(2019) 10:332. doi: 10.3389/fneur.2019.00332, 21. Another major factor involved in promoting neuroplasticity after spinal cord injury is performing high repetitions. Two studies in this special issue use a newer neuroimaging method called functional near-infrared spectroscopy to measure cortical activity during dual-task walking.2,3 Impaired dual-task walking is common in neurological populations and can interfere with the ability to perform daily life activities. Depending on the severity of your spinal cord injury, there may be hope for improved mobility. Therapies like Eye Movement Desensitization and Reprocessing (EMDR) therapy show promising. THE ULTIMATE KEYS TO HEAL TRAUMA: Discover the secret o Enhancing brain plasticity to promote stroke recovery. (2013) 33:17115. My Doctor Told Me I Have High Cholesterol, Now What? Dez-Tejedor E, Gutirrez-Fernndez M. Why do we say neuroprotection' in stroke when we mean brain protection or cerebroprotection'? Applied Sciences | Free Full-Text | Influence of Sports on - MDPI Neuroplasticity or brain plasticity is defined as the ability of the nervous system to change its activity in response to intrinsic or extrinsic stimuli by reorganizing its structure, functions, or connections. It involves a process called neurogenesis, which is the formation of new neurons in the brain (and elsewhere in the nervous system). Neuroplastic changes induced by cognitive rehabilitation in traumatic brain injury: A review. by Beatrice Awasthifigures by Shreya Mantri. J TranslMed. The cell body is the main part of the cell and contains the genetic material and most cellular machinery inside a structure called the nucleus. https://www.frontiersin.org/articles/10.3389/fncel.2017.00076/full, https://www.hindawi.com/journals/np/2019/6042132/, https://www.frontiersin.org/articles/10.3389/fnins.2016.00460/full, https://journals.sagepub.com/doi/full/10.1177/1545968317723748, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2600417/, https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2777627, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5574370/, https://pubmed.ncbi.nlm.nih.gov/29959048/, https://www.frontiersin.org/articles/10.3389/fneur.2020.554089/full, https://www.cdc.gov/traumaticbraininjury/data/index.html, https://www.uab.edu/medicine/tbi/newly-injured/questions-about-traumatic-brain-injury-tbi/what-is-expected-in-recovering-from-a-tbi, Seasonal Affective Disorder Can Affect You in the Summer Too, 'Euphoria' Star Angus Cloud's Mother Says He Did Not Intend to End His Life, How Ive Learned to Set Boundaries and Save My Energy for Therapy. There is still much to learn about the optimal interventions and parameters of dose and intensity necessary to achieve adaptive neuroplastic changes. Specifically, aerobic exercise has been found to stimulate the release of special signals that facilitate synaptic strengthening; one group found that engaging in high-intensity cycling intervals immediately after learning a new skill enhanced long-term retention. (2020) 9:8. doi: 10.3390/biomedicines9010008, 44. Cell-based therapies for stroke: promising solution or dead end? Rhythm games, such as dance simulators or exercise games, can help improve visuospatial memory (movement tracking) and attention. Extracellular vesicles improve post-stroke neuroregeneration and prevent postischemic immunosuppression. A better understanding of neuroplasticity and the mechanisms through which the nervous system rewires itself could pave the way for improved treatments that promote rehabilitation after trauma. We link primary sources including studies, scientific references, and statistics within each article and also list them in the resources section at the bottom of our articles. doi: 10.1055/s-0041-1725138, 11. Researchers report that a generic version of the substance ketamine helped one in five people with treatment-resistant depression in a recent study, Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. Music therapy is a potential intervention for cognition of Alzheimers disease: A mini-review. What Is Neuroplasticity? - Optometrists.org Jurkowski MP, Bettio L, Woo EK, Patten A, Yau SY, Gil-Mohapel J. *Correspondence: Exuperio Dez-Tejedor, exuperio.diez@salud.madrid.org; Mara Gutirrez-Fernndez, mgutierrezfernandez@salud.madrid.org, Understanding Stroke Recovery to Improve Outcomes: From Acute Care to Chronic Rehabilitation, View all (2015) 15:87381. However, its also important to understand that the central nervous system never completely runs out of neuroplasticity. Evidence suggests that neuroplasticity exercises may play a role in restoring these functions after brain trauma. Evidence from preclinical studies suggests that combinational therapies such as enriched environments, which take advantage of multiple mechanisms underlying neuroplasticity, may promote greater functional recovery than a single therapy.10 The researchers examine the effects of a high-dose enriched task-specific therapy, which combines physical therapy with social and cognitive stimulation on motor recovery in individuals with chronic stroke. