10, Who doesn't love that number?

How about10 Principles of Neuroplasticity? I love it, you may too.

Now that the word Neuroplasticity has some meaning (if not, read prior Blog post), let’s dive into the principles that drive brain change. Full warning, I am a Neuroplasticity Nerd. I love it, I breathe it, it is a frame-work and paradigm that sings to my heart. I want to spread my love for the miracle of the human brain to you. Jump in, it can unlock and unleash your brain!

I am not the genius who came up with this. Many many many geniuses contribute to the science of rehabilitation. Here's the reference to the research article that drives this post's nerdiness: Kleim JA and Jones TA. Principles of Experience-Dependent Neural Plasticity: Implications for Rehabilitation After Brain Damage. Journal of Speech, Language, and Hearing Research • Vol. 51 • S225–S239 • February 2008

Neuroplasticity Principles

1. Use it or Lose It

2. Use It and Improve It

3. Specificity

4. Repetitions Matters

5. Intensity Matters

6. Time Matters

7. Salience Matters

8. Age Matters

9. Transference

10. Interference

1. Use it or Lose It:

Failure to drive specific brain functions can lead to functional degradation

Have you thrown a baseball or a frisbee in the last 10 years? Were you shocked at how different it felt and the performance of your throw? Yea, you didn’t use it, so you lost it. Skill requires practice. If we don’t flex that muscle and practice the skill, we lose the accuracy, strength, and coordination to perform it well. The brain is similar, the area that controls movement of your hand on piano keys needs to be used to keep the timing, speed, and accuracy of playing the piano. Think of the number of free throws Michael Jordan has thrown to perform at his level of accuracy and precision. Without practice we return to amateur status. Have you lost the accuracy or ability to perform a skill? Let’s get to practicing it because principle number 2 works in your brain’s favor!

2. Use It and Improve It:

Training that drives a specific brain function can lead to an enhancement of that function

Amateur status can return to pro status, whether it be frisbee throwing, playing catch with a baseball, or simply turning over in bed, sitting up on the side of the bed. Performing the activity you want to get better at, A LOT, will improve performance. It is not just the movement, but the sensation of the movement that improves skill performance. The brain is changing with your practice in a motor and sensory context. If you want to improve your walking, you will have to go walking. If you want to improve getting off the couch, you will have to get off the couch over and over and over again. It will get better. But your hard work is required. A physical therapist knows how to challenge the environment and your task to improve your performance quicker and with quality to avoid secondary injuries. You say, but I can’t stand up, so how do I practice standing up? A physical therapist will problem-solve and be creative with you to show you your successes, and guide you through building back the capability of standing up. Let’s start using it!

3. Specificity:

The nature of the training experience dictates the nature of the plasticity

If you want to get better at walking on grass, you have to walk on uneven surfaces that simulate grass, and walk…on…grass. There is no way around it, the skill you are wanting to acquire or optimize requires practice to be similar to the task. For example, if you are trying to perfect a chocolate chip cookie recipe, you are not going to fine tune the recipe for oatmeal raisin cookies…you are going to make many batches of chocolate chip cookies fine tuning the amounts of flour, sugar, chocolate chips, adjusting the components of the cookie to make the end result delicious. Same thing, you have to move the joints and activate the muscles in the direction of the task you want to improve. Practicing the combined effort of the many joints and muscles that move your body, not just one.

4. Repetition Matters:

Induction of plasticity requires sufficient repetition

To learn or relearn a skill, you will need to practice A LOT! Your dedication and persistence are paramount. Time with your physical therapist is to learn the quality of movement and how to self-assess your quality to keep yourself on task. The true learning, or permanence, happens with the repetition that happens outside of your therapy session. I can’t do the task for you, I am here to teach you how to do it and how to keep progressing the quality as you improve. The work of doing it, it is 100% on you. We learn the specificity of the movement, then we repeat the task performance to produce a brain change over time and over many repetitions of quality performance. The principle of repetition, builds on the principle of specificity. They are not mutually exclusive.

As a physical therapist, I can outline your practice, educate you on the value of performing repetitious movement, provide feedback on the quality of your performance, and discuss strategies for implementation based on your tendencies and preferences. All in all, if you want to improve, you will have to practice A LOT. Three sets of 10 repetitions is not going to cut it here. I have the easier role, I’m here to outline and support your hard work.

