Early Interventions for Neuroplasticity
Recently, there has been an increasing focus on childhood disabilities and the effect that adversity or environmental changes have on the development of a child’s brain, during the critical formative years. The National Scientific Council on the Developing Child (2014) suggested that the first five years of a child’s life were the most critical phase for neural development, providing a relatively time bound phase for interventions to help with neural learning, so that it is most effective.
Neuroplasticity is known as the forming and re-forming of neural pathways, which results in the brain’s ability to unlearn and re-learn actions or behaviors. This is known to occur most consistently and rapidly during the first five years of a child’s life.
There are various adversities that can occur during childhood that may result in loss of motor, sensory functions or cause disruptions in mental acuity or emotional health. These include:
- Physical disabilities: due to genetic abnormalities, cerebral palsy, loss of hearing, vision or speech, cranial or spinal cord injury due to due hypoxia or trauma.
- Mental disabilities: with delayed milestones, low memory or organizational skills leading to poor academic performance
- Emotional Disabilities: Studies have shown the effect of the child’s environment, specifically poverty and lack of maternal support leading to neglect, abuse or abandonment, on a child’s emotional health. It may lead to erratic behavior or depression as the brain does not know how to regulate emotions.
The promise of interventions based on neuroplasticity, is that seemingly permanent disabilities, may be improved due to the brain’s ability to evolve and develop alternate or latent neuronal pathways to adjust and adapt to a situation, if moulded to do so, by the experiences it faces. Although neural plasticity has largely positive benefits , where in an adaptive change would lead to gain in sensory or motor functions or improved emotional health, a maladaptive change could result in deterioration of a patient’s condition as well. ( for example :the onset of seizures months or years after a cerebral injury due to new neuronal pathways formed after the injury that cause alterations in neuronal signals, therefore causing seizures)
Interventions that may be introduced to improve neuroplasticity and brain stimulation are:
- Physical Therapy
- Aerobic exercise is always advocated as far as the child’s condition allows it
- Motor learning : this is repetitive practice or experience of a particular motor skill which results in formation of new neuronal pathways in the central nervous system, which produces a newly learnt motor skill.
- Biofeedback: Neuromuscular training done so that patients are able to appreciate and therefore act on their own physiological signals, through visual or auditory cues.(example : EMG for muscle tension helps with urinary incontinence, or biofeedback mechanisms to deal with chronic pain and anxiety.
- CIMT (Constraint Induced Movement Therapy) This improves the movement of an affected limb , by restraining the unaffected limb, virtually compelling the weaker limb to take over the action.
- PNF (Proprioceptive Neuromuscular Facilitation Strategy) This relies on stretching muscles to their limit to trigger an inverse myotatic reflex, which is protective and causes the muscle to relax, leading to improved range of motion for the affected muscle group, or limb movement.
- Cognitive Training
- Mental exercises that help to stimulate memory uptake through tasks or games, which may range from crosswords or sudoku to app based games, video games or immersive video games , that help with engagement and attention skills.
- Playing an instrument
- Learning a new language
- Non Invasive Technology
- Transcranial magnetic stimulation : using magnetic fields to stimulate and modulate nervous system and cortical activity
- Transcranial direct current stimulation : using low voltage electric current through electrodes for specific enhancement of cortical plasticity
- Neural Interface Technology
This is assistive technology using a BCI ( Brain Computer Interface) as a direct communication pathway, between the brain and external devices in order to exert faster and more intuitive control for patients with motor disabilities due to stroke or spinal cord injuries .
Using EEG Biofeedback, patients learn to voluntarily modulate their brain activity as the EEG provides real time feedback of brain activity, teaching them to control specific neuronal responses with practice. This is used with patients suffering from ADHD, anxiety, sleep disorders , among other conditions.
- Deep brain stimulation (DBS) is a , invasive method that places a lead or electrode in a selected region of the brain. It is reversible and allows an adjustable treatment tailored to the patient’s needs. It has been used safely in various neurological disorders, including Parkinson disease. More recently, this approach has been attempted for the treatment of obsessive-compulsive disorder, epilepsy, and depression.
As research progresses towards more effective means to achieve brain stimulation, advances in technology may be harnessed to take advantage of neuroplasticity early enough, to gradually improve the quality of life of patients suffering from chronic neurological conditions.