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher. Children develop new neurons as they grow, but adults can also develop new neurons. Click to email a link to a friend (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Twitter (Opens in new window), Click to share on Reddit (Opens in new window). Given that this self-repair capacity is limited, there has been a growing interest in the potential for brain plasticity-inducing interventions to enhance post-stroke recovery through rehabilitation, trophic factors, cell therapy, and extracellular vesicles. Safety of autologous bone marrow mononuclear cell transplantation in patients with nonacute ischemic stroke. Galetto V, et al. (2016) 7:37887. Neuroplasticity: how lost skills can be regained after injury or illness Over the past decade, we have witnessed a flourishing of novel strategies to enhance neuroplasticity and promote axon regeneration following spinal cord injury, and results from preclinical . Axons are single, long arms that carry nerve impulses to other neurons or body parts. Art therapy: A complementary treatment for mental disorders. The brain is an amazing complex organ that manages everything that we think, feel and do. Steinberg GK, Kondziolka D, Wechsler LR, Lunsford LD, Coburn ML, Billigen JB, et al. Stem Cell Res Ther. In many cases, persisting symptoms of pain, weakness, and fatigue can be due to dysfunction of the nervous system. Wolters Kluwer Health We investigated the effects of musical training on patients with behavioral and cognitive deficits following a mild traumatic brain injury (mTBI) and found significant functional neuro-plastic changes in the OFC's networks. Brain Plasticity and Stroke Rehabilitation | Stroke - AHA/ASA Journals Respiratory Training and Plasticity After Cervical Spinal Cord Injury This is where brain plasticity can help you heal after a brain injury. (2016) 6:28796. Her research focuses on the effects of tissue context on growth factor signaling. doi: 10.1016/S0306-4522(01)00117-8, 7. Its really a great device that minutely takes care of each and every muscle of your affected body part. Shreya Mantri is a PhD student in Biological and Biomedical Sciences at Harvard Medical School. Doeppner TR, Bhr M, Giebel B, Hermann DM. Terriaca S, Fiorelli E, Scioli MG, Fabbri G, Storti G, Cervelli V, et al. Neurons communicate with each other along circuits called pathways. Given the progress of research on EVs, further information on brain-derived EVs under stroke conditions is necessary (45). Massed practice like this helps stimulate and rewire the nervous system. doi: 10.1212/WNL.0000000000011440, 31. The severity of symptoms depends on which, Head injuries range from mild to severe. Sign up to receive a free PDF ebook with recovery exercises for stroke, traumatic brain injury, or spinal cord injury below: Government Contract Vehicles | Terms of Service | Return Policy | Privacy Policy | My Account, Copyright 2023 All rights Reserved. Further signaling between neurons in the brain allows the player to decide to pass, and motor neurons in the brain send signals to the players muscles, allowing them to kick the ball. Predicting the degree and length of recovery from a severe TBI is very difficult, and should be done on a case-by-case basis. Thored P, Arvidsson A, Cacci E, Ahlenius H, Kallur T, Darsalia V, et al. doi: 10.1634/stemcells.2005-0281, 8. Similarities and differences in extracellular vesicle profiles between ischaemic stroke and myocardial infarction. Functional and structural neuroplasticity induced by short-term tactile training based on Braille reading. Due to their small size, MSC-EVs can be saved from phagocytosis by macrophages. Marian V, et al. Expected changes include learning, experience, and aging. Exercise enhances this neuroplasticity in the further course of the condition, which might modulate the connectivity patterns in brain regions responsible for movement execution and imagination. Treatment can, therefore, be administered at an early stage, which is crucial for a disease where delays result in irrevocable loss of brain function. Detante O, Jaillard A, Moisan A, Barbieux M, Favre IM, Garambois K, et al. Neuroplasticity refers to the central nervous systems ability to rewire its neural circuitry to make adaptive changes. to maintaining your privacy and will not share your personal information without This binding can trigger changes within the receiving neuron, such as releasing its own neurotransmitters