Neuroplasticity
![](http://upload.wikimedia.org/wikipedia/commons/thumb/9/9f/Brain_2.jpg/320px-Brain_2.jpg)
Neuroplasticity, also known as brain plasticity, is an umbrella term that describes lasting change to the brain throughout an animal's life course. The term gained prominence in the latter half of the 20th century, when new research[1] showed many aspects of the brain remain changeable (or "plastic") even into adulthood.[2] This notion contrasts with the previous scientific consensus that the brain develops during a critical period in early childhood, then remains relatively unchangeable (or "static") afterward.[3]
Neuroplastic change can occur at small scales, such as physical changes to individual neurons, or at whole-brain scales, such as cortical remapping in response to injury; however cortical remapping only occurs during a certain time period meaning that if a child were injured and it resulted in brain damage then cortical remapping would most likely occur, however if an adult was injured and it resulted in brain damage, then cortical remapping would not occur since the brain has made the majority of its connections.[4] Behavior, environmental stimuli, thought, and emotions may also cause neuroplastic change,[4] which has significant implications for healthy development, learning, memory, and recovery from brain damage.
Neuroscientists distinguish synaptic plasticity, which refers to changes in how neurons connect to each other, from non-synaptic plasticity, which refers to changes in the neurons themselves.
Localizationism
Dating all the way back to the late 1500s, the study of neurology had utilized the ideology of localizationism, which states that the human brain operates using parts with each strictly designated to a single function, as a platform from which to base all research. Prior to localizationism, the Greeks introduced a more primordial ideology: the idea of the universe functioning as one living organism, translating into our bodily organs being viewed as nothing more than inanimate objects. This belief gained popularity in a time where all logical thought, including the scientific realm, was intertwined with a more extramundane or religious way of thinking. The secular and spiritual worlds of classical human civilization were undoubtedly connected through the church’s efforts, and society commonly accepted its devout and mystic theories.[5] The technology of this time was highly inadequate as well. The methods for treatment of the mentally ill included everything from trepanation (boring holes into one’s skull) to exorcisms. Because technological advancements were not sufficient enough to find the problems with these early theories and methods, the living organism theory ultimately dominated all other concepts of neurological thought. The scientific mindset would remain this way until a newly formed ideology, localizationism, gained traction.
When localizationism arose, the stark contrast to its predecessor advocated for a complete reformation of neurological theories and led to an eruption of scientific exploration, which propelled neurological research into the modern age. Famed astronomer Galileo Galilei is credited with the creation of localizationism. According to Norman Doidge, an esteemed and highly recognized psychiatrist and researcher of neurological studies, Galileo’s studies of space and its celestial bodies led him to believe “all nature functioned as a large cosmic clock” and these bodies “began to explain individual living things, including our bodily organs, mechanistically”.[6] He saw the universe as a giant machine rather than a living organism. When applied to the brain, this means its parts have hardwired functions as a machine has parts designated to a certain area.[6] According to this theory, because functions are fixed, if one part gets damaged it cannot be repaired and this led certain diseases or conditions to be labeled untreatable. This is the problem with localizationism: it leaves no room for new technologies and methods seeking to repair the impaired brain, as opposed to simply controlling the damage done to it.
Neurobiology
One of the fundamental principles of how neuroplasticity functions is linked to the concept of synaptic pruning, the idea that individual connections within the brain are constantly being removed or recreated, largely dependent upon how they are used. This concept is captured in the aphorism, "neurons that fire together, wire together"/"neurons that fire apart, wire apart," summarizing Hebbian theory. If there are two nearby neurons that often produce an impulse simultaneously, their cortical maps may become one. This idea also works in the opposite way, i.e. that neurons which do not regularly produce simultaneous impulses will form different maps.
Cortical maps
Cortical organization, especially for the sensory systems, is often described in terms of maps.[7] For example, sensory information from the foot, projects to one cortical site and the projections from the hand, target another site. As the result of this, somatotopic organization of sensory inputs to the cortex, cortical representation of the body resembles a map (or homunculus).
