Harnessing neuroplasticity for clinical applications

Abstract

Neuroplasticity can be defined as the ability of the nervous system to respond to intrinsic or extrinsic stimuli by reorganizing its structure, function and connections. Major advances in the understanding of neuroplasticity have to date yielded few established interventions. To advance the translation of neuroplasticity research towards clinical applications, the National Institutes of Health Blueprint for Neuroscience Research sponsored a workshop in 2009. Basic and clinical researchers in disciplines from central nervous system injury/stroke, mental/addictive disorders, paediatric/developmental disorders and neurodegeneration/ageing identified cardinal examples of neuroplasticity, underlying mechanisms, therapeutic implications and common denominators. Promising therapies that may enhance training-induced cognitive and motor learning, such as brain stimulation and neuropharmacological interventions, were identified, along with questions of how best to use this body of information to reduce human disability. Improved understanding of adaptive mechanisms at every level, from molecules to synapses, to networks, to behaviour, can be gained from iterative collaborations between basic and clinical researchers. Lessons can be gleaned from studying fields related to plasticity, such as development, critical periods, learning and response to disease. Improved means of assessing neuroplasticity in humans, including biomarkers for predicting and monitoring treatment response, are needed. Neuroplasticity occurs with many variations, in many forms, and in many contexts. However, common themes in plasticity that emerge across diverse central nervous system conditions include experience dependence, time sensitivity and the importance of motivation and attention. Integration of information across disciplines should enhance opportunities for the translation of neuroplasticity and circuit retraining research into effective clinical therapies.

Exercise training for neural recovery in a restricted sample of pediatric brain tumor survivors: a controlled clinical trial with crossover of training versus no training

“…It will be important to determine the longer-term impact of exercise as well as outcomes following longer and more frequent training periods. As is the case for many interventions focused on brain repair, 47 we acknowledge that our sample size was relatively small. We do note, however, that our sample size and/or participation rate are consistent with prior exercise trials in children.…”

Dynamic causal modeling of load-dependent modulation of effective connectivity within the verbal working memory network

“…To test for hemispheric laterality, models were divided into a Left-sided (Models 1, 3, 4, 5, 6, 7, 9, 10, 11) and a Right-sided Family (Models 2,8,12,13,14,15,16,17,18). To test for directionality of working memory information three Families where created for each experimental condition, Forward (Models 3,5,10,14,16,17), Backwards (Models 4,6,9,13,15,18) and Lateral (Models 1,2,7,8,11,12). All models were included in the BMS procedure, both when comparing individual models and model Families.…”

“…We applied random effects BMS at the Family level to clarify the contribution of each hemisphere (Left: Models 1, 3,4,5,6,7,9,10,11;Right: Models 2,8,12,13,14,15,16,17,18) and to elucidate the direction of information (Forward, Backward or Lateral) at different memory loads. The Left-sided Family showed the highest exceedance probability (65%; Figure 3A) in the 1-back modulation.…”

Cognitive Remediation for Schizophrenia

“…43) Spontaneous clinical improvement in stroke, trauma, and spinal cord injuries is associated with observable changes at both the cellular level and within the functional connectivity of the relevant neural networks. 44) Moreover, therapies designed to employ the brain's plasticity have been shown to mimic or exceed these changes. For example, studies of post-stroke therapies demonstrate both restoration of functional organization and creation of neuronal projections [45][46][47] while similar studies of brain or spinal cord injuries correlate clinical improvement with observable changes in functional and structural neuroimaging.…”