to stimulate another neuron. (2017) 7:27887. (2015) 6:121. doi: 10.1186/s13287-015-0111-4, 19. An MRI can detect many changes in brain structure and function. doi: 10.1016/j.neurol.2014.10.005, 4. It is, therefore, important to focus on brain protection as a whole rather than neuroprotection in isolation (1). Similarly, a 2017 review of studies on cognitive rehabilitation following TBI, suggests that memory and other thinking skills may be recovered to some degree with the help of cognitive rehabilitation. The axon of the transmitting neuron releases a small signaling molecule called a neurotransmitter, which travels across the synapse and is bound by the dendrites of the receiving neuron. By cultivating the belief that you can and will change, you help your brain do what it needs to heal. Throughout the lifespan, neuroplasticity is essential . your express consent. Brain-derived neurotrophic factor administration mediated oligodendrocyte differentiation and myelin formation in subcortical ischemic stroke. Brain basics: The life and death of a neuron. Does abraininjury increase neuroplasticity? Intravenous delivery of adipose tissue-derived mesenchymal stem cells improves brain repair in hyperglycemic stroke rats. Exploring BCI-induced plasticity can not only promote post-stroke rehabilitation but also expand our understanding of the mechanisms underlying motor learning. What Happens to the Brain During a Stroke? Below, well discuss three essential components for promoting neuroplasticity after spinal cord injury: specificity, repetition, and intensity. doi: 10.1016/j.omtn.2017.04.010, 43. Your email address will not be published. However, individuals must repetitively stimulate the spinal cord by practicing weakened movements. What to know, processing of musical syntax, such as chords, harmonies, and scales, mapping certain sounds to certain movements, balancing multiple senses, like sight, sound, and touch. The more signaling that happens between two neurons, the more changes are induced within both neurons that stabilize a synapse and strengthen the synaptic connection between them. Mesenchymal stem cell-based therapy for stroke: current understanding and challenges. But when it's combined with therapy that drives neuroplasticity in a positive direction, it's a very powerful component in recovery. 28 Highly Influential PDF Hu J, et al. Marquez de la Plata C, et al. Bang OY, Kim EH. Otero-Ortega L, Laso-Garca F, Gmez-de Frutos M, Fuentes B, Diekhorst L, Dez-Tejedor E, Gutirrez-Fernndez M. Role of exosomes as a treatment and potential biomarker for stroke. In most mice, new clusters continued to form while practicing the task over subsequent days. Training specifically is crucial for promoting neuroplasticity after spinal cord injury because each movement you make is attributed to a specific set of neural pathways. To view the content in your browser, please download Adobe Reader or, alternately, 10. Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. In the end, these efforts will certainly lead us to improved interventions that help to restore function and health to our patients. We also observed differences in the levels of the microRNA content of EVs according to the topography of the stroke (subcortical and cortical-subcortical ischemic stroke) and related to improved recovery after stroke (44). Winona, MN 55987 | Neurology. Can 'biological race' explain disparities in health? Motor recovery: how rehabilitation techniques and technologies can enhance recovery and neuroplasticity. 2. Exercises that promote positive neuroplasticity, then, may help "rewrite" these patterns to improve well-being. (2011) 6:4552. In recent years, trophic factors have generated a great deal of interest in the clinical context, given that their administration is not restricted to a narrow therapeutic window. Evidence from a 2019 study on the structural effects of several game genres found the following effects after about 16 hours of gameplay: A 2020 study examined people with combat-related post-traumatic stress disorder (PTSD) who underwent eye movement desensitization and reprocessing (EMDR) therapy. Neuroplastic Changes Induced by Cognitive Rehabilitation in Traumatic This will help the spinal cord perceive demand for those functions and promote neuroadaptive changes. (2014) 170:77998. Puderbaugh M, et al. J Cereb Blood Flow Metab. FitMi works by encouraging you to practice rehab exercises with high repetition. Collaborations between rehabilitation clinicians and researchers will enhance and hasten the translation of neuroplasticity research into effective clinical therapies. mesenchymal stem cell-derived extracellular vesicle therapy for stroke: challenges and progress. (2015) 13:46. doi: 10.1186/s12967-015-0406-3, 18. Hess DC, Wechsler