In the late 1970s and early 1980s, several groups began exploring the impacts of removing portions of the sensory inputs. Michael Merzenich, Jon Kaas and Doug Rasmusson used the cortical map as their dependent variable. They found—and this has been since corroborated by a wide range of labs—that if the cortical map is deprived of its input it will become activated at a later time in response to other, usually adjacent inputs. Merzenich’s (1984) study involved the mapping of owl monkey hands before and after amputation of the third digit. Before amputation, there were five distinct areas, one corresponding to each digit of the experimental hand. Sixty-two days following amputation of the third digit, the area in the cortical map formerly occupied by that digit had been invaded by the previously adjacent second and fourth digit zones. The areas representing digit one and five are not located directly beside the area representing digit three, so these regions remained, for the most part, unchanged following amputation.[8] This study demonstrates that only those regions bordering a certain area will invade it to alter the cortical map. In the somatic sensory system, in which this phenomenon has been most thoroughly investigated, JT Wall and J Xu have traced the mechanisms underlying this plasticity. Re-organization is not cortically emergent, but occurs at every level in the processing hierarchy; this produces the map changes observed in the cerebral cortex.[9]
Merzenich and William Jenkins (1990) initiated studies relating sensory experience, without pathological perturbation, to cortically observed plasticity in the primate somatosensory system, with the finding that sensory sites activated in an attended operant behavior increase in their cortical representation. Shortly thereafter, Ford Ebner and colleagues (1994) made similar efforts in the rodent whisker barrel cortex (also somatic sensory system). These two groups largely diverged over the years. The rodent whisker barrel efforts became a focus for Ebner, Matthew Diamond, Michael Armstrong-James, Robert Sachdev, and Kevin Fox. Great inroads were made in identifying the locus of change as being at cortical synapses expressing NMDA receptors, and in implicating cholinergic inputs as necessary for normal expression. However, the rodent studies were poorly focused on the behavioral end, and Ron Frostig and Daniel Polley (1999, 2004) identified behavioral manipulations as causing a substantial impact on the cortical plasticity in that system.
Merzenich and DT Blake (2002, 2005, 2006) went on to use cortical implants to study the evolution of plasticity in both the somatosensory and auditory systems. Both systems show similar changes with respect to behavior. When a stimulus is cognitively associated with reinforcement, its cortical representation is strengthened and enlarged. In some cases, cortical representations can increase two to threefold in 1–2 days at the time at which a new sensory motor behavior is first acquired, and changes are largely finished within at most a few weeks. Control studies show that these changes are not caused by sensory experience alone: they require learning about the sensory experience, and are strongest for the stimuli that are associated with reward, and occur with equal ease in operant and classical conditioning behaviors.
An interesting phenomenon involving cortical maps is the incidence of phantom limbs. Phantom limbs are experienced by people who have undergone amputations in hands, arms, and legs, but it is not limited to extremities. Although the neurological basis of phantom limbs is still not entirely understood it is believed that cortical reorganization plays an important role.[10]
Norman Doidge, following the lead of Michael Merzenich, separates manifestations of neuroplasticity into adaptations that have positive or negative behavioral consequences. For example, if an organism can recover after a stroke to normal levels of performance, that adaptiveness could be considered an example of "positive plasticity". Changes such as an excessive level of neuronal growth leading to spasticity or tonic paralysis, or an excessive release of neurotransmitters in response to injury which could kill nerve cells, would have to be considered "negative" plasticity. In addition, drug addiction and obsessive-compulsive disorder are deemed examples of "negative plasticity" by Dr. Doidge, as the synaptic rewiring resulting in these behaviors is also highly maladaptive.[10][11]
A 2005 study found that the effects of neuroplasticity occur even more rapidly than previously expected. Medical students' brains were imaged during the period when they were studying for their exams. In a matter of months, the students' gray matter increased significantly in the posterior and lateral parietal cortex.[12]
Applications and example
The adult brain is not entirely "hard-wired" with fixed neuronal circuits. There are many instances of cortical and subcortical rewiring of neuronal circuits in response to training as well as in response to injury. There is solid evidence that neurogenesis (birth of brain cells) occurs in the adult, mammalian brain—and such changes can persist well into old age.[2] The evidence for neurogenesis is mainly restricted to the hippocampus and olfactory bulb, but current research has revealed that other parts of the brain, including the cerebellum, may be involved as well.[13]
There is now ample evidence [citation needed] for the active, experience-dependent re-organization of the synaptic networks of the brain involving multiple inter-related structures including the cerebral cortex. The specific details of how this process occurs at the molecular and ultrastructural levels are topics of active neuroscience research. The manner in which experience can influence the synaptic organization of the brain is also the basis for a number of theories of brain function including the general theory of mind and epistemology referred to as Neural Darwinism. The concept of neuroplasticity is also central to theories of memory and learning that are associated with experience-driven alteration of synaptic structure and function in studies of classical conditioning in invertebrate animal models such as Aplysia.
