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Session 301: Rerouting Neural Pathways: Advancing Pediatric Function Through Neuroplasticity

Karen Pryor PhD, PT, DPT

Leading the Way in Continuing Education and Professional Development. www.Vyne.com

Why is neuroplasticity needed?

Approximately 95% of the children we treat have a neurological injury or abnormality.

When there is an injury or an omission of part of the brain…

We have to treat and engage the lower centers to make changes, new connections

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Frontal lobe damage - 1848

Newtonian Physics To Quantum Physics

Symptom Versus Cause

Treating the symptoms only - is a slow process

Treating the cause and the symptoms speeds development and function

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Head to Toe AssessmentHistory – Images

Primitive reflexes

Tone Qualities

Cranial nerves

Balance

Vision

Symmetry

Developmental level

Neonatal Abstinence Syndrome

Connected to Those That Formed Before

During neuronal migration in a fetus, the 6 layers of the cortex are built

Growth and development of the brain is from innermost to outermost

Migrating neurons travel outward through nearby lower level cells

Synapses form between the axon of one neuron and dendrite of another

Connections to everything

Skilled early treatment is vital

Area X – Neuroplasticity and Novelty

Pasko Rakic – Yale University School of Medicine

Area 17 and 18 – Primary visual cortex

Area that must receive sensory information from the eyes before visual association cortex tells us what we see and how we feel about it.

Rakic’s team removing part or all of the optic nerve during development yeilds: Thalamus that relays information from retina to primary visual cortex is smaller

Area 17 is smaller – due to lack of stimulation

Area 18 no change in area size

Area X – new area, hybrid of the two, capable of novel functioning

https://www.ncbi.nlm.nih.gov/books/NBK234146/

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Neuroplasticity is a Tool We Can Use

If you don’t use it….

Typical Infant is born with100 billion neurons

Fetal brain grows 250.000 nerve cells per minute

Can develop 100 trillion interconnections

If activities are novel, synapses feed connections

Sense of smell and stem cell formation

Sense of smell and stem cell formation

Through neurogenesis, cells are generated in the subventricular zone of the brain

Adult born stem cells travel the rostral migratory stream to the olfactory bulb

Neurons in the olfactory bulb sort information and send novel information to the rest of the brain

https://www.nih.gov/news-events/news-releases/scientists-sniff-out-unexpected-role-stem-cells-brain

Smell and the Brain – NIH 2014

The sense of smell

Makes new stem cells

Than means more connections can develop

More function

Champion mind – champion body

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Neurological Examination

Find out what is working

Find out what is not working

Rewire to promote function

Hebb principle

What fires together – wires together

Multi-sensational learning modes

Therapists treat infants and children through sensation

Correction is through feedback loops

Information that enters the brain is sensory

We try to leave hands and feet open to experience their environment unless there are misalignments or deformities

3 Dimensional sensation

3-dimentional stimulation assists in the child recognizing their body parts related to their neck and trunk

If they know where they are…

Stimulate in sequence of development Head

Neck

Trunk

Arms – hands

Legs – feet

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Constrain induced therapy

Edward Taab

If we restrict use of the “functional arm” then the dysfunctional arm will improve

This is through neuroplasticity

Bracing and CIT?

Asleep Brain

Conscious brain is asleep

Changes in spastic responses

Covering hands, feet and ankles

The infant and child requires stimulation to add connections for additional function.

The brain of an infant adds brain connections through sensory and motor activities

Rotation is one of the essential requirements to start and stop movements

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Changing the Brain and the Use of Bracing

If hands and feet are covered, stimulation is restricted and new connections are not formed

Goal to increase strength and active functional movement

Consider static and dynamic bracing principles

The brain remembers what ever they experience the most

1 hour stimulation to hands and feet or bracing for 8 hours?

