2.79 CME

La neuroplasticité et son rôle dans la récupération après un AVC

Conférencier: Dr Dharam P. Pandey

Director & HOD, Department of Physiotherapy & Rehabilitation Sciences, Manipal Hospitals, Delhi

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Description

Neuroplasticity, the brain's remarkable ability to reorganize itself by forming new neural connections, plays a critical role in recovery after stroke. When a stroke occurs, blood flow to parts of the brain is interrupted, causing cell death and impairing function in affected areas. Neuroplasticity facilitates recovery by allowing other parts of the brain to take over the functions lost due to the stroke. This process is driven by the brain's inherent capacity to adapt through mechanisms such as synaptic plasticity, where synapses strengthen or weaken over time, and structural plasticity, involving the growth of new neurons and the reorganization of neural networks. Rehabilitation therapies, such as physical, occupational, and speech therapy, leverage neuroplasticity by providing repetitive, task-specific practice that encourages the brain to rewire itself. Advanced techniques like constraint-induced movement therapy, mirror therapy, and non-invasive brain stimulation further enhance neuroplasticity by promoting activity in the affected regions. The timing and intensity of these interventions are crucial, as the brain is most malleable in the early stages following a stroke. However, neuroplasticity can continue to support recovery even months or years after the initial event. Factors influencing the extent of neuroplastic changes include the severity of the stroke, the individual's age, overall health, and engagement in rehabilitation. Ultimately, neuroplasticity is a foundational concept in stroke recovery, providing a pathway for regaining lost functions and improving quality of life through targeted, adaptive interventions.

Résumé

  • Stroke is a medical condition where blood supply to the brain is interrupted, leading to potential brain cell death and impacting physical, emotional, cognitive, and financial aspects of a person's life. While neurological recovery involves spontaneous improvements influenced by pharmacological means, functional recovery focuses on improving mobility and daily living activities through rehabilitation.
  • Neuroplasticity is the brain's ability to reorganize itself, adopting new situations, strengthening weak connections, and responding to internal and external stimuli. Unlike the old belief that the brain is hardwired, it is now considered a dynamic structure capable of being molded and reorganized.
  • The mechanism of neuroplasticity can be divided into cellular level changes, involving neurotransmitters, and activity-driven changes, where activities stimulate neurotransmitter release and synaptic strengthening. There's a positive and negative side to plasticity, with maladaptive plasticity referring to potentially harmful changes.
  • Three key phenomena drive neuroplasticity: synaptic plasticity (strengthening or weakening of synapses), neurogenesis (birth of new neurons), and cortical remapping (reorganizing brain areas). The activity-driven neuroplasticity is facilitated by potentiation and depression, leading to strengthened or weakened synaptic connections based on activity.
  • Factors influencing neuroplasticity include age, stroke severity, and the type of rehabilitation provided. Task-specific training and the repetition of activities are crucial for promoting motor learning and structural changes in the brain.
  • Technology, such as virtual reality, offers immersive and engaging experiences, providing real-time feedback to the brain and facilitating high-intensity training. This aids in positive plastic changes, helps regain functional capability after any stroke so rehabilitation plans should incorporate them.

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