Plasticity of the nervous system

- an old concept with a new meaning

a brief introduction

Jrgen Borg MD PhD

Department of Clinical Sciences, Rehabilitation Medicine
Karolinska Institutet, Danderyd Hospital
Stockholm, Sweden

Plasticity of the nervous system

fundamental for learning and
relearning - rehabilitation
interventions
evolving in parallel with basic
and clinical neuroscience

Plasticity
Plasticity the ability to be moulded
/shaped (from Greek plastos )

Neuroplasticity

Brain plasticity
Peripheral nerve system plasticity

Brain plasticity introduced by

William James (1842-1910)
N American psychologist
and philosopher
brain functions are not fixed
throughout life (Principles of
Psychology 1890)

Neurons and their

communication...

Nerve cells visualised

Santiago Ramn y Cajal
(1852 1934) Spanish
histologist, Nobel laureate
1906
microscopic structure of
nerve cells and synaptic cleft

Synapse
Synapse" from Greek "synaptein "syn" ("together") and "haptein" ("to
clasp"), introduced by
Charles Sherrington ( 1857 1952)
English neurophysiologist and
histologist, Nobel Laureate 1932

Neurotransmission/modulation
Henry Dale - identified acetylcholine
in 1914
Otto Loewi (1873 1961) later
demonstrated its role in the nervous
system
Nobel laureates 1936

Synaptic plasticity- Hebbian

learning
Donald Hebb (1904 1985), Canadian
psychologist
. ..two cells or systems of cells that are
repeatedly active at the same time will
tend to become 'associated', so that
activity in one facilitates activity in the
other. (1949)

Synaptic strength - Long Term

Potentiation and Depression
Terje Lmo 1966: synaptic long-lasting/long-term
potentiation /LTP - increase in the synaptic
strength of neurons in hippocampus following
electrical stimulation
change of postsynaptic cell's sensitivity to input
from presynaptic cells
LTP and LTD important mechanisms for learning
and memory

New synapses

- in response to experiences in normal brain

- from dendritic and axonal sproutes in injured brain

Cortical networks - in response to

manipulated input to normal brain
In experimental animals:
Plasticity in visual cortex
critical period
Hubel DH, Wiesel TN.
1960ies
Plasticity in auditory and
somatosensory cortex
Merzenich MM and
Blake DT

Cortical networks - in response to injury

in experimental animals:
Spared regions adjacent to the infarct
and far removed from the infarct
undergo functional alterations that are
modified by behavioural experience
Long-range intracortical pathways can
be rerouted to completely novel
territories
Randolph J. Nudo,
Rewiring of intracortical pathways after
ischemic injury to M1. Stroke. 2007;38[part
2]:840-845.)

Hand motor map in monkey

postinjury and with no training or
with training (Nudo RJ, 1997 Mol
Psychiatry).

Clinical observations reclaiming

function...
F
U
N
C
T
I
O
N

Intervention

SMA

Time after Injury

3 mo

6 mo

Clinical recovery and plasticity

Numerous studies have described the recovery curve of
various functions in patients with stroke and TBI
Correlates with reorganisation of networks - as
demonstrated by an increasing number of imaging studies since the pioneering studies by Chollet F et al /PET, Cao Y et
al/fMRI in the 1990-ies
Reorganisation depends on age at injury, time since injury
and interventions

Reorganisation of motor networks early

in life - role of ipsilateral motor cortex

Two types of ipsilateral reorganization in congenital hemiparesis:

a TMS and fMRI study. Staudt M, Grodd W, Gerloff C, Erb M,
Stitz J, Krgeloh-Mann I. Brain. 2002 Oct;125(Pt 10):2222-37

Dynamic changes of networks in adults

at various time points after stroke
Three phases:
a strongly reduced activation
of remaining left language
areas in the acute phase is
followed by
an up regulation with
recruitment of homologue
language zones, which
correlates with language
improvement
a normalization of activation is
observed, possibly reflecting
consolidation in the
language system.

Saur et al 2006

Interventions - Activity dependent

Numeral studies have
demonstrated reorganisation
of brain activity pattern in
response to
Intense training of motor and
cognitive tasks
Imagination of movements
Functional relevance
confirmed by virtual TMS
lesions
Lindberg PG et al. Use-dependent up- and down-regulation of
sensorimotor brain circuits in stroke patients.: Neurorehabil
Neural Repair. 2007 Jul-Aug;21(4):315-26.

Behind today's concept..

Huge number of observational and experimental studies
Last two decades:
Human brain networks related to sensory-motor, speechcognitive functions, emotions and consciousness
Reorganisation of these networks in response to injury and
interventions

References in PubMed April 2010

Neuroplasticity 28 268 (>90% after 1990)

Brain plasticity 24 757
Synaptic plasticity 15 009
fMRI and plasticity 1 206
PET and plasticity 166

Learning and plasticity 8 473

Motor recovery and plasticity 869
Pain and plasticity 1 354
TMS and plasticity 245
DCS and plasticity 73

Rehabilitation and plasticity 1 128

Current meaning of brain plasticity in

rehabilitation medicine?
Functional improvements after an acquired brain injury are
paralleled by reorganisation of cerebral networks
Such reorganisation is activity driven new technologies may be
supportive (also in order to avoid maladaptive plasticity?)
Functional imaging will soon be part of routine functional
diagnostic set up and used to design individualised interventions(?)