Neuroplasticitet og Neurorehabilitering

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

dk Center for Research in Spasticity and Neurorehabilitation Purpose: Coordination of research activities in danish laboratories devoted to

2 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 ( ) Synaptic plasticity

In the adult brain the nerve paths are fixed and immutable:

3 1 1 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 will we end up with Gall Phrenology all over again?

$)} Extent threshold k = 0 voxels 200 20 40 60 80 Design matrix SPMresults:G:\fmri_sci\an_data\f4814 Height threshold T = 1.655970 {p<0.$

4 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!!

5 af Klint, Grey, SInkjær, Nielsen J Physiol 2008 Neuroplasticity map changes, some examples Michael Merzenich Paul Bach-Y-Rita Vilanyanur Ramachandran Mark Hallett

6 The sensory and motor homunculi illustrate the amount of cortical area devoted to a particular function Cortical map plasticity: the Merzenich experiments in somotosensory cortex Merzenich et al. J Comp Neurol, 1984

7 Cortical map plasticity: the Merzenich experiments in somotosensory cortex Allard et al. J Neurophyiol, 1991 Cortical map plasticity: the Merzenich experiments in somotosensory cortex Jenkins et al. J Neurophyiol, 1990

J Neurophyiol, 1991 somotosensory cortex Jenkins et

8 Jeffrey Kleim et al.

9 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

10 Larger corticospinal and interhemispheric connections in children playing the piano Bengtsson et al. Nat Neurosci Sep;8(9): It takes time to become an expert

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

12 No change in cortical representation with passive movement or non-skill training Donald Hebb Fire together- wire together Perez et al Exp Brain Res Lundbye-Jensen, Leukel & Nielsen 2009

1904-1985 Fire together- wire together Perez et al

13 What happens if you train different tasks immediately after each other? Lundbye-Jensen, Petersen & Nielsen - in progress

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

15 Exercise in combination with DHA (omega-3) boosts learning -at least in rodents + = Gomez-Pinilla 2008 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! Consider possible interference effects Close relationship between nutrition, cognition, exercise and emotions. So: Think of the whole person. And remember to sleep well!

000 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.

16 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.

øge synergieffekten ved at træne opmærksomhed, hukommelse og motorik samtidigt. 2.

18 Read more in: which can be bought at: Jens Bo Nielsen Institut for Idræt & Institut for Neurovidenskab og Farmakologi Panum Københavns Universitet

dk/ Jens Bo Nielsen Institut for Idræt &

19 Changes in central organization occur throughout life in response to normal and abnormal experience Development & Learning Changes in central organization occur throughout life in response to normal and abnormal experience Reorganization after sensory loss Rehabilitation

and abnormal experience Reorganization after sensory loss

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

dk en i neurorehabiliteringsforskning at skabe meningsfuld og bru Meget nemmere sagt end gjort Vi har brug for objektive kvantitative fysiologiske mål der på

21 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 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)

22 Virkningen af proteinsyntesehæmmer på hukommelse Brashers-Krug & Shadmehr, Nat

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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