Ten Principles of Neuroplasticity
- Use it or lose it – failure to drive specific central nervous system function leads to functional and neural circuitry degradation. (Most clients that participate at WTL have experienced negative changes from non-use at the time they commence training in the program.)
- Use it and improve it – training that drives the CNS leads to enhancement of function and positive reorganization of neural circuits
- Specificity – the nature of the training experience determines the neuroplasticity that evolves from it
- Repetition matters – this is self-evident and the most important driving factor for neuroplasticity
- Intensity matters – neuroplasticity requires sufficient training intensity. (This is why WTL sessions are 3 hours in duration)
- Time matters – different forms of neuroplasticity occur at different times during training and over the course of recovery
- Salience matters – the experience must be relevant and have meaning to the client
- Age matters – neuroplasticity occurs more readily in the young but is a lifelong process
- Transference – neuroplasticity in response to one training experience can enhance acquisition of similar functional task performance
- Interference – neuroplasticity in response to one experience can interfere with the acquisition of other behaviors. Developing neural connections that help compensate for lost function may interfere with development of different neural connections to learn new function.
Principles of motor learning are also applied in the WTL protocol. Skilled motor task acquisition is an essential focus of the program. Skilled actions are those that demonstrate consistency, flexibility and efficiency (8).
Consistency refers to the repeatability of performance over a period of trials conducted over a number of training sessions. Repetition during and across training sessions, mental practice, verbal/visual/tactile demonstration, cueing and feedback, EMG biofeedback regarding performance along with directing the client to attend to their internal sensory cues are contributory components to achieving consistency.
Flexibility (transferability) refers to the ability to adapt and modify the task performance based on changing environments or conditions. Clients are challenged at WTL by external variation of the task and physical environment. For example gait training is initially performed only in the gym on a level tile floor. As performance improves gait training is progressed to other surfaces (carpet, cement, etc), then advanced further to stairs, grass and inclines. Clients are also challenged intrinsically by directing their focus to unrelated cognitive tasks while performing physical activities. The purpose of conducting concurrent cognitive exercises during performance of physical activities is to drive the neural pathways to become integrated at a subconscious level, requiring less direct concentration to perform complex motor tasks. Initial training often involves “closed” skills where the performer can start or stop at any time because the regulatory features of the environment remain constant (e.g. going to/from sitting in a chair, many activities of daily living). More advanced “open” skills are introduced later in training. These skills require the performer to conform to changes in the environment for success (e.g. maintaining balance in short sitting while catching/throwing a ball). Flexibility for complex motor task performance is facilitated by implementation of all of these training strategies.
Efficiency pertains to reduced energy expenditure for performance of a task as a result of cardiovascular conditioning, improved central nervous system coordination and proper biomechanics of motion. The WTL protocol integrates aerobic training, proprioceptive neuromuscular facilitation (PNF), dynamic coordination training, optimal posture and joint biomechanics leading to improved endurance and efficiency for performance of skilled motor tasks.
In summary, the WTL protocol applies known physical therapy training methods to facilitate propriospinal input, muscle activation, postural control and core strength while minimizing compensatory movements in areas of the body affected by spinal cord and traumatic brain injury. Surface EMG with time-correlated video monitoring confirms that motor learning and positive neuroplastic changes of the central nervous system are outcomes of the protocol regardless of the severity of the impairments, duration since the trauma, or age of the client.