Neuroplasticity etc. Flashcards
Neuroplasticity definition
brain’s capacity to alter its structure and function in response to environmental demands
6 principles of neuroplasticity
experience-dependent; dose dependency of magnitude and durability of change; may lessen in adulthood but can happen at any age; critical windows; reliance of brain functions on certain regions; not always good
Critical windows in brain injury rehabilitation
period of time wherein the brain is most neuroplastic and there is high potential for recovery
Effect of function distribution on neuroplasticity
the more distributed a function, the greater the likelihood that the neural networks underlying the function will be flexible after a brain injury
4 ways in which neuroplasticity happens in healthy people
increased chemical signaling; changing brain structure (e.g. synaptic connectivity, dendritic length and density); clusters of neurons become more readily excitable; neurogenesis
Neurogenesis
growth of new neurons
2 phenomena in brain injury recovery
repair of partially damaged brain tissue (e.g. restored function in stroke penumbra, remyelination after MS attack); same neuroplasticity mechanisms (primarily changing brain structure) as in healthy people
6 ways to facilitate neuroplasticity
electrical stimulation; robotic exoskeletons; video games; medications; exercise; stem cells
What is research on neurological disorders focused on?
biomarkers; genetics; drug a vs b; optimal timing, dose, type of rehabilitation
5 social determinants of health
healthcare access and quality; neighborhood and built environment; social and community context; economic stability; education access and quality
How do indigenous communities view dementia?
as a part of the “circle of life” or normal aging
What do indigenous peoples believe are the causes of dementia?
normal aging, adoption of Western diet, less active lifestyle, environmental pollutants, trauma, etc.
3 indigenous beliefs about treatment for dementia
caregiving supported by cultural values of interdependence and reciprocity; emphasis on acceptance and adaption; traditional remedies and ceremonies essential to wellness
6 types of brain injury rehabilitation that is culturally appropriate for Indigenous communities
attention to spiritual health as part of overall wellness; active role for injured person; shared decision-making; individualized traditional healing practices; learning to live well vs fixing problems; incorporation of traditional healers in the healthcare system
Remediation vs compensation
restoring deficits through mass or repetitive practice; mitigating impact of deficits in daily life
4 things to consider for cognitive remediation to maximize neuroplasticity
timing, dose, difficulty of task, task type (most effective when there’s variety)
Far transfer problem
difficulty showing therapeutic improvements on cognitive remediation tasks (e.g. less improvement the farther from the task)
Findings on computerized cognitive training by Cochrane Library
low-quality evidence for small benefits immediately after training but no long-term benefits or far-transfer
Prevalence of mental health problems
20-50% across people with neurological conditions; 1.5 to 5x the general population
Risk factors of mental health problems
pre-injury mental health history, social support, severity of brain dysfunction (though has a weak and sometimes reverse correlation e.g. anosognosia protects from depression)
Etiology of mental health problems
reactive psychological mechanism and brain damage (e.g. altered monoamine production, HPA axis function, prefrontal-subcortical circuit connectivity)
Symptoms of MDD
persistent low mood and/or anhedonia; changes in appetite/weight; fatigue; psychomotor agitation or retardation; insomnia or excessive sleep
Symptoms of PTSD
hyperarousal, re-experiencing, avoidance, dissociative subtype (depersonalization, disengagement)
Overlapping symptoms of MDD and PTSD
anhedonia, concentration difficulties, memory impairment, sleep disturbances, distorted cognition (guilt), depressive and negative thoughts (self-blame, worthlessness, death, suicide)
Relationship between mental health problems and neurological diseases
bidirectional (neurological disease causes mental health problems; mental health problems amplify impairments like cognition, ADLs, mobility)
7 stages of grief with loss from brain injury
shock, denial, frustration, depression (common but not inevitable), experiment, decision, integration
2 ways of coping after brain injury
adaptive or maladaptive
Adaptive coping strategies
problem-solving, using emotional support, humor, positive reframing
Effects of adaptive coping
positive affect, high self-esteem, healthy relationships
Maladaptive coping strategies
venting, self-distraction, substance abuse, avoiding/disengaging
Effects of maladaptive coping
negative affect, mental health disorders, interpersonal dysfunction
3 treatments for psychological problems in patients with brain dysfunction
antidepressant medications, psychotherapy, aerobic exercise
Examples of antidepressant medications
SSRIs, SNRIs (serotonin and norepinephrine)
Examples of psychotherapy
cognitive behavioral therapy; acceptance and commitment therapy; mindfulness-based therapies
Therapy modifications for attention, concentration, alertness problems
breaks during sessions; shorter length of sessions; increase frequency of sessions
Therapy modifications for communication problems
clear and structured questioning; use of visual resources; emphasis on behavioral techniques
Therapy modifications for memory problems
therapy notebook or folder for client; memory aids (e.g. written notes, audiotapes); summarize and repeat salient points
What is exercise effective for?
various neurological conditions (e.g. MCI, stroke, TBI, etc.); improves cognition, balance, mood, etc.
What kind of exercise is most effective?
aerobic or combined with resistance training better than resistance training alone
Mechanism behind exercise
multiple mechanisms of action (e.g. increased brain-derived neurotrophic factor expression, functional connectivity, cerebral blood flow)
What is good nutrition effective for?
prevention of aging and neurological disorders (e.g. AD, parkinson’s, autism, migraine, depression, schizophrenia)
MIND diet and effectiveness
combination of mediterranean and DASH diets; may protect the brain from AD and dementia but not as promising
How can we make lifestyle interventions more effective?
multicomponent programs (rather than single-domain) that focus more on adherence (sustained behavior change); begin intervention in mid-life; target people with behavioral risk factors for dementia
Findings from FINGER study
found that a multifaceted lifestyle intervention (e.g. nutritional counseling, exercise, cognitive training) worked well
Impact of an enriched vs standard environment
having a lot of things to do results in greater dendritic branches in the brain
Modalities of art-based neurorehabilitation
dance, music, visual arts, writing, drama
Examples of benefits of music for neurorehabilitation
high-groove music improves gait synchronicity in Parkinson’s; playing piano or guitar improves finger coordination after stroke; patients with MS better remember sung vs spoken words
