Neurorehabilitering og Neuroplasticitet Odense 3. Marts 2010

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1 Neurorehabilitering og Neuroplasticitet Odense 3. Marts 2010 Jens Bo Nielsen Department of Physical Exercise and Sport Science & Department of Neuroscience and Pharmacology Panum Københavns Universitet

2 Center for Research in Spasticity and Neurorehabilitation Purpose: Coordination of research activities in danish laboratories devoted to research in Spasticity and Neurorehabilitation By: 1) Facilitate transfer of knowledge from basic neurobiology to clinic 2) Facilitate development of new evaluation and rehabilitation techniques with a neuroscientific basis

3 Once development is complete, the sources of growth and regeneration of axons and dendrites are irretrievably lost. In the adult brain the nerve paths are fixed and immutable: everything can die, nothing can be regenerated. Ramón y Cajal ( )

4 Synaptic plasticity

5 left_foot < < left_foot < < SPMmip [ e-016, , ] < SPM{T 138 } contrast(s) SPMmip [ e-016, , ] < SPM{T 138 } contrast(s) SPMresults:G:\fmri_sci\an_data\f4814 Height threshold T = {p<0.001 (unc.)} Extent threshold k = 0 voxels Design matrix SPMresults:G:\fmri_sci\an_data\f4814 Height threshold T = {p<0.05 (unc.)} Extent threshold k = 0 voxels Design matrix

6 The multiwired brain What's really cool is that they've done fmri (functional magnetic resonance imaging) studies of musicians while they are improvising, like in jazz. Their entire brain lights up, with random connections going to before uncharted areas of brain real estate. Very Cool!!

7 Neuroplasticity map changes, some examples Michael Merzenich Paul Bach-Y-Rita Vilanyanur Ramachandran Mark Hallett

8 Jeffrey Kleim et al.

10 Training of 5 finger sequence and mapping of motor cortex 5 days training 5 weeks training - 2 different phenomena 5 days training - motor vs. Mental training

11 Larger corticospinal and interhemispheric connections in children playing the piano Bengtsson et al. Nat Neurosci Sep;8(9):

12 It takes time to become an expert

14 Vores hjerne skrumper når den ikke bliver brugt Lundbye-Jensen & Nielsen 2009

15 Fysioterapi er langt mindre intensiv end den træning der har dokumenteret effekter hos dyr (Lang et al. 2009) Experimental reaching training: Monkeys on average reach and grasp food 600 times in one session. Repeated every day for many weeks Experimental gait training in cat: Average 2000 steps pr session repeated every day for several weeks Hand function training: Average 30 movements pr session. Seldom repeated every day even in acute phase. Gait training: Average 300 steps pr session. Seldom repeated every day even in acute phase.

16 Konklusion: Det er en fuldtidsbeskæftigelse af komme sig efter en hjerneskade. Det er ikke tilstrækkeligt med lidt fysioterapi eller lignende af og til. Det kræver daglig vedholdende indsats, hvilket ligger uden for mulighederne i offentligt regi. Altså: det er op til den enkelte at tage ansvaret!

17 Move It To Improve It Virtuelt web træningssystem Formålet med at anvende computerbaseret web-træning er at: 1. øge synergieffekten ved at træne opmærksomhed, hukommelse og motorik samtidigt. 2. motivere til hjemmetræning, der kan fungere sammen med de offentlige tilbud. 3. opnå en mere intensiv træning ved daglige rutiner og praksis.

18 117+/-8.8 days (range: days) out of 140 days; i.e. 83 % Each child on average trained /- 5.9 minutes pr day total average of / hours (range: hours) In total the children trained more than 30 minutes on 872 days out of the total 1540 training days; corresponding to 57 %.

19 Muscle strength 25 Step-up test No of steps P<

20 No change in cortical representation with passive movement or non-skill training Donald Hebb Fire together- wire together Perez et al Exp Brain Res. 2004

21 Lundbye-Jensen, Leukel & Nielsen 2009

24 Some of the effects of exercise on the brain are mediated by Brain-Derived Neutrophic Factor (BDNF)

25 Exercise in combination with DHA (omega-3) boosts learning -at least in rodents + = Gomez-Pinilla 2008

29 Neuroplasticity-based principles of neurorehabilitation Continuous training (it takes hours to be as good as possible) Motivation: Training should be challenging and if possible fun (but not all agree on what is challenging etc., so individualize) Attention and active participation. Experience of succes i.e. Simple, (preferably) immediate and understandable reward! Close relationship between nutrition, cognition, exercise and emotions. So: Think of the whole person. And remember to sleep well!

30 Read more in: which can be bought at:

31 Jens Bo Nielsen Institut for Idræt & Institut for Neurovidenskab og Farmakologi Panum

32 Changes in central organization occur throughout life in response to normal and abnormal experience Development & Learning

33 Changes in central organization occur throughout life in response to normal and abnormal experience Reorganization after sensory loss Rehabilitation

34 Spasticitet og neurorehabilitering Jens Bo Nielsen Department of Physical Exercise and Sport Science & Department of Neuroscience and Pharmacology Panum Københavns Universitet

35 n i neurorehabiliteringsforskning at skabe meningsfuld og bru Meget nemmere sagt end gjort Vi har brug for objektive kvantitative fysiologiske mål der på den ene side entydigt afspejler skaden på neurale kredsløb og på den anden side har funktionel relevans for patientens livskvalitet Forsker Hvilket spørgsmål giver forskningsmæssig mening? Behandler Hvad er det klinisk relevante problem? Hvad er problemet for patienten? Patient

36 Center for Research in Spasticity and Neurorehabilitation Purpose: Coordination of research activities in danish laboratories devoted to research in Spasticity and Neurorehabilitation By: 1) Facilitate transfer of knowledge from basic neurobiology to clinic 2) Facilitate development of new evaluation and rehabilitation techniques with a neuroscientific basis

37 Lidelser i bevægeapparatet (frakturer, gigt, slidgigt etc.) antal stort, men sjældent alvorligere handikap Lidelser i CNS Apopleksi ( pr år stigende 50 % varigt mén) Hjernetraumer ( pr år) MS ( pr år) Parkinsons sygdom ( pr år) Rygmarvslæsion ( pr år) Cerebral parese o.lign. (125 pr år)

38 Virkningen af proteinsyntesehæmmer på hukommelse

39 Brashers-Krug & Shadmehr, Nat

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Neuroplasticitet og Neurorehabilitering

Neuroplasticitet og Neurorehabilitering Jens Bo Nielsen Department of Physical Exercise and Sport Science & Department of Neuroscience and Pharmacology Panum Københavns Universitet E-mail: J.B.Nielsen@mfi.ku.dk