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Neuroplasticity and Rehabilitation Strategies

Neuroplasticity and Rehabilitation Strategies. Robert K. Shin M.D. VA MS Center of Excellence Assistant Professor Departments of Neurology and Ophthalmology University of Maryland School of Medicine. Neuroplasticity?. The ability of cortex to reorganize in response to injury. Question.

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Neuroplasticity and Rehabilitation Strategies

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  1. Neuroplasticity and Rehabilitation Strategies Robert K. Shin M.D. VA MS Center of Excellence Assistant Professor Departments of Neurology and Ophthalmology University of Maryland School of Medicine

  2. Neuroplasticity? • The ability of cortex to reorganize in response to injury

  3. Question • Is the brain compensating for damage from MS in order to maintain normal function?

  4. Functional MRI • BOLD contrast analysis • Oxyhemoglobin • Deoxyhemoglobin • Alternating periods of task vs. rest • Activated regions determined statistically

  5. Reddy et al. Neurology 2000;54:236-244

  6. A dynamic cortical response? • Initially increased activation of contralateral sensorimotor cortex • Ipsilateral activation seen initially as well • Activation gradually reduced as patient recovered

  7. Clinically isolated syndrome • 16 consecutive patients with a CIS suggestive of multiple sclerosis • 15 age- and sex-matched controls • Functional MRI during finger flexion Rocca et al. NeuroImage 2003;18:847-855

  8. Rocca et al. NeuroImage 2003;18:847-855

  9. A response to cortical pathology? • Decreased NAA found in clinically stable CIS patients • Increase in activation of somatomotor cortex correlated with worsening brain damage

  10. Another puzzle • Optic neuritis causes vision loss and prolonged VEPs • Vision in optic neuritis almost always recovers • VEPs frequently remain abnormal

  11. Question • Is the brain somehow compensating for impaired optic nerve function?

  12. Recovery from optic neurits • 7 patients who had recovered from optic neuritis • 7 controls • Functional MRI during photic stimulation Werring, et al. JNNP 2000;68:441-449

  13. Werring, et al. JNNP 2000;68:441-449

  14. Functional reorganization? • Only occipital activation seen in controls • Additional extra-occipital areas were activated in patients who had recovered from optic neuritis

  15. Attention and memory • 22 patients with RR-MS • 22 age-matched controls • Functional MRI study • Paced Auditory Serial Addition Test (PASAT) • Recall task Mainero, et al. NeuroImage 2004;21:858-867

  16. PASAT Mainero, et al. NeuroImage 2004;21:858-867

  17. Recall Mainero, et al. NeuroImage 2004;21:858-867

  18. T2 LL Mainero, et al. NeuroImage 2004;21:858-867

  19. An adaptive mechanism? • Altered activation during cognitive tasks in MS patients • Activation increases as T2 lesion load increases • But activation is greater in patients with better function

  20. Conclusions • Functional MRI activity is altered in MS patients • These changes appear to be an adaptive response to brain damage

  21. Implications for rehabilitation? • Can functional MRI be used to prognosticate? • Can “cortical plasticity” be enhanced? • Proprioceptive stimulation • Forced use • Neurotrophic factors • Increased neurotransmitter release

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