Deans' stroke musings

Changing stroke rehab and research worldwide now.Time is Brain!Just think of all the trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 493 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It's quite disgusting that this information is not available from every stroke association and doctors group.
My back ground story is here:

Tuesday, August 9, 2016

Neuroplasticity and Clinical Practice: Building Brain Power for Health

What is your doctors clinical practice on using neuroplasticity to build better brain power in stroke survivors? ANY PROTOCOLS AT ALL? 
  • Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
The focus of this review is on driving neuroplasticity in a positive direction using evidence-based interventions that also have the potential to improve general health. One goal is to provide an overview of the many ways new neuroscience can inform treatment protocols to empower and motivate clients to make the lifestyle choices that could help build brain power and could increase adherence to healthy lifestyle changes that have also been associated with simultaneously enhancing vigorous longevity, health, happiness, and wellness. Another goal is to explore the use of a focus in clinical practice on helping clients appreciate this new evidence and use evolving neuroscience in establishing individualized goals, designing strategies for achieving them and increasing treatment compliance. The timing is urgent for such interventions with goals of enhancing brain health across the lifespan and improving statistics on dementia worldwide.


Since 2011, our Director of NIMH has encouraged “the 21st century discipline of clinical neuroscience” to include brain-plasticity based strategies in providing clinical care (White, 2011). Neuroplasticity, the capacity of brain cells to change in response to intrinsic and extrinsic factors, can have negative or positive influence at any age across the entire lifespan. How can these factors be influenced in clinical settings? In keeping with the increasing shift in focus from illness to what maximizes wellness, psychologists are uniquely trained to use evidence based behavioral techniques as effective methods for driving neuroplasticity in a positive direction.
Search efforts for this review were primarily focused within the PubMed database using combinations of keywords listed above as well as names of prominent researchers in the field. Also, bibliographies of these articles and related reviews were searched. Studies accepted for review included animal as well as human studies. Studies reviewed met rigorous scientific standards, were almost exclusively broad review articles or random controlled trials, and were included without a specified time span. Periodic searches of this nature were conducted between 2005 and 2016.
It has been estimated that dementia has been detected at the rate of one new person about every 7 s around the world (Ferri et al., 2005). Brookmeyer et al. (2007) estimate that success in delaying the onset of dementia by as little as a year could reduce the global burden of Alzheimer’s disease by as much as 9,200,000 cases in 2050, a number that makes driving brain plasticity in a positive direction a top priority worldwide.
The focus of this article is to review the scientific foundation and recent progress in research of neuroplasticity; relate that to the various ways these findings can influence treatment; propose ways treatment protocols could increase adherence to brain plasticity based therapeutics; and suggest research questions going forward. Before proceeding on how to impact the so called “normal age-related cognitive decline,” it is important to consider recent research on the myth of cognitive decline (Ramscar et al., 2014). While noting that there are changes in performance on many psychometric tasks with aging, the results of this long series of studies indicate that these changes reflect the “consequences of learning on information processing, and not cognitive decline.” Across the years adults develop a greater sensitivity to small details of differences in stimuli, accumulate more acquired knowledge, and, as a result, have more and different demands in their memory search “which escalate as experience grows.” These researchers concluded that the performance of older adults is a reflection of predictable outcomes of increased learning on information processing and is not an indication of cognitive decline. Viewing cognitive differences across the lifespan as related to better awareness of details and accumulated learning is an example of a hopeful perspective which could effectively empower any individual to factor neuroplasticity into their efforts to promote improved business and health behaviors.
Researchers have referred to Michael Merzenich as the “father of plasticity” because he enjoyed a long career that established that the human brain is highly plastic and that led Merzenich to develop science-based novel interventions to drive improvements. Because of her decades of research preceding that of Merzenich, let us consider Marian Diamond to be the “mother of neuroplasticity.” Her work influenced a paradigm shift for scientists when she was the first to prove that the brain shrinks with impoverishment and grows in an enriched environment at any age (Diamond et al., 1971, 1984; Malkasian and Diamond, 1971). Fred Gage brought science another paradigm shift with the proof of neurogenesis in humans (Eriksson et al., 1998); showing how animals could sustain fivefold induction of neurogenesis (Kempermann et al., 2002); demonstration of how humans can increase neurogenesis (Pereira et al., 2007); and using human induced pluripotent stem cells to model neurogenesis in the hippocampus (Yu et al., 2014). Richard Davidson’s research found that thought alone was associated with neuroplastic gains (Davidson and Lutz, 2008; Davidson and McEwen, 2012) and improved immune response (Davidson et al., 2003; Kaliman et al., 2014).
There is a growing corpus of literature on ways to drive brain plasticity in a positive direction that could contribute more powerfully in strategies of intervention for healing and enhancement of function than would research on what drives loss. These findings coupled with recent neuroscience clearly showing the potential for improving brain plasticity (Goh and Park, 2009) could give humans unprecedented hope for personal empowerment. Neuroplasticity research has fleshed out what these chemical, anatomical, and performance gains could include.
Healthcare providers including psychologists (Cramer et al., 2011) need to address all of the essentials identified by Diamond as well as other lifestyle choices such as sleep (Jacobs et al., 2004; Guzman-Marin and McGinty, 2006; Zhu et al., 2012; Castronovo et al., 2014; Irwin, 2014), reducing inflammation (Kohman and Rhodes, 2012; Rosano et al., 2012; Irwin, 2014) and turning stress into power (Sapolsky, 2004; Zucconi et al., 2006). Psychology is uniquely positioned to maximize the “revolution which is set to transform the diagnosis and treatment of mental illness and reverse the lack of major progress made in curbing associated ill health and death over the past 100 years” (White, 2011). This specialty can influence “the development of a credible risk score coupled with some, or all of, cognitive training, psychosocial approaches, education, and the use of specially designed video and computer games” as well as promoting choices that can enhance neuroplasticity for, per Marian Diamond, “Enriching Heredity.”
Applying interventions in positive ways to enhance neuroplasticity is the model proposed herein because it captures changes made in the Diamond lab; the only change in their enriched environment was having lab workers hold and talk with the rats; that “TLC” resulted in fifty percent increase in longevity while maintaining plastic gains even in animals that lived to the equivalent of ninety human years (Diamond et al., 1984). Diamond opined these plastic gains could be enjoyed by humans at any age. She identified five essentials for a healthy brain: newness, challenge, exercise, diet, and love.

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