LR, Clark WM, Savitz SI, Ford GA, Chiu D, et al. Their findings demonstrate that the enriched task-specific therapy intervention is feasible, and suggest that it may be beneficial for repair and recovery long after a stroke. Neural correlates of music listening: Does the music matter? A 2017 mini-review even proposed music therapy to slow cognitive decline, improve motor function, and preserve memory in people with Alzheimers disease. Following a spinal cord injury, the central nervous system experiences increased neuroplasticity levels for several months as the spinal cord attempts to stabilize itself. Thanks to the development of delivery system technologies, MSC-derived EVs can be engineered and designed to carry specific therapeutic molecules (47) according to brain tissue repair needs, avoiding molecules that could induce adverse effects, moving toward personalized medicine. TikTok's 'bed rotting' trend, which consists of spending long periods of time in bed scrolling on a phone or binge-watching TV, isn't the self-care. However, access to free or low cost online courses via YouTube and other platforms has never been easier. (2019) 10:212. doi: 10.1186/s13287-019-1322-x, 22. Zhang RL, Zhang ZG, Zhang L, Chopp M. Proliferation and differentiation of progenitor cells in the cortex and the subventricular zone in the adult rat after focal cerebral ischemia. Acomplete spinal cord injurydescribes when the spinal cord is completely transected. Doeppner TR, Herz J, Gorgens A, Schlechter J, Ludwig AK, Radtke S, et al. Ting WK, Fadul FA, Fecteau S, Ethier C. Neurostimulation for stroke rehabilitation. Developing these skills individually will help form the building blocks to practice walking again. However, we would like to focus on other novel and promising strategies, such as the administration of trophic factors, stem cells, and extracellular vesicles. By observing his thoughts, instead of getting caught up in them, he has moved from a place of self-deprecation to self-compassion. Brain plasticity is a term that refers to the brain's ability to restructure and reconfigure itself in response to change. In their roles as clinicians and as scientists, physical therapists and other rehabilitation professionals harness neuroplasticity using evidence-based interventions to maintain or enhance functional performance in individuals with neurological disorders. (2021) 15:628940. doi: 10.3389/fncel.2021.628940, 24. (2017) 16:3608. MNT answers the question and provide a look at symptoms and most effective treatments. Get instant access to our free exercise ebook for SCI survivors. (2019). Improvements in brain excitability were found following the aerobic exercise, which suggest that the capacity for neuroplasticity exists in this population. Tobin MK, Stephen TKL, Lopez KL, Pergande MR, Bartholomew AM, Cologna SM, et al. We appreciate Morote Traducciones S. L. support for their editing assistance. Capstone Paper. Both interventions altered electroencephalogic measures indicative of motor planning duration and amplitude of stepping; furthermore, duration changes for all participants were in the direction of those acquired from healthy adult values. New iOS features are stepping up capabilities to follow mental and vision health data. Neuroplasticity has a profound impact on the manifestation and progression of clinical symptoms in many psychiatric illnesses. (2021) 21:2084. doi: 10.3390/s21062084, 12. 2009;22(6):563569. Alia C, et al. Stem Cells Transl Med. By inducing neuroplasticity and restoring lost function, BCI represents a feasible option for post-stroke rehabilitation. Eur Stroke J. Neuroplasticity can lead to positive or negative changes in function, which are referred to as adaptive and maladaptive neuroplasticity, respectively. But why settle for administering a single factor when we can administer the whole arsenal? (n.d.). Learning to play a musical instrument involves several complex processes. (2019) 10:211. doi: 10.3389/fneur.2019.00211, 42. Mesenchymal stem cells in the treatment of ischemic stroke: progress and possibilities. Intravenous administration of xenogenic adipose-derived mesenchymal stem cells (ADMSC) and ADMSC-derived exosomes markedly reduced brain infarct volume and preserved neurological function in rat after acute ischemic stroke. Improved measures for assessment of neuroplasticity in humans are needed, such as biomarkers (including movement-related biomarkers) for diagnosing disorders, and predicting and monitoring treatment effectiveness. doi: 10.2217/rme.10.97, 25. This article outlines how five specific activities may help reconfigure the brain. Neuroplasticity for Spinal Cord Injury Recovery | Flint Rehab Meyer M, et al. Front. Stein M, et al. Likewise, the limitations of cell therapy will be determined