5. Intensity Matters:

Induction of plasticity requires sufficient training intensity

Oh, it’s not just about repetition. And there is a difference between doing 60 repetitions and 400 repetitions PER DAY. It’s about doing the hard stuff. If it is easy, the brain and body have already acquired that skill. It’s a waste of your time, your brain isn’t going to change. The hard stuff tasks your brain and body to improve, achieve, and be better. When I challenge you, it’s because I know your time and effort are worth getting better and your brain is begging for the intensity. Respect your brain and body and mentally accept the hard. How do we measure hard? Perceived effort, heart rate, quality of mechanics. This is a physical therapist’s bread and butter and we bring it to your body to improve your movement and ease of mobility.

6. Time Matters:

Different forms of plasticity occur at different times during training

When the brain experiences damage, there is a cascade of changes happening on the level of the neurons, the synapses that join neurons in communication, and the neurotransmitters that shape the conversation in the synapses. Changes to the brain are not singular but a process, where one form of brain change relies on another form of brain change. Two different forms of brain change occur simultaneously and respond to early intervention/therapy. Neuroprotective brain changes make the tissue less vulnerable to further damage or future damage. Another form of brain change is reorganization of the remaining connections. Research supports early intervention after an initial injury to the brain is more effective at changing the brain and promoting recovery.

If you want to grab that cookie on the table, by golly you are going to figure out a way to do it. Sometimes the “new” ways you come up with to move, can actually get in the way of relearning in the brain and restoring movement. The quicker you finish that cookie and work with a professional, the more likely you will recover movement to keep you moving pain-free and with less energy expended. I call this effective and efficient movement. The good news for those of us who missed the “days after injury” window, the brain has shown to make measurable and meaningful changes greater than 10 years after an injury when the principles of neuroplasticity are applied. The best time to start, yesterday. Call your physical therapist and maximize your “time matters” principle.

7. Salience Matters:

The training experience must be sufficiently salient to induce plasticity

Salient: most prominent, important

If the brain thinks it is important, it will learn more effectively. Food is necessary for survival. In the research, a certain auditory tone was paired with the reward of food. The brain learns the tone that is associated with receiving food, and the area of the brain that becomes active to that specific tone becomes larger! That tone is important for the brain and YOUR survival, therefore the brain changes to recognize, activate, and respond. Do you feel the potential here?

A key component, your mental attention has to be directed at the salient task for the brain change to be as robust. The physical performance and the mental attention to the performance elevate the brain change. This is why your physical therapist doesn’t always keep the conversation going, it’s not because we’re bad conversationalists, it’s because we want your brain to change to aide your recovery! We also spend a lot of time explaining the human body and how it works to you, because when you are emotionally invested, research shows that your brain change is greater! Physical therapy is not just physical, we tap into your mental attention, emotional investment, and motivation to maximize your brain change and physical recovery.

8. Age Matters:

Training-induced plasticity occurs more readily in younger brains

You know that cut on your hand that would have healed and practically disappeared overnight in your teens? And now it’s lingering for a week or more? It still heals, it may take a few extra minutes. We aren’t fighting age, we are accepting that the brain healing process is a little slower and less profound compared to a younger brain. But we still DO NOT have a defined END POTENTIAL for neuroplasticity, so we push, push, push. Shoot for the moon, we may land among the stars.

9. Transference:

Plasticity in response to one training experience can enhance the acquisition of similar behaviors

Snowball effect! When learning and skill acquisition begins, the ball gets bigger and heavier and is able to pick up more snow as it rolls over the ground, grows in size quicker and quicker. The effect of stimulating the brain and starting the physiologic processes of brain recovery aids in establishing an environment in the brain that supports even more healing, learning, and skill acquisition. Exercise promotes physiologic changes that also support this healing environment. Physical therapists tend to impose an immediate behavioral change of participating in a daily walking program or daily exercise program at home. This is because you will gain more from your therapy sessions as you are priming and accelerating the brain’s learning system outside of the therapy sessions. Your snowball just started rolling, jump on the accelerator.

10. Interference:

Plasticity in response to one experience can interfere with the acquisition of other behaviors

It is not all rose colored lenses and fresh scented flowers. Your physical therapist knows the positive and negative spin/potential of each neuroplasticity principle. The idea that the brain controls many functions, movements, sensations, and emotions acknowledges that focusing on one, may interfere with another. The ability to adapt your learning experience and environment to maximize your brain’s recovery and multiple functions is where a physical therapist excels. Physical therapists closely monitor your movement, sensation, motivation and emotion to guide a change in your practice and approach to support your greatest return of function and capability. Sometimes what we don’t know can harm us, work with a professional to support your greatest outcome.

Want to learn more? We will dive into each neuroplasticity principle, the research, and the comedic analogy to empower the brain to change, recover, and adapt. Those lemons are turning into lemonade.