Treatment of brain damage
A surprising consequence of neuroplasticity is that the brain activity associated with a given function can move to a different location; this can result from normal experience and also occurs in the process of recovery from brain injury. Neuroplasticity is the fundamental issue that supports the scientific basis for treatment of acquired brain injury with goal-directed experiential therapeutic programs in the context of rehabilitation approaches to the functional consequences of the injury.
Neuroplasticity is gaining popularity as a theory that, at least in part, explains improvements in functional outcomes with physical therapy post-stroke. Rehabilitation techniques that have evidence to suggest cortical reorganization as the mechanism of change include constraint-induced movement therapy, functional electrical stimulation, treadmill training with body-weight support, and virtual reality therapy. Robot assisted therapy is an emerging technique, which is also hypothesized to work by way of neuroplasticity, though there is currently insufficient evidence to determine the exact mechanisms of change when using this method.[14]
One group has developed a treatment that includes increased levels of progesterone injections to give to brain-injured patients. "Administration of progesterone after traumatic brain injury[15] (TBI) and stroke reduces edema, inflammation, and neuronal cell death, and enhance spatial reference memory and sensory motor recovery."[16] In their clinical trials, they had a group of severely injured patients that after the three days of progesterone injections had a 60% reduction in mortality.[17] A study published in the New England Journal of Medicine in 2014 detailing the results of a multi-center NIH-funded phase III clinical trial of 882 patients found that treatment of acute traumatic brain injury with the hormone progesterone provides no significant benefit to patients when compared with placebo.[18]
Vision
After decades in which the assumption that binocular vision, in particular stereopsis, had to be achieved in early childhood lest it could never be gained, in recent years the successful improvements in persons with amblyopia, convergence insufficiency or stereo vision anomalies have become prime examples of neuroplasticity; binocular vision improvements and stereopsis recovery are now active areas of scientific and clinical research.[19][20][21]
Treatment of learning difficulties
Michael Merzenich developed a series of "plasticity-based computer programs known as Fast ForWord.[22] FastForWord offers seven brain exercises to help with the language and learning deficits of dyslexia. In a recent study, experimental training was done in adults to see if it would help to counteract the negative plasticity that results from age-related cognitive decline (ARCD). The ET design included six exercises designed to reverse the dysfunctions caused by ARCD in cognition, memory, motor control, and so on. After use of the ET program for 8–10 weeks, there was a "significant increase in task-specific performance."[citation needed] The data collected from the study indicated that a neuroplasticity-based program could notably improve cognitive function and memory in adults with ARCD. However, a systematic meta-analytic review fount that "There is no evidence from the analysis carried out that Fast ForWord is effective as a treatment for children's oral language or reading difficulties." [23]
Sensory prostheses
Neuroplasticity is involved in the development of sensory function. The brain is born immature and it adapts to sensory inputs after birth. In the auditory system, congenital hearing impairment, a rather frequent inborn condition affecting 1 of 1000 newborns, has been shown to affect auditory development, and implantation of a sensory prostheses activating the auditory system has prevented the deficits and induced functional maturation of the auditory system [24] Due to a sensitive period for plasticity, there is also a sensitive period for such intervention within the first 2–4 years of life. Consequently, in prelingually deaf children, early cochlear implantation as a rule allows to learn mother language and acquire acoustic communication.[25]
Phantom limbs
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The experience of phantom limbs is a phenomenon in which a person continues to feel pain or sensation within a part of their body which has been amputated. This is strangely common, occurring in 60–80% of amputees.[26] An explanation for this refers to the concept of neuroplasticity, as the cortical maps of the removed limbs are believed to have become engaged with the area around them in the postcentral gyrus. This results in activity within the surrounding area of the cortex being misinterpreted by the area of the cortex formerly responsible for the amputated limb.
