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2 types of neuroplasticity:
1. structural plasticity - brain’s ability to actually change its’
physical structure (re-wiring) as a result of learning from
experiences and memories
2. functional plasticity - brain's ability to move functions (re-
routing) from a damaged area of the brain to other undamaged
areas

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What can influence neuroplasticity?
Build the appropriate mindset and rewire your brain. Despite
some concrete pathways which are strengthened every time we
do a routine thing, the brain has an ability to form new
pathways which are also strengthened if we practice new
habits. Furthermore, old pathways which are not used in an
ordinary fashion anymore, weaken. We can deliberately rewire
our brains by directed attention towards a desired change. You
can rewire your brain to stimulate the process of neuroplasticity
just by thinking. But you must practice, practice and again,
practice! The process of neuroplasticity is quite simple but you
must follow it rigidly every day. Avoid substances, habits or
situations that provide you with unhealthy rewards. Learn to
combine comfortable and responsible part of life in which your
brain is rewarded by further healthy pursuits. Exercise,
meditate, sleep and eat well. Seek support from your friends,
family and peers when you get too tired, too hungry, too lonely
or too angry.
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How does the brain reorganize?
1. synaptic plasticity - refers to changes in the strength between
neurons (synapses), chemical or electric meeting points
between brain cells. Synaptic plasticity is a general term and the
name itself has no meaning other than that something changed
within the synapse but can include many specific processes such
as long-term changes in the number of receptors for certain
neurotransmitters or changes where some proteins are being
synthetized more within the cell. Synapses can become
"stronger" or "weaker" when faced with repeated stimulus.
2. synaptogenesis - refers to formation and fitting of synapse or
group of synapses into a neural circuit. Structural plasticity is a
normal marking of fetal neurons during brain development and
is called developmental plasticity including neurogenesis and
neuronal migration. Structural plasticity is changes in the wiring
of the brain
3. neuronal migration - a process in which neurons travel from
their place of birth in fetal ventricular or subventricular zone
towards their final position in the cortex 34
Principles necessary for brain remodelling to take place:
1. change is mostly limited to those situations in which the brain
is in the mood for it. If you are alert, on the ball, engaged,
motivated and ready for action, the brain releases the
neurochemicals necessary to enable brain change. When
disengaged, inattentive, distracted or doing something without
thinking that requires no real effort, your neuroplastic switches
are “off.”
2. the harder you try, the more motivated you are, the more
alert you are and the better (or worse) the potential outcome -
the bigger the brain changes. If you’re intensely focused on the
task and really trying to master something for an important
reason, the change experienced will be greater.

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Principles necessary for brain remodelling to take place:
3. what actually changes in the brain are the strengths of the
connections of neurons that are engaged together, moment by
moment, in time. The more something is practiced, the more
connections are changed and made to include all elements of
the experience (sensory info, movement, cognitive patterns).
You can think of it like a “master controller” being formed for
that particular behavior which allows it to be performed with
remarkable facility and reliability over time.
4. learning-driven changes in connections increase cell-to-cell
cooperation which is crucial for increasing reliability - imagine
the sound of a football stadium full of fans all clapping at
random versus the same people clapping in unison. The more
powerfully coordinated your nerve cells are, the more powerful
and more reliable their behavioral productions.

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Principles necessary for brain remodelling to take place:
5. the brain also strengthens its connections between teams of
neurons representing separate moments of successive things
that reliably occur in serial time - this allows your brain to
predict what happens next and have a continuous associative
flow. Without this ability, your stream of consciousness would
be reduced to “a series of separate, stagnating puddles”.
6. initial changes are temporary - your brain first records the
change then determines whether it should make the change
permanent or not. It only becomes permanent if your brain
judges the experience to be fascinating or novel enough or if
the behavioral outcome is important, good or bad.

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Principles necessary for brain remodelling to take place:
7. The brain is changed by internal mental rehearsal in the same
ways and involving precisely the same processes that control
changes achieved through interactions with the external world -
you don’t have to move an inch to drive positive plastic change
in your brain. Your internal representations of things recalled
from memory work just fine for progressive brain plasticity-
based learning.

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Principles necessary for brain remodelling to take place:
8. memory guides and controls most learning - as you learn a
new skill, your brain takes note of and remembers the good
attempts while discarding the not-so-good trys. Then, it recalls
the last good pass, makes incremental adjustments and
progressively improves.
9. every movement of learning provides a moment of
opportunity for the brain to stabilize and reduce the disruptive
power of potentially interfering backgrounds or noise - each
time your brain strengthens a connection to advance your
mastery of a skill, it also weakens other connections of neurons
that weren’t used at that precise moment. This negative plastic
brain change erases some of the irrelevant or interfering activity
in the brain.

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Neuroplasticity can be good or bad - that depends on the
mindset

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Common problems encountered in patients with neurological
disease:

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How to be diagnosis specific when encountered with a problem
list brought about by neurologic disease:

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How to be diagnosis specific - need to assess activities of daily
living (ADL)

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How to be diagnosis specific - need to assess activities of daily
living (ADL)

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How to be diagnosis specific - need to assess instrument of
activities of daily living (IADL)

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How to be diagnosis specific - need to assess instrument of
activities of daily living (IADL)

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How to be diagnosis specific - need to assess muscle strength
(MS)

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How to be diagnosis specific - need to assess presence of
spasticity

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How to be diagnosis specific - need to assess presence of
spasticity

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How to be diagnosis specific - need to assess presence of
spasticity

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How to be diagnosis specific - need to assess gait

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How to be diagnosis specific - need to assess gait

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How to be diagnosis specific - use diagnostics

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How to be diagnosis specific - use electromyography (EMG)

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How to be diagnosis specific - use electromyography (EMG)

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How to be diagnosis specific - use nerve conduction studies
(NCS)

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How to be diagnosis specific - use nerve conduction studies
(NCS)

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Baclofen pump - to treat spasticity

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Physiotherapy:

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Aquatic therapy / exercises:

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Transcutaneous electrical nerve stimulation (TENS):

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Orthotic devices:

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Prosthesis:

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Gait training:

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CIMT:

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Mirror therapy:

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Mirror therapy:

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FES:

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Virtual reality in stroke rehabilitation:

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BWSTT:

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