by the results of clinical trials. How does neuroplasticity work? How musical training shapes the adult brain: Predispositions and neuroplasticity. Sensory neurons collect information about the environment (such as temperature and texture), motor neurons coordinate movement, and interneurons connect sensory and motor neurons. Finally, for the first time Vive et al9 translate to the clinical setting the enriched environment model used in laboratory-based animal studies. It found that over the course of daily lessons, for 3 weeks, study participants developed increased connectivity in regions of the brain involved in processing sensations like touch. To achieve this recovery, there is a crucial need for increasing the understanding of the pathophysiological mechanisms that spontaneously engage early after stroke, which involve excitotoxicity, free radical damage, increased glutamate concentrations, and inflammation, leading to cell death. 31 Articles, This article is part of the Research Topic, Trophic Factors as Therapeutic Strategy to Promote Brain Plasticity, Cell Therapy: The Factory of Trophic Factors and Key Molecules to Improve Recovery, Extracellular Vesicles: The Novel Strategy to Enhance Brain Recovery, https://doi.org/10.3389/fneur.2021.768958, Creative Commons Attribution License (CC BY), Neurological Sciences and Cerebrovascular Research Laboratory, Department of Neurology and Stroke Center, La Paz University Hospital, Neuroscience Area of Hospital La Paz Institute for Health Research (IdiPAZ), Universidad Autnoma de Madrid, Madrid, Spain. How to Promote Neuroplasticity Following Trauma - Winona State University The yellow and blue pucks track your movement and provide feedback. Abstract. Hoppes et al2 examine frontal lobe activation patterns in individuals with and without visual vertigo during dual-task walking. Neuroscience. Background: Cognitive deficits are among the most disabling consequences of traumatic brain injury (TBI), leading to long-term outcomes and interfering with the individual's recovery. Author. There are two main types of neuroplasticity: Functional plasticity is the brain's ability to move functions from a damaged area of the brain to other undamaged areas. How to Promote Neuroplasticity Following Trauma. Currently you have JavaScript disabled. Clinical outcomes of transplanted modified bone marrow-derived mesenchymal stem cells in stroke: a phase 1/2a study. (2020) 14:576444. doi: 10.3389/fncel.2020.576444, 6. As a result, only individuals with incomplete SCIs have the ability to utilize neuroplasticity to recover functions affected by injury. This may be why the American Congress of Rehabilitation Medicine suggests art as an activity for boosting neuroplasticity and helping people recover from brain injuries or stroke. (2021) 41:16776. According to a 2021 research review, these processes include: The Oxford Handbook of Music and the Brain notes that researchers have observed changes in the brains of experts who engage in ongoing, consistent musical practice. 6 Citations Metrics Abstract Purpose of Review The ability to promote greater neuroplasticity through external influencers is an emerging field of study with potentially significant consequences on the treatment of neurologic injury. Participants' responses to the exercise were greater in those with higher cardiorespiratory fitness and less body fat. Exercise-induced neuroplasticity: Balance training increases cortical thickness in visual and vestibular cortical regions. In order to post comments, please make sure JavaScript and Cookies are enabled, and reload the page. By following these tips, you can help promote neuroplasticity and keep your brain healthy and resilient! (2017). Save my name, email, and website in this browser for the next time I comment. Li W, Shi L, Hu B, Hong Y, Zhang H, Li X, et al. Additionally, research suggests that certain activities can support neuroplasticity. Braun RG, Wittenberg GF. Enriched, task-specific therapy in the chronic phase after stroke. Post-stroke neurogenesis: friend or foe? Read on to find out about the lessons this writer learned. Their findings suggest that repeated practice is essential to enhancing synaptic adaptation when learning a new skill and is therefore key to mastering it. Stroke. Copyright. doi: 10.1002/sctm.20-0369, 32. Because connections between the brain and areas below the level of injury are still intact, individuals may have some motor control and/or sensation below their level of injury. (2021) 27:716. Dolcetti E, Bruno A, Guadalupi L, Rizzo FR, Musella A, Gentile A, et al. Like with the mice, practice can rewire the brain even if youre only practicing in your head! FitMi helps transform rehab exercises into an engaging, interactive experience. For EVs, their ability