The relationship between phantom limbs and neuroplasticity is a complex one. In the early 1990s V.S. Ramachandran theorized that phantom limbs were the result of cortical remapping. However, in 1995 Herta Flor and her colleagues demonstrated that cortical remapping occurs only in patients who have phantom pain.[27] Her research showed that phantom limb pain (rather than referred sensations) was the perceptual correlate of cortical reorganization.[28] This phenomenon is sometimes referred to as maladaptive plasticity.
In 2009 Lorimer Moseley and Peter Brugger carried out a remarkable experiment in which they encouraged arm amputee subjects to use visual imagery to contort their phantom limbs into impossible configurations. Four of the seven subjects succeeded in performing impossible movements of the phantom limb. This experiment suggests that the subjects had modified the neural representation of their phantom limbs and generated the motor commands needed to execute impossible movements in the absence of feedback from the body.[29] The authors stated that:"In fact, this finding extends our understanding of the brain's plasticity because it is evidence that profound changes in the mental representation of the body can be induced purely by internal brain mechanisms—the brain truly does change itself."
Chronic pain
Individuals who suffer from chronic pain experience prolonged pain at sites that may have been previously injured, yet are otherwise currently healthy. This phenomenon is related to neuroplasticity due to a maladaptive reorganization of the nervous system, both peripherally and centrally. During the period of tissue damage, noxious stimuli and inflammation cause an elevation of nociceptive input from the periphery to the central nervous system. Prolonged nociception from periphery will then elicit a neuroplastic response at the cortical level to change its somatotopic organization for the painful site, inducing central sensitization.[30] For instance, individuals experiencing complex regional pain syndrome demonstrate a diminished cortical somatotopic representation of the hand contralaterally as well as a decreased spacing between the hand and the mouth.[31] Additionally, chronic pain has been reported to significantly reduce the volume of grey matter in the brain globally, and more specifically at the prefrontal cortex and right thalamus.[32] However, following treatment, these abnormalities in cortical reorganization and grey matter volume are resolved, as well as their symptoms. Similar results have been reported for phantom limb pain,[33] chronic low back pain[34] and carpal tunnel syndrome.[35]
Meditation
A number of studies have linked meditation practice to differences in cortical thickness or density of gray matter.[36][37][38] One of the most well-known studies to demonstrate this was led by Sara Lazar, from Harvard University, in 2000.[39] Richard Davidson, a neuroscientist at the University of Wisconsin, has led experiments in cooperation with the Dalai Lama on effects of meditation on the brain. His results suggest that long-term, or short-term practice of meditation results in different levels of activity in brain regions associated with such qualities as attention, anxiety, depression, fear, anger, the ability of the body to heal itself, and so on. These functional changes may be caused by changes in the physical structure of the brain.[40][41][42][43]
Fitness and exercise
Aerobic exercise promotes adult neurogenesis by increasing the production of neurotrophic factors (compounds which promote the growth or survival of neurons), such as brain-derived neurotrophic factor (BDNF), insulin-like growth factor 1 (IGF-1), and vascular endothelial growth factor (VEGF).[44][45][46] Exercise-induced neurogenesis in the hippocampus is associated with measurable improvements in spatial memory.[47][48][49][50] Consistent aerobic exercise over a period of several months induces marked clinically significant improvements in executive function (i.e., the "cognitive control" of behavior) and increased gray matter volume in multiple brain regions, particularly those which give rise to cognitive control.[46][47][51][52] The brain structures that show the greatest improvements in gray matter volume in response to aerobic exercise are the prefrontal cortex and hippocampus;[46][47][48] moderate improvements seen in the anterior cingulate cortex, parietal cortex, cerebellum, caudate nucleus, and nucleus accumbens.[46][47][48] Higher physical fitness scores (measured by VO2 max) are associated with better executive function, faster processing speed, and greater volume of the hippocampus, caudate nucleus, and nucleus accumbens.[47]
Human echolocation
Human echolocation is a learned ability for humans to sense their environment from echoes. This ability is used by some blind people to navigate their environment and sense their surroundings in detail. Studies in 2010[53] and 2011[54] using functional magnetic resonance imaging techniques have shown that parts of the brain associated with visual processing are adapted for the new skill of echolocation. Studies with blind patients, for example, suggest that the click-echoes heard by these patients were processed by brain regions devoted to vision rather than audition.[55]
ADHD stimulants
Reviews of magnetic resonance imaging (MRI) studies suggest that the long-term treatment of attention deficit hyperactivity disorder (ADHD) with stimulants, such as amphetamine or methylphenidate, decreases abnormalities in brain structure and function found in subjects with ADHD, and improves function in several parts of the brain, such as the right caudate nucleus of the basal ganglia.[56][57][58]
In animals
In a single lifespan, individuals in an animal species may encounter various changes in brain morphology. Many of these differences are caused by the release of hormones in the brain; others are the product of evolutionary factors or developmental stages.[59][60][61][62] Some changes occur seasonally in species to enhance or generate response behaviors.
