Change Your Client’s Brain

By: Gabe Byars OTR/L

Gone are the days that we believed that our brain is unchanging.  This worldview has replaced by one centered on neuroplasticity, where the brain is constantly changing and adapting to our experiences.   Neuroplasticity has broad implications for occupational therapy.   Therapy literally re-wires the brain.  This has an incredible impact for learning of facts and movements. If an individual does not use their hemiplegic arm following stroke, their brain adapts so that the brain region controlling that arm loses connections and shrinks.   The brain of an individual with a rotator cuff injury has adapted to years of movement patterns that create stress, damage, and pain.  Beyond simply strengthening and stretching muscles, therapy must utilize neuroplasticity to change the brain and those movements.  However in order to capitalize on neuroplasticity, we need to shift how we perform our therapy.  We need to ensure our therapy is meaningful, challenging and contains enough repetitions in order to promote neuroplasticity. 

First, our therapy must be meaningful.  It turns out that our brain responds differently to goal-directed, meaningful tasks than it does to rote exercise.  Our brain largely turns off with rote exercise.  Have you ever experienced this?  Distractedly thinking about dinner rather than the movement while walking or exercising.  This exercise was strengthening the muscle but not the brain.   In order to change the brain with neuroplasticity, the activity must be meaningful and goal-directed for our clients.  Back to our example of an individual following rotator cuff injury, repeated exercise will strengthen the muscles, but the brain and therefore the problematic movement won’t change.  The only way to change the brain is to perform meaningful and functional tasks while focusing on the desired movement. 

Second, our therapy must challenge the brain.  Our brains like tasks that are novel or challenging.  In contrast, our brains ‘turn off’ when not challenged.  I can look back to my own brain state when cooking Thanksgiving dinner.  Every burner on the stove was on and I was managing 5 dishes at once.  My brain was ‘on.’  Compare that to the next night when I was heating up some leftovers.  My brain was ‘off.’ Only in the first state was I challenged enough to drive neuroplasticity.  We need our client’s brains to be this challenged.  When I am working with a client to promote neuroplastic change, I tell them that, “I want your brain to be tired before your muscles get tired.” 

Finally, our therapy must have enough repetitions to change the brain.  To create neuroplastic change we have to repeat a task hundreds and hundreds of times.  Studies suggest that our therapy sessions only provide 10-30 repetitions of a task.  This is not enough to create neuroplastic change.  Think back to the last time you learned something new – dancing, climbing, speaking a new language, or playing an instrument.  How many times did you have to repeatedly practice before you were proficient?  We need to give our clients this same opportunity for repeated practice.  Spend a week counting repetitions.  Try to get 100 repetitions of a task per session.  Remember to keep grading the task to ensure it is always challenging.  This will multiply to hundreds of repetitions per week and thousands over the course of your treatment plan. 

Neuroplasticity has become a core tenant of my practice, and I find that it to be very helpful in all scenarios with all types of clients.  Too often, we only think about neuroplasticity with our ‘neuro’ clients, but all our clients have to learn and neuroplasticity is how they learn.  This article summaries three critical principals of neuroplasticity – meaningful and challenging therapy with enough repetitions to drive change.  These three simple principles will help you re-wire your clients brains.    

Gabe Byars, OTR/L

Occupational Therapy Assistant Program

Salt Lake Community College

gabe.byars@slcc.edu

References and Resources

Canadian Partnership for Stroke Recovery. (2017). Clinician’s Handbook – Evidence-Based Review of Stroke Rehabilitation. Retrieved December 2, 2017, from http://www.ebrsr.com/clinician-handbook

Dimyan, M. A., & Cohen, L. G. (2016). Neuroplasticity in the context of motor rehabilitation after stroke. Nature Reviews Neurology, 7(2), 76–85. https://doi.org/10.1038/nrneurol.2010.200.Neuroplasticity

Kleim, J. A., & Jones, T. a. (2008). Principles of experience-dependent neural plasticity: implications for rehabilitation after brain damage. Journal of Speech, Language, and Hearing Research : JSLHR, 51(1), S225-39. https://doi.org/10.1044/1092-4388(2008/018)

Pelletier, R., Higgins, J., & Bourbonnais, D. (2015). Is neuroplasticity in the central nervous system the missing link to our understanding of chronic musculoskeletal disorders? BMC Musculoskeletal Disorders, 16(1), 25. https://doi.org/10.1186/s12891-015-0480-y

Taub, E., Uswatte, G., Mark, V. W., & Morris, D. M. (2006). The learned nonuse phenomenon: implications for rehabilitation. Eura Medicophys, 42(3), 241–56. Retrieved from http://www.minervamedica.it/en/getfreepdf/HPRpxz2TCxz8%252FNZUPDO3kK8jZttz4MQan9qketY2sIFPvSWn9f%252BdvLCFViktdi5GZo7O9yQ5m6CX%252B7c3H5n0RA%253D%253D/R33Y2006N03A0241.pdf

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