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Neuroplasticity and rehabilitation

Harnessing its power to optimise outcomes in neuro-rehab



Therapists are always seeking new and practical ways to translate research into practice. As one of the key concepts underpinning neuro-rehabilitation is neuroplasticity, specialists are particularly interested in applying the evidence base behind this to optimise treatment outcomes for patients. 

In this article, GripAble senior occupational therapist and neuro-rehabilitation specialist Lauren Edwards describes the ten principles of neuroplasticity and how GripAble provides a platform to harness its power to optimise rehab and support better treatment outcomes


Neurons that fire together, wire together

Plasticity describes the adaptability of an organism to change according to the demands of the environment. Neuroplasticity specifically describes the adaptive capacity of the central nervous system to adapt and change, enhancing existing neural connections and forming new neural connections.

Following a stroke or brain injury the brain becomes primed for learning. Neuroplastic potential is greatest in the peri infarct areas and contralateral motor system of the brain. Neuro-rehabilitation can benefit a person at any stage of their recovery; however, it must be prioritised in these early stages to fully capitalise on neuroplastic potential. The brain responds to environmental input and neural networks can be laid down and strengthened during this period. Indeed, we know that the more a neural network is used, the stronger it becomes and the more resilient it is to deterioration. 

Ten principles of neuroplasticity

The evidence base underpinning neuroplasticity is vast, and it’s important to understand and consider the various factors influencing and impacting the brain’s potential for change.  

  1. Use it or lose it – neural circuits which are not actively used will deteriorate, and increase the risk of learned non-use, which occurs when parts of the body are not used, and the brain ‘forgets’ how to use the affected hand or limb
  2. Use it to improve it – we know that repetition of movement is required to induce long lasting neuroplastic change
  3. Time since injury – research shows there is a time sensitive window of great opportunity for neuroplasticity in the sub-acute phase. Changes can also be seen years after injury, as neuroplastic potential remains, but at a lower capacity
  4. Age of person – it is thought that neuroplastic potential declines with age, and neural changes may be slower and less profound the older the patient is
  5. Transference – as motor practice can improve performance in multiple functional domains, the effects of neuroplasticity can spill over into other areas of the brain.
  6. Interference – neuroplasticity is not always positive. The brain is shaped by the environment a person lives in, and we must consider the impact of stress, use of orthotics, and other daily activities the person is carrying out
  7. Repetitions – a significant and positive relationship exists between dose and response, meaning the more repetitions of a movement, the more neuroplastic changes will be laid down and strengthened. Moreover, the dose and duration of activities also play a role, with the best results delivered when therapy is given at a high intensity over a short period of time
  8. Intensity – it is important to get the intensity of the activity ‘just right’ and gradually increase it through ‘growing’ the challenge, combining increased coordination, sensory input, and strength to create a demand for better performance and achieve systematic progression 
  9. Specificity – making exercises task-orientated helps to ensure they are relevant, interesting, challenging, and goal directed for the patient
  10. Salience – having the ability to gain and maintain a patient’s attention, motivate them by initiating and generating repetitions, and induce a sense of ‘flow’ are also key variable factors influencing neuroplasticity

The capability of the brain to grow and change can be truly life changing, so it is crucial that patients can access tools and techniques that harness the power of neuroplasticity. 

Neurotechnology offers applications and devices which can drive neuroplasticity and enhance function. Combining elements of gamification using sensor-based devices encourage a significant number of movement repetitions through fun and engaging games. 

GripAble: supporting neuroplasticity

GripAble is a two-in-one assessment and training device with a neurorehabilitation specific design, to help people with impaired upper limb movement. Used by neurological, paediatric and musculoskeletal therapists in both therapy and community settings, the handheld device connects to an app on a tablet and tracks four key hand movements – grip and release, wrist extension and flexion, radial and ulnar deviation, and pronation and supination, together with repetitions, and minutes of training.

The device is highly sensitive and can be used by most patients, even those with limited grip or movement. Easy to set up, GripAble can be calibrated and personalised to each user’s ability, with real-time feedback to help build motivation and engagement.

GripAble supports neuroplasticity by requiring recorded repetitions, with the level of challenge increasing over an extended period, and can be used early on in the rehab process within the time sensitive window. Portable and easy to use in a variety of settings, patients can play up to 12 interactive games, with multi-player options encouraging social connection, competition, and engagement.

Underpinned by the fundamental principles of neuroplasticity, GripAble is an evidence-based innovation that is both fun and engaging, making it the ideal addition to every therapist’s toolbox. 

Contact the GripAble team to see if GripAble could help you support better treatment outcomes for your patients.