Why Intensity & Individualization Matter in Neuro Rehab: The Science Behind Neuroplasticity

Understanding neuroplasticity enhances our knowledge of the brain's adaptability, especially following an injury, and its vital role in rehabilitation. This blog post will delve into the science of neuroplasticity, focusing on key principles such as intensity and saliency, and why these concepts are essential parts of rehabilitation and recovery.

Introduction to Neuroplasticity

Neuroplasticity is the mechanism by which the brain encodes experiences and learns new behaviors. It also enables injured brain areas to relearn lost or impaired functions. Our brain and nervous system are constantly learning, adapting, and evolving in response to the stimuli we encounter and our environments.

The Mechanisms of Neuroplasticity

Neuroplastic changes occur at the cellular level, involving individual neurons and their connections. There are 5 primary mechanisms by which these adaptations occur.

• Habituation is when there is a decreased neuronal response following repeated, not harmful stimuli

• Long term potentiation/depression is the strengthening (or weakening in the case of long term depression) of the connections (synapses) between neurons. This mechanism is crucial for learning and changing habits.

• Synaptic sensitivity encompasses a few processes that all relate to the number of receptors on a neuron, the amount of neurotransmitter released from a neuron, and the effectiveness of the communications between neurons.

• Unmasking silent synapses occurs when damage to one neuronal pathway leads to other, previously inactive pathways to become active again.

• Axonal sprouting occurs in our peripheral nervous system (nerves that aren't our brain or spinal cord). This process involves regrowth and regeneration of axons, which form the connection pathways between neurons.

Each of these mechanisms work together to shape our brain and nervous systems response to experiences and allow us to constantly adapt and learn.

Principles of Neuroplasticity

There are 10 neuroplasticity principles we incorporate into our rehabilitation plans to drive the mechanisms mentioned earlier and enhance your recovery! Here, we will concentrate on two of those principles, which I believe are essential for successful recovery after a neurological injury.

Intensity

Challenge drives adaptation. In rehabilitation and exercise, greater intensity usually means more challenging activities. This results in continuous adaptation of your nervous system and beneficial neuroplastic changes, enhancing recovery. When an activity lacks challenge, our nervous system doesn't need to adapt significantly, resulting in a lower degree of neuroplasticity.

Salience

This principle emphasizes the significance and value of an activity to you. The more significant a task is, the more motivated you become to participate in it, resulting in a stronger response from your nervous system and positive adaptations, driving improved recovery.

Integrating Neuroplasticity Principles into Your Rehabilitation

Understanding these mechanisms and principles is one thing, but the key piece of the puzzle is designing rehabilitation programs incorporating them. Salient activities drive neuroplasticity and positive adaptions, therefore, your interests and goals are have to be placed at the forefront. Intensity stems from challenge, which positively stresses our nervous system, leading to adaptations and changes. Each individual has unique interests, goals and levels of appropriate intensity. Neuroplasticity is integrated into rehabilitation programs by diving deep into your goals, being constantly curious about what interests you and the activities you want to return to, and continuously monitoring and adjusting the challenge of each activity to achieve the right intensity.

What This Looks Like in Real Life

Let's say you have a goal of being able to garden. First thing we'll do is really dive into this, asking questions about what that looks like for you. Do you want to be able to carry items from your house to the garden? Get down on the ground to pull weeds? Walk comfortably on the uneven ground? Are you planting flowers, fruits, vegetables? How many? And lots of other questions too. This helps us understand the importance of the goal to you and customize future activities to be as specific to the goal as possible. After we have a better understanding of the goal and the parts that make up that goal, we'll start creating activities that challenge the areas you have difficulty with. Maybe you don't feel steady walking on the uneven outdoor ground, then we'll design dynamic balance activities including uneven surfaces. Maybe getting on and off the ground is something you haven't done since your injury. We'll break that movement down to build up your strength and confidence to then complete the whole activity. To challenge the intensity, we are constantly adjusting the activities and pairing them together to make sure they remain difficult. This continual challenge is what pushes our brain and nervous system to adapt and learn!

Conclusion

Neuroplasticity is the process allowing our brain to learn and adapt. Following neurologic injury it is crucial to utilize these principles to maximize recovery. While there are 10 principles of neuroplasticity, I believe that salience and intensity are two of the most important to use in neuro rehabilitation. Our brains require constant challenges to adapt and we respond best to the things that are meaningful to us!