Neonatal abstinence syndrome

The sensation may be altered

Learning may decreased due to poor interaction with therapist and environmental stimulation

Sensation is key to learning

Intensive teaching to the caregiver is necessary

PT phone home program

Brain stem

https://upload.wikimedia.org/wikipedia/commons/e/e0/Blausen_0114_BrainstemAnatomy.png

Homeostasis

Relay – Sensory - Motor

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Strength is different than tone

Low tone – gravity takes over movements

Difficult to move and raise arms and legs while laying on back

High tone – changes in position related to gravity and touch

Invisible restrictions hold back movements

Primitive reflexes travel in gangs

Primitive reflexes

We always have them

Strength is present

Children may retain primitive reflexes

Neuroplasticity techniques assist in changing the voluntary function of the infant and child

Change the Low Tone

If we could just change the tone

The child would develop at a typical rate

Low and high tone are successfully treated through neuroplasticity techniques

Neuroplasticity reinforces sensory integration and nervous system connections for development

Child with Down Syndrome

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High tone – Stroke, Cerebral Palsy

Cerebellum Connections

Spinocerebellum

Cerebrocerebellum

Vestibulocerebellum - coordinates information with vision and sensation.

Motor learning and coordination of movements, spatial orientation, posture, balance and speech

Plasticity: In a single cerebellar module

can be as many as a billion parallel fibers

converge onto a group of less than 50 deep nuclear cells

nuclear cells are adjustable in neuroplasticity.

Boyden ES, Katoh A, Raymond JL (2004). "Cerebellum-dependent learning: the role of multiple plasticity mechanisms". Annu. Rev. Neurosci. 27: 581–609.

Feedback loops – Sensory and Motor corrections

Primitive reflex responses

Balance

Tremors

Nystagmus

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Occipital Lobe

https://en.wikipedia.org/wiki/Occipital_lobe#/media/File:Slide3aa.JPG

Sight

Vision

Visual data

Routes to other areas of brain for identification and memory

Visual processing of the mammal brain

Rerouting information for vision is through senses.

Vision development

Vision connects to 85% of all the brain connections

Alignment of eyes allows 3 dimensional vision

Visual tracking is important to safety and reading

Vision impairment

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Idiopathic Toe walking

Where they are looking ? Nose up – Toes up / Nose down – Toes down

Helmets

Covering peripheral vision decreased stimulation and connections of brain cells

Firing pathways feeds nerve cells and helps them thrive

Without novel stimulation they are pruned

Parietal Lobe

Integrates sensory information Sense of touch

Mechanoreception

Somatosensory cortex

Proprioception – spatial sense and navigation

Dorsal stream from visual system

Skin Touch

Temperature

Pain relay through thalamusSchenk, Thomas; McIntosh, Robert D. (2010). "Do we have independent visual streams for perception and action?". Cognitive Neuroscience. 1(1): 52–62.

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Temporal Lobe

Primary auditory perception

Visual memory, interpret meaning of visual stimuli, recognition of visual objects

Language – works in tandem with frontal lobe (Broca’s area) speech comprehension

Emotion association – include hippocampus

Hickok, Gregory; Poeppel, David (May 2007). "The Cortical Organization of Speech Processing". Nature Reviews Neuroscience. 8 (5): 393–402. doi:10.1038/nrn2113. PMID 17431404. Retrieved 16

April 2017.

Children That Experienced Strokes

Strength of Primitive Reflexes – Brain Hemorrhage

Vision connects to 85% of the brain

Low and high connections

Key to disengage primitive reflexes

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Frontal Lobe

Emotion

Executive function

Primary motor cortex

Similarities and differences between things and events – safe?

Memories associated with emotion from limbic system – conform them to a situation – round memory in a square hole

Learning moments

The child can learn best when relaxed and calm

Home visits are optimal because toys, blankets and towels can be utilized as part of the treatments

PT phone home program – video parent working with PT and exercises so they can be done at home daily

Brain learns through novel activities and repeated practice

Mammal Brain

Limbic system

Record memories of behaviors that produced agreeable and disagreeable experiences

Responsible for emotions in human beings

Main structures of the limbic brainhippocampusamygdalahypothalamus.

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Sensory - incoming

Suck and swallow relates to primary reflex and survival

Primitive reflexes

See - Visual identification – processing

Objects – hand to mouth – 3 dimensions

Feet on uneven ground

The Development and Shaping of the Brain. Retrieved 041517. Chapter 6. https://www.ncbi.nlm.nih.gov/books/NBK234146/

Motor - outgoing

Visual tracking

Head and neck

Movement arms

Reach and grasp

Movement of legs and feet

Early treatment is key

Earlier treatment begins

Faster the changes occur

Family involvement in home program

Our goals are the same

Change their lives for best function

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Questions?

Karen Pryor PhD, PT, DPT

karenpryorpt@gmail.com