Neuroplasticity After Stroke
Original Editor - Lucinda Hampton
Introduction[edit | edit source]
Following a stroke, the healthy areas of the brain around the damaged brain tissue region are able to compensate and develop new functions. Neuroplasticity is the term that describes this rewiring and reorganising process. This process includes: inter-hemispheric lateralisation, association cortical regions making new connections in the injured area, and re-organisation of cortical representational maps. Brain plasticity leads to a great degree of spontaneous recovery, and stroke rehabilitation plays an important role in modifying and boosting this neuronal plasticity process.
Table 1  shows different neuroplastic changes in each component.
Table 1 - Key neuroplastic changes associated with stroke rehabilitation
|Neuroplastic changes||Description of changes||Neural structures involved|
|Dendritic remodelling||Structural changes in dendrites, including sprouting and arborisation||Affected and unaffected brain regions|
|Synaptic plasticity||Strengthening or weakening of synapses based on activity and experience||Neurotransmitter systems, cortical and subcortical regions|
|Cortical reorganisation||Changes in cortical maps and functional organisation of brain regions||Motor and sensory cortices, association areas|
|Neurogenesis||Generation of new neurons in specific brain regions||Hippocampus, subventricular zone|
|Axonal sprouting||Formation of new connections or sprouting of existing axons||Corticospinal tract, other neural pathways|
Neuroplasticity-based Rehabilitation Modalities[edit | edit source]
Using noninvasive imaging techniques such as PET and fMRI helps in exploring the mechanisms of neuroplasticity.
Table 2  shows different modalities and its effects in stroke recovery.
Table 2 - Table comparing different neuroplasticity-based interventions in stroke recovery
|Intervention type||Description of intervention||Targeted neural mechanisms||Efficacy in stroke recovery|
|Constraint-induced movement therapy (CIMT)||Restricting the use of the unaffected limb to promote intensive use of the affected limb||Motor cortex reorganisation, synaptic plasticity||Improved motor function, increased use of affected limb|
|Physical therapy||Rehabilitation techniques involving exercises, stretches, and movements to improve motor function and mobility||Motor learning, neuroplasticity||Improved motor function, functional outcomes|
|Transcranial direct current stimulation (tDCS)||Noninvasive brain stimulation using a weak direct current to modulate neural activity in targeted brain regions||Modulation of cortical excitability, synaptic plasticity||Improved motor function, cortical reorganisation|
|Speech therapy||Targeted exercises and techniques to improve speech and language deficits resulting from stroke||Neuroplasticity in language areas, cortical reorganisation||Improved speech and language function|
|Brain–machine interface (BMI)||A direct connection between the brain and an external device, allowing individuals to control devices using their brain signals||Neuroplasticity, cortical reorganisation||Improved motor function, communication, and control of external devices|
|Brain–computer interface (BCI)||Similar to BMI, BCI enables communication and control of devices using brain signals, focusing on nonmotor functions||Neuroplasticity, cortical reorganisation||Improved communication, assistive technology control, cognitive function, and quality of life|
|Cell therapy||Transplantation of stem cells or progenitor cells into the brain to promote regeneration and functional recovery||Neuroregeneration, trophic support, modulation of neuroinflammation||Potential for improved motor and cognitive function, but further research is needed|
Physical Activity And Neuroplasticity[edit | edit source]
Physical activity (PA) can promote neural plasticity.
- PA effects in the peri-infarct site (post stroke): promotes cerebral angiogenesis, vasomotor reactivity, neurotrophic factor release; reduces apoptosis processes, excitotoxicity, and inflammation.
- PA provides neuroprotective effects capable of reducing adverse effects of brain ischemia, with pre-stroke physical fitness decreasing the severity of motor deficits.
- Stroke therapy combining physical training with pharmacological treatments, is known to promote neuroplasticity. 
- Brain-derived neurotrophic factor (BDNF) is a key facilitator of neuroplasticity. Evidence suggests that aerobic exercise is an important intervention for improving brain function, these effects are mediated partly by upregulation of BDNF. As such aerobic exercise–induced increases in BDNF help facilitate motor learning-related neuroplasticity for rehabilitation after stroke.
Physiotherapy[edit | edit source]
Utilising the brains' ability to create and lay down new pathways, the physiotherapist can play a big role in rehabilitation and improved quality of life. Physical therapy can positively promote neuroplasticity during stroke rehabilitation, approaches include:
- Constraint induced movement therapy (CIMT) for the arm and hand
- Task-oriented therapy and repetition of novel movements
- Gait training
- Aerobic exercises
- Dual-task training, involving Motor Dual-Task Training and Cognitive Dual-Task Training
- Vitual Reality
- Mental Imagery
- Action Observation Therapy
- Electrical Stimulation
- Mirror Therapy
References[edit | edit source]
- Hara Y. Brain plasticity and rehabilitation in stroke patients. Journal of Nippon Medical School. 2015 Feb 15;82(1):4-13. Available: https://www.jstage.jst.go.jp/article/jnms/82/1/82_4/_article(accessed 1.1.2023)
- Pin-Barre C, Laurin J. Physical exercise as a diagnostic, rehabilitation, and preventive tool: influence on neuroplasticity and motor recovery after stroke. Neural plasticity. 2015 Oct;2015. Available:https://www.hindawi.com/journals/np/2015/608581/?utm_source=bing&utm_medium=cpc&utm_campaign=HDW_MRKT_GBL_SUB_BNGA_PAI_DYNA_JOUR_X_X0000_WileyFlipsBatch2&utm_term=Acta%20Neurologica%20Scandinavica&utm_content=JOUR_X_X0000_WileyFlipsBatch2_ActaNeurologicaScandinavica (accessed 1.1.2023)
- Mang CS, Campbell KL, Ross CJ, Boyd LA. Promoting neuroplasticity for motor rehabilitation after stroke: considering the effects of aerobic exercise and genetic variation on brain-derived neurotrophic factor. Physical therapy. 2013 Dec 1;93(12):1707-16.Available:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3870490/ (accessed 1.1.2023)
- Penna LG, Pinheiro JP, Ramalho SH, Ribeiro CF. Effects of aerobic physical exercise on neuroplasticity after stroke: systematic review. Arquivos de Neuro-Psiquiatria. 2021 Oct 18;79:832-43.
5. Aderinto, Nicholas MBBSa; AbdulBasit, Muili O. MBBSa; Olatunji, Gbolahan MBBSb; Adejumo, Temilade MBBSa. Exploring the transformative influence of neuroplasticity on stroke rehabilitation: a narrative review of current evidence. Annals of Medicine & Surgery 85(9):p 4425-4432, September 2023. | DOI: 10.1097/MS9.0000000000001137