An update on brain plasticity for physical therapists

Physiotherapy Practice and Research 01/2013; 34:1-8. DOI: 10.3233/PPR-2012-0009


The understanding that the human brain is capable of structural and functional change throughout life has significant implications for the future of physical therapy. Cortical plasticity impacts on many areas of physical therapy including clinical practice, research and education. Although the principles of plasticity underpin developments in neurological physical therapy, relevance to musculoskeletal physical therapy is still emerging. How will key areas of musculoskeletal physical therapy change as our understanding of plasticity advances? If cortical plasticity can be harnessed, new plasticity-based therapies, that enhance
performance in healthy individuals and improve pain and function in patient populations, have the potential to become the cornerstone of musculoskeletal physical therapy. In addition, common physical therapy techniques, such as electrical stimulation, require reconsideration of their clinical efficacy and application in light of new discoveries in neuroscience. The aim of this appraisal is to provide an update on brain plasticity for physical therapists in relation to clinical practice, research and education

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Available from: Lucy S Chipchase, Oct 10, 2015
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    • "Spasticity, muscle weakness, diminished dynamic stability, osteoporosis and associated physical inactivity not only make walking cost-ineffective, but also seriously hinder locomotion mechanisms, and even increase the risk of falling [1]. Gait rehabilitation in neurologically impaired individuals takes advantage of neuroplasticity, a capability of the brain to form new neuron pathways and synapses [2–5]. However, since the human brain is the most susceptible to such changes early after neurological injury and deteriorates thereafter, it is imperative to commence gait rehabilitation as soon as possible in order to maximize the chance for rehabilitation success. "
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    ABSTRACT: Background: After neurological injury, gait rehabilitation typically focuses on task oriented training with many repetitions of a particular movement. Modern rehabilitation devices, including treadmills, augment gait rehabilitation. However, they typically provide gait training only in the forward direction of walking, hence the mechanisms associated with changing direction during turning are not practiced. A regular treadmill extended with the addition of rotation around the vertical axis is a simple device that may enable the practice of turning during walking. The objective of this study was to investigate to what extent pelvis and torso rotations in the transversal plane, as well as stride lengths while walking on the proposed rotating treadmill, resemble those in over ground turning. Methods: Ten neurologically and orthopedically intact subjects participated in the study. We recorded pelvis and torso rotations in the transversal plane and the stride lengths during over ground turning and while walking on a rotating treadmill in four experimental conditions of turning. The similarity between pelvis and torso rotations in over ground turning and pair-matching walking on the rotating treadmill was assessed using intra-class correlation coefficient (ICC - two-way mixed single measure model). Finally, left and right stride lengths in over ground turning as well as while walking on the rotating treadmill were compared using a paired t-test for each experimental condition. Results: An agreement analysis showed average ICC ranging between 0.9405 and 0.9806 for pelvis and torso rotation trajectories respectively, across all experimental conditions and directions of turning. The results of the paired t-tests comparing left and right stride lengths showed that the stride of the outer leg was longer than the stride of the inner leg during over ground turning as well as when walking on the rotating treadmill. In all experimental conditions these differences were statistically significant. Conclusions: In this study we found that pelvis rotation and torso rotation are similar when turning over ground as compared to walking on a rotating treadmill. Additionally, in both modes of turning, we found that the stride length of the outer leg is significantly longer than the stride length of the inner leg.
    Journal of NeuroEngineering and Rehabilitation 08/2014; 11(1):127. DOI:10.1186/1743-0003-11-127 · 2.74 Impact Factor
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    ABSTRACT: The aim of this study was to investigate possible differences in the organisation of the motor cortex in people with knee osteoarthritis (OA) and whether there is an association between cortical organisation and accuracy of a motor task. fMRI data were collected while 11 participants with moderate/severe right knee OA (6 male, 69 ± 6 [mean ± SD] years) and seven asymptomatic controls (5 male, 64 ± 6 years) performed three visually guided, variable force, force matching motor tasks involving isolated isometric muscle contractions of: 1) quadriceps (knee), 2) tibialis anterior (ankle) and, 3) finger/thumb flexor (hand) muscles. fMRI data were used to map the loci of peak activation in the motor cortex during the three tasks and to assess whether there were differences in the organisation of the motor cortex between the groups for the three motor tasks. Root mean square of the difference between target and generated forces during muscle contraction quantified task accuracy. A 4.1 mm anterior shift in the representation of the knee (p = 0.03) and swap of the relative position of the knee and ankle representations in the motor cortex (p = 0.003) were found in people with knee OA. Poorer performance of the knee task was associated with more anterior placement of motor cortex loci in people with (p = 0.05) and without (p = 0.02) knee OA. Differences in the organisation of the motor cortex in knee OA was demonstrated in relation to performance of knee and ankle motor tasks and was related to quality of performance of the knee motor task. These results highlight the possibility mechanistic link between cortical changes and modified motor behavior in people with knee OA.
    Arthritis research & therapy 06/2015; 17(1):164. DOI:10.1186/s13075-015-0676-4 · 3.75 Impact Factor