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Neuroplasticity & Implications for Stroke Recovery

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Neuroplasticity & Implications for Stroke Recovery 4/6/2016 Neuroplasticity Mechanisms: Selected Neural Plasticity References How Therapy Changes the Brain • Bryck & Fisher (2012) Training the Brain: Practical Applications of Neural Plasticity From the Intersection of Cognitive Neuroscience, Developmental Psychology and Prevention Science. Am Psychol. 67(2): 87–100 Review as applied to perdiatrics After Injury Part 2 • Kerr, AL, Cheng, SY, Jones, TA (2011) - Experience-dependent neural plasticity in the adult damaged brain. Commun Disord. 44(5): 538–548 • Kleim, Jeffrey (2011) Neural plasticity and neurorehabilitation: Teaching the new MSHA brain old tricks. Journal of communication disorders, 44(5) • Kleim, J. and Jones, T.A. (2008) Principles of experience-dependent neural plasticity. JSHR 51(1), S225-S239. • Murphy & Corbett (2009) Plasticity during stroke recovery: from synapse to Martha S. Burns, Ph.D. behaviour. Nature Reviews Neuroscience • Pekna,M., Pekny, M., Nilsson,M.(2012) Modulation of Neural Plasticity as a Basis Joint Appointment for Stroke Rehabilitation. Stroke 43: 2819-2828 Thorough review for all disciplines Professor • Takeuchi, N & Izumi, S (2013) Rehabilitation with Poststroke Motor Recovery: A Review with a Focus on Neural Plasticity. Stroke Research and Treatment. Volume Northwestern University 2013, Article ID 128641 Excellent review for PT and OT • Warraich Z, Kleim JA. (2010) Neural plasticity: the biological substrate for neurorehabilitation. PM R. 2:S208 –S219. , References – EB task specific References on Recovery procedures • Corbetta M, Kincade MJ, Lewis C, Snyder AZ, Sapir A. (2005) Neural basis and • Harris, J., Eng, J., Miller, W., Dawson, A.(2009) A Self- recovery of spatial attention deficits in spatial neglect. Nature Neuroscience 8:1603-10. Administered Graded Repetitive Arm Supplementary • Castellanos, N et al. (2010) Reorganization of functional connectivity as a correlate Program (GRASP) Improves Arm Function During Inpatient of cognitive recovery in acquired brain injury. Brain 133; 2365–2381 Stroke Rehabilitation A Multi-Site Randomized Controlled • Cramer, S.C., Sur, M., & Dobkin, B.H. et. Al. (2011) Harnessing neuroplasticity for Trial. Stroke 40: 2123-2128 clinical applications. Brain 134(6), 1591 – 16 • Hamilton, R., Chrlysikou, E., & Coslett, B. (2011 ) Mechanisms of Aphasia Recovery • Lo, A. et al (2010) Robot-Assisted Therapy for Long-Term After Stroke and the Role of Noninvasive Brain Stimulation. Brain and Language Upper-Limb Impairment after Stroke N Engl J Med 118(1-2) 40-50. 2010;362:1772-83. • Jiang, Q et al (2010) MRI of Stroke Recovery. Stroke 41: 410-414 1 • Mishra, J. and Gazzaley, A. (2014) Harnessing the neuroplastic potential of the • Norouzi-Gheidari N , Archambault PS, Fung J (2012)Effects human brain & the future of cognitive rehabilitation. Frontiers in Human of robot-assisted therapy on stroke rehabilitation in upper Neuroscience. 8 (218) 1-4 limbs: systematic review and meta-analysis of the • Saur , et. al. (2006) Dynamics of language reorganization after stroke. Brain (2006), 129, 1371–1384 literature. Rehabil Res Dev. 49(4):479-96. • WEBSITEhttp://www.ucl.ac.uk/ion/departments/sobell/Research/NWard/docume nts/tsrnward 1 4/6/2016 References on issues related to when References on Neuromodulators to begin treatment after stroke • Dromerick, A.W. et al.(2009) Very Early • Lesch and Waider (2012) Serotonin in the Modulation of Constraint-Induced Movement during Stroke Neural Plasticity and Networks: Implications for Neurodevelopmental Disorders. Neuron, 76, October 4, Rehabilitation. Neurology 73;195-201 2012 • Holland, A & Fridriksson, J. (2001) Aphasia • Nicolas X. Tritsch and Bernardo L. Sabatini (2012) management during the early phases of recovery Dopaminergic Modulation of Synaptic Transmission following stroke. American Journal of Speech - in Cortex and Striatum. Neuron 76, October 4, 2012 Language Pathology; 10, 1 • Picciotto, Higley and Mineur (2012) Acetylcholine (ACh) as a neuromodulator: Cholinergic Signally Shapes Nervous • Turkstra, Lyn (2013) Inpatient cognitive System Function and Behavior. Neuron, 76, October 2012. rehabilitation, is it time for a Change? Journal of • Sara and Bouret (2012) Orienting and Reorienting: The Head Trauma Rehabilitation.Vol. 28, No. 4, pp. Locus Coeruleus Mediates Cognition through Arousal. 