body as the body is sending the movement message to the brain. This simultaneous input can assist in making connections either using the traditional pathway or creating new ones.

One of the strategies used to enhance neuroplasticity is repetitive movement or patterned activity. Performing an activity over and over again has been demonstrated to aid in neurological recovery especially in stroke and spinal cord injury. The repetitive movement appears to have responses when an activity is not only physically moved by the individual or caretaker but also mentally thought through such as using visualization techniques and biofeedback strategies while doing the activity. Encouraging engagement of the senses appears to be a key in remapping function.

Other techniques have been used to aid neuroplasticity stimulation through light and laser therapy, and music. There have been reports of varying success with these techniques on brain function including treatment for dyslexia. Functional electrical stimulation and partial weight supported walking are techniques that have been used to encourage body function with some success but further research is being conducted especially to figure out how and why this process might work as well as for dosing and new practical strategies.

Imaging studies have been beneficial to note neuroplasticity. It is not critical for treatment but very beneficial to long term research and understanding of neuroplasticity recovery. Functional MRI (fMRI) is a test that will demonstrate parts of the nervous system that are functioning with activity. This imaging study has been used in assessing traditional areas of nervous control of movement and function compared to remapping of the nervous system. Meditation has been studied to demonstrate brain remapping thereby creating the idea that thinking about movement has some connection to the actual activity of moving.

There are many remaining questions about neuroplasticity. Why some have recovery after paralysis, how much activity is needed and how to best access the treatments are to name but a few. Recovery after paralysis is most likely a multifactorial process. Understanding neuroplasticity is a part of this process. Rethinking recovery after paralysis is a new field for many healthcare providers. Your body wants to recover and so it does through the process of neuroplasticity.

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Nurse Linda

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