The role of visual attentional load in the induction of neuroplasticity in the human motor cortex

So if you aren't paying attention during your therapy neuroplastic changes don't take as well. I do wish they had disclosed that they were working on easy neuroplasticity(penumbra) since TMS will only work when there is still some brain function left. They took the easy way out and just continued proving the same thing over and over again, penumbra plasticity works. Hey, everyone understands that, work on the hard stuff, relocation of functions to new areas.
http://espace.library.uq.edu.au/view/UQ:239978
The human brain is capable of ongoing change during adulthood, a phenomenon known as neuroplasticity. Such neuroplasticity involves both structural reorganisation as well as modification of the strength of connections between individual neurons. Within the motor cortex – the region of the brain responsible for voluntary movement – plasticity is assumed to underlie the consolidation of motor skills, as well as recovery of function following brain injury. It has been suggested that mechanisms of attention can modulate brain plasticity, but only a few studies have tested this idea empirically. The overarching aim of the present study was to investigate the role of visual attentional load in plasticity induced within the human motor cortex using transcranial magnetic stimulation (TMS). Plasticity was induced in 12 healthy participants using a TMS protocol in which stimulation of a peripheral nerve to the hand was repeatedly combined with TMS over the contralateral motor cortex. Concurrently, participants undertook an easy ('low load') or difficult ('high load') task while fixating a stream of visual stimuli, or passively observed the visual stimuli in a third condition ('no load'). The effectiveness of this manipulation was verified behaviourally. Electromyographic recordings from the stimulated muscle in the hand revealed a significant increase in motorevoked potentials from baseline to 5 minutes following the protocol under Low Load, but no significant increase under High Load. These results suggest that when attention is diverted or otherwise engaged elsewhere, neural plasticity in the motor cortex is reliably attenuated(weakened). These findings have important implications for understanding the neural mechanisms underlying the consolidation of new motor skills, in healthy functioning as well as following focal brain lesions.