to cross the BBB and their editable cargo provide live information on molecules that participate in damage and post-stroke repair, which could lead to personalized and precision medicine. > While scientists do not fully understand the biological mechanisms that make mental practice effective, one possible explanation is that visualization of a movement strengthens synaptic connections by repeatedly activating the motor circuitry necessary for that movement. (2010) 3:15763. Characterization of brain-derived extracellular vesicles reveals changes in cellular origin after stroke and enrichment of the prion protein with a potential role in cellular uptake. Harnessing neuroplasticity for clinical applications. > Calmerry is a new teletherapy platform that specializes in online therapy. It is recommended to start rehabilitation as soon as possible so that individuals can take advantage of these increased levels of neuroplasticity. Erickson KI, et al. doi: 10.1177/2396987319831928, PubMed Abstract | CrossRef Full Text | Google Scholar, 2. Spared neural pathways are an essential component of spinal cord injury recovery because damaged neurons in the spinal cord are not capable of regeneration. Fortunately, neuronal networks possess a remarkable capacity for rewiring, especially in the face of damage. Otero-Ortega L, Alonso-Lpez E, Prez-Mato M, Laso-Garca F, Gmez-de Frutos MC, Diekhorst L, et al. Trauma, treatment and Tetris: Video gaming increases hippocampal volume in male patients with combat-related posttraumatic stress disorder. Semin Neurol. Darrell W. Krueger Library Following injury to the brain or spinal cord that induces motor deficits, many physical rehabilitation interventions have been reported to induce functional improvements. Figure 1. Journal of Neurologic Physical Therapy44(2):119-120, April 2020. What is Neuroplasticity and Why is It Important? - BetterUp Medical News Today has strict sourcing guidelines and draws only from peer-reviewed studies, academic research institutions, and medical journals and associations. Seasonal affective disorder is most often associated with winter, but it can occur during the summer too. If youd like to learn more about FitMi, click the button below: Do you have this 15 pages PDF of SCI rehab exercises? Activated mesenchymal stem cells induce recovery following stroke via regulation of inflammation and oligodendrogenesis. A 2017 study of neuroimaging after TBI notes that fMRI can detect changes in thinking skills, emotions, and the course of neuroplasticity after an injury to the brain. Neural correlates of beauty. Your message has been successfully sent to your colleague. What is brain plasticity? All neurons are composed of a cell body, dendrites, and axons. https://openriver.winona.edu/counseloreducationcapstones/113. Copyright 2021 Otero-Ortega, Gutirrez-Fernndez and Dez-Tejedor. Consequently, brain signals cannot travel past the damage, resulting in the complete loss of sensation and motor control below the level of injury. A TBI differs from a nontraumatic brain injury, also known as an acquired brain injury. You want to consistently challenge yourself to stay engaged, but not make the task at hand so overwhelming or frustrating that you want to quit. Listening to music may also help change how different parts of the brain communicate and respond to sounds. Neuroplasticity. (2018). The Tetris group saw reductions in PTSD, depression, and anxiety symptoms and growth in the hippocampus. While you can achieve massed practice with a written sheet of exercises, it can be tough to stick with it consistently and consistency is key to recovery. Beatrice Awasthi is a PhD student in Biological and Biomedical Sciences at Harvard Medical School. Changes in white-matter connectivity in late second language learners: Evidence from diffusion tensor imaging. For these skills, practice makes perfect or, at least, enhances mastery and leaves its mark within the networks of the brain. This enhances the synapse over time in accordance with the idea by Konorski and Hebb. What does this mean for users? Change that can influence the brain comes in several forms. A full recovery from a mild TBI can be expected in about 3 months. (2023). 507.457.5140 | The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Rehabilitation approaches such as task-oriented training that emphasize high repetition and challenge have been shown to facilitate recovery of mobility and function in neurological populations, but responses are varied and residual deficits often remain.5,6 There is still much to be learned about how to deliver the best interventions to optimize nervous system adaptive neuroplasticity and learning that ultimately lead to optimal functional recovery.
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