Priming the Brain to Capitalize on Metaplasticity in Stroke Rehabilitation

You can have your doctor get this to see if it is useful. Assuming that your doctor does more than write E.T.(Evaluate and Treat) prescriptions 

Priming the Brain to Capitalize on Metaplasticity in Stroke Rehabilitation

 Jessica M. Cassidy, Bernadette T. Gillick, James R. Carey J.M. Cassidy,

PT, DPT, Doctoral Candidate , DPT Program in Physical Therapy and Graduate Program in Rehabilitation Science, University of Minnesota, 420 Delaware St SE, MMC 388, Minneapolis, MN 55455 (USA). Address all correspondence to Ms Cassidy at: krea0014@umn.edu. B.T. Gillick,

PT, PhD, Program in Physical Therapy and Graduate Program in Rehabilitation Science, University of Minnesota.

J.R. Carey,

PT, PhD, Program in Physical Therapy and Graduate Program in Rehabilitation Science, University of Minnesota. [Cassidy JM, Gillick BT, Carey JR. Priming the brain to capitalize on metaplasticity in stroke rehabilitation.
 Phys Ther
. 2014;94:xxxÐxxx.]


2 © 2013 American Physical Therapy Association Published Ahead of Print: XXX Accepted: August 2, 2013 Submitted: January 27, 2013

 Abstract

Repetitive transcranial magnetic stimulation (rTMS) is emerging as a potentially valuable intervention to augment the effects of behavioral therapy for stroke. When used in conjunction with other therapies, rTMS embraces the concept of metaplasticity. Due to homeostatic mechanisms inherent to metaplasticity, interventions known in isolation to enhance excitability can interact when applied successively under certain timing conditions and produce enhanced or opposite effects. It will be shown that similar to Òmuscular wisdomÓ, with its self-protective mechanisms, there also appears to be synaptic wisdom in neural networks with homeostatic processes that prevent over- and under-excitability. These processes hold implications for both enhancing and suppressing the desired effects from behavioral therapy. The purpose of this paper is to relate the concept of metaplasticity, as derived from studies in healthy humans, to stroke rehabilitation and consider how it can be leveraged to maximize stroke outcomes.