332–336 Neuron, 76, October 4, 2012 What is Neuroplasticity (Cramer et.al. Objectives 2011) Describe the early physiological recovery processes after stroke and how they affect • the ability of the assessment in early post-stroke acute care settings. nervous system to Utilize research on treatment driven neuroplastic recovery mechanisms to select evidence-based post stroke treatment content for OT, PT and Speech. respond to intrinsic or Utilize research on treatment driven neuroplastic recovery mechanisms to maximize extrinsic stimuli upregulation of neuromodulators of motivation including dopamine. • by reorganizing its Utilize research on treatment driven neuroplastic recovery mechanisms to maximize upregulation of neuromodulators of attention including acetylcholine and structure, function and norepinephrine. connections. Design treatment programs that are balanced with appropriately selected content and methods that maintain patient confidence and maximize outcomes. 2 4/6/2016 I. Overview of neuroplasticity Spontaneous Recovery of Function mechanisms after stroke After Stroke (Pekna,M., Pekny, M., Nilsson,M.,2012) • Neurophysiology of diaschesis • Loss of function attributable to stroke results from • Neurophysiology of neural recruitment – cell death in the infarcted region • Neurophysiology for white matter tract – cell dysfunction surrounding areas recovery • In addition, the function of remote brain regions (including the contralateral areas) connected to the area of tissue damage, is compromised because of diaschisis which includes: – hypometabolism, – neurovascular uncoupling, and – aberrant neurotransmission E Taub, G Uswatte, T Elbert - Nature Reviews Spontaneous Recovery of Function Neuroscience, 2002 After Stroke (Pekna,M., Pekny, M., Nilsson,M.,2012) Loss of function attributable to stroke results from cell death in the infarcted areas region cell dysfunction surrounding Four Processes of Spontaneous areas E Taub , G Recovery after Brain Injury Uswatte, T Elbert - Nature Reviews Neuroscience, 2002 3 4/6/2016 Functional spontaneous recovery involves Functional spontaneous recovery involves 3 (likely) overlapping, phases: 3 (likely) overlapping, phases: (Pekna,M., Pekny, M., Nilsson,M.,2012) (Pekna,M., Pekny, M., Nilsson,M.,2012) – (1) reversal of diaschisis, activation of cell genesis, (2) change in the The basic and repair; properties of processes existing neuronal underlying phases pathways; 2 and 3 also are (3) involved in neuroanatomical normal learning plasticity leading to the formation of new neuronal E Taub, G Uswatte, T Elbert - Nature Reviews connections.1 E Taub, G Uswatte, T Elbert - Neuroscience, 2002 Nature Reviews Neuroscience, 2002 Experience-Dependent Plasticity of the Experience-Dependent Plasticity of the Cerebral Cortex (Pekna,M., Pekny, M., Nilsson,M.,2012) Cerebral Cortex • “The ability to adapt in response to the changing • The structural constituents of neural plasticity environment is the most fundamental property of the nervous tissue and constitutes the basis for learning.” jointly determine • Neural plasticity - neurobiological basis for ability to – the complexity of neuronal networks and their adapt & learn in an experience-dependent manner activity and – At the structural level, neural plasticity could be defined in – contribute to recovery of function after stroke and terms of other CNS injury • dendritic and axonal arborization, • spine density, • synapse number and size, • receptor density, • and in some brain regions also the number of neurons. 4 4/6/2016 NICK WARD, UCL INSTITUTE OF NEUROLOGY, QUEEN SQUARE, 2013 NICK WARD, UCL INSTITUTE OF NEUROLOGY, QUEEN SQUARE, 2013 Use of Neuroscience imaging and Modeling to predict outcome and recovery Predicting Motor Recovery depends on identification of intact networks The relationship between clinical phenotypes, neuroplasticity, therapeutic interventions and assessment of function (adapted from Cramer, 2011) Neurophysiology of white matter tract recovery (Jiang, Q 2010) Clinical Phenotypes for Neuroplasticity Adult Rehab • Neurorestorative treatment of Neurotrauma Adaptive/Maladaptive stroke significantly increases Stroke Alternate/Latent Pathways both progenitor and mature Neurodegeneration oligodendrocytes in the Aging ipsilateral hemisphere of the ischemic brain. • Oligodendrocytes generate myelin and contribute to the integrity of white matter tracks in the brain. Assessments Interventions • Stimulation and amplification of these cells may lead to Behavioral Physical Training restructuring of axons and Neural – fMRI and DCM Language Training myelin. Functional Cognitive Training Adjunctive Therapies 5 4/6/2016 Neurophysiology of white matter tract Nazareth P. Castellanos et al. recovery (Jiang, Q 2010) Brain 2010;133:2365-2381 • White matter architecture in the ischemic boundary Illustration of experimental is altered by • Functional neurorestorative protocol and hypothesis: connectivity patterns treatment, from patients with • axonal density in the peri- After a neuropsychological rehabilitation traumatic brain injury (After a neuropsychological rehabilitation infarct area is significantly (post-rehabilitation) the connectivity were calculated a few increased after pattern
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