The Unexplored

Aspects of
Neurorehabilitation
Ishika Sharma
MScRRPT Student
Dalhousie University

Overview
Brain disease/injury
Brain Plasticity
Creativity and arts
Aesthetics
Enriched environment
Future Direction

Brain disease/injury
Infection

Trauma

Brain Insult

Genetic and
Congenital

Degeneration

Brain Plasticity
The ability to change structure and
function of neural tissue in the brain
Primary mechanism to explain process of
learning, remodelling of tissue and
recovery after brain insults.

Task intensity

Experience
dependent

Task repetitions

Creativity and Arts

State of brain that generates action that are novel and
useful to a community (the 3 factor definition; Flaherty et
al, 2011).

Associated with creative problem solving, arts,

abstraction etc.

Brain illness and creativity

Increased creative drive seen for patients with
frontotemporal dementia, bipolar disorder and people
with autism (Savant syndrome: detail oriented
processing skill).
Increased creative drive after pharmacological
treatment of Parkinson's Disease.
Creativity is associated with goal driven approach
motivation associated with dopamine. (Flaherty et al,
2011).

Brain areas associated with

creativity
Hemispheric lateralization and fronto-temporal connectionsInteract to create conceptual schemes

Right brain and temporal lobe- Skill in novelty detection

(more active in people untrained in arts).
Left brain and Frontal lobe- generate new patterns of action
from novel perception (more active in people trained in
arts). (Martin 1999, Berkowitz et al 2010)

Two studies (Maxwell et al 2007, Harmon-Jones

2004) further showed that right lobe is associated
with avoidance and left lobe with curiosity and
pursuit. So, right lobe is possibly associated with
avoidance of catering to novelty.
Greater creativity is associated with bilateral brain
activation. Greater hemispheric dominance
associated with lesser creativity.

Evidence of brain activity change

associated with creative thinking
Mashal et al 2007.
Analysed brain activation using fMRI associated with
creative thinking. Also studied reaction times.
Groups tested for recognizing: literal phrases, conventional,
novel and unrelated metaphors.
Least reaction time and
greatest relative
significant signal change
for novel metaphors.
Primarily right side.

Arts and neuroscience (Puretic,

2009)
Studies have shown visual arts to be associated with
changes in brain activation on fMRI and effect of rhythm
and melody on frontal lobe.
Larger motor cortex size associated with piano training in
novice players.
Plastic effects seen within minutes of practice. If these arts
are associated with brain, can they be used to train the
brain??

Johansson BB (2006) reviewed that music is capable

of inducing brain plastic processes.
Bengtsson et al (2005) carried out diffuse tensor
imaging in children, adolescents and adults who
underwent music training on a piano. Greater
pyramidal tract organization associated with training,
especially in children. Could this suggest that early
creative training has greater impact on white matter
organization?

Mozart effect
Rauscher et al (1993) studied that in a group listening to
Mozart's sonata K448 for 10 minutes the scores of spatial
reasoning were greater than those for the group listening to
relaxation music.

Many studies, since, have been able to replicate this effect.

So does the nature of art an individual is exposed to have a
different effect on their cognition?

Evidence of improvement in motor

dysfunction in Stroke associated with
music therapy
Altenmuller et al, 2009.
Acute stroke incidence- grouped into control and music therapy
group.
Conventional treatment compared against 15 sessions of 30
minutes of music supported therapy for 3 weeks.
Use of MIDI piano and electronic drum. Played same set of 8
tones on either or both instruments.
Treatment increased in complexity in stepwise manner.
EEG analyses of ERD alongwith motor skills tests was done for
analysis.

Lower power in
alpha and beta
band for ERD
prior to
response.

Greater coherence amongst neuronal populations

seen for MG.
Behavioural analyses significant only
for MG and not CG. Small effect size
seen for pronation/supination and 9
hole peg test.

More evidence: Parkinson

Disease
Thaut et al (1996) tested three groups (receiving music
associated exercises/EX, self paced exercises/SPT and no
training) for gait quality and EMG variables for a training period
of 3 weeks.
Significant improvement seen in gait parameters in EX vs SPT
and EX vs no training.
Tibialis anterior showed lower variability and greater symmetry of
response for EX group.
Could the effect in gait velocity in EX be associated with use of
faster rhythm of music?

Whole brain function: Response

to creative arts like painting
Bogousslavsky (2005)

Evidence: Neural responses to

dancing
Van de Winckel et al (2004) did a study on 25 women with
dementia. 15 did dance therapy while 10 were in control group (3
months period), selected by coin flip!!
A significant change in MMSE scores was observed for dancing
group with a main effect of group and time interaction.
Significant post training increase in fluency score of Amsterdam
Dementia Screening test-6 was seen for dancing group.
Mechanism: Temporary arousal state stimulating cognitive
activity.
Limitation: Coin flip!!
Arousal due to association of music to movements or
due to movements only?

Dancing alone: Agilando

Katenstroth et al (2013) studied the effect of Agilando training
(n=25) compared to control (n=10) on 35 healthy elderly
subjects. Agilando includes 20 min of warm up before 40 min of
dancing.
Duration and frequency: 24 weeks (1 hr/ week).
Tested domains: Attention, Fluid Intelligence, Reaction time on
visuo-tactile task, Posture, Motor performance on task by Kalisch
et al in 2006, Tactile performance and Cardio-pulmonary
performance.

The improvement in Motor performance and Posture were

expected. Improvement in Cognition is associated with use
of greater attention and planning associated with learning
novel steps.
Could this be a possible whole body training approach?

Aesthetics

Nieminen et al (2011) suggest in a review that mirror neuron

system is associated with motor response to music. The
MNS in inferior prefrontal cortex is associated with
understanding meaning and intention of signal evoking
representation in the perceiver's brain.

Aesthetics depend on perception of individual brain and

hence can affect motor skills.

Zinetti et al (1991) have shown significant change in

aesthetics with age as well. Can the age related change in
skills be associated with this?

Could the aesthetics associated with creative arts affect skills?

Enriched Environment
Brain function can be affected by the nature of feedback
obtained from the environment.
Stimulating or Inhibiting environment.
Can the environment in which the individual is trained affect the
outcomes?

Evidence in rats
Yang et al (2013) tested two groups of rats: EE and SE to analyse
possible delay in loss of myelin fibres in white matter of rats.
Results suggested that EE-induced an increase in myelinated fibers in
the white matter of aging rats primarily due to marked remyelination
and some ongoing myelination.

Similar to this, enriched environment has

shown effect in humans. Spatial memory
decline, which is associated with white
matter decline, has been shown to improve
with enriched environment provision.

Looking for evidence in Stroke

A trial was started in 2012 by Janssen et al registered under
australian-new zealand clinical trial recovery.
The authors will carry out behavioral mapping of inpatient stroke
subjects for 19 days: one group in standard environment and
another in an individual and communally enriched environment.
They will do pre and post test analyses of domains like boredom,
activity and cognition.

Future prospects
More evidence on role of painting.
Determine best mode of delivering
training.
Establish role of aesthetics.
Combine enriched environment with
creative training.
Associate methods of engagement and
motivation in therapy.