Seasonal brain changes
Changing brain behavior and morphology to suit other seasonal behaviors is relatively common in animals.[63] These changes can improve the chances of mating during breeding season.[59][60][61][63][64][65] Examples of seasonal brain morphology change can be found within many classes and species.
Within the class Aves, black-capped chickadees experience an increase in the volume of the hippocampus and strength of neural connections to the hippocampus during fall months.[66][67] This change in brain morphology for spatial memory within the hippocampus is not limited to birds, and affects some rodents and amphibians.[63] In songbirds, many song control nuclei in the brain increase in size during mating season.[63] Among birds, changes in brain morphology to influence song patterns, frequency, and volume are common.[68] Gonadotropin-releasing hormone (GnRH) immunoreactivity, or the reception of the hormone, is lowered in European starlings exposed to longer periods of light during the day.[59][60]
The California sea hare, a gastropod, has more successful inhibition of egg-laying hormones outside of mating season due to increased effectiveness of inhibitors in the brain.[61] Changes to the inhibitory nature of regions of the brain can also be found in humans and other mammals.[62] In the amphibian Bufo japonicus, part of the amygdala is larger before breeding and during hibernation than it is after breeding.[64]
Seasonal brain variation occurs within many mammals. Part of the hypothalamus of the common ewe is more receptive to GnRH during breeding season than at other times of the year.[65] Humans experience a change in the "size of the hypothalamic suprachiasmatic nucleus and vasopressin-immunoreactive neurons within it"[62] during the fall, when these parts are larger. In the spring, both reduce in size.[69]
Operation of brain-machine interfaces
Brain-machine interface (BMI) is a rapidly developing field of neuroscience. According to the results obtained by Mikhail Lebedev, Miguel Nicolelis and their colleagues,[70] operation of BMIs results in incorporation of artificial actuators into brain representations. The scientists showed that modifications in neuronal representation of the monkey's hand and the actuator that was controlled by the monkey brain occurred in multiple cortical areas while the monkey operated a BMI. In these single day experiments, monkeys initially moved the actuator by pushing a joystick. After mapping out the motor neuron ensembles, control of the actuator was switched to the model of the ensembles so that the brain activity, and not the hand, directly controlled the actuator. The activity of individual neurons and neuronal populations became less representative of the animal's hand movements while representing the movements of the actuator. Presumably as a result of this adaptation, the animals could eventually stop moving their hands yet continue to operate the actuator. Thus, during BMI control, cortical ensembles plastically adapt, within tens of minutes, to represent behaviorally significant motor parameters, even if these are not associated with movements of the animal's own limb.
Active laboratory groups include those of John Donoghue at Brown, Richard Andersen at Caltech, Krishna Shenoy at Stanford, Nicholas Hatsopoulos of University of Chicago, Andy Schwartz at University of Pittsburgh, Sandro Mussa-Ivaldi at Northwestern and Miguel Nicolelis at Duke. Donoghue and Nicolelis' groups have independently shown that animals can control external interfaces in tasks requiring feedback, with models based on activity of cortical neurons, and that animals can adaptively change their minds to make the models work better. Donoghue's group took the implants from Richard Normann's lab at Utah (the "Utah" array), and improved it by changing the insulation from polyimide to parylene-c, and commercialized it through the company Cyberkinetics. These efforts are the leading candidate for the first human trials on a broad scale for motor cortical implants to help quadriplegic or locked-in patients communicate with the outside world.
Traumatic brain injury research
Randy Nudo's group found that if a small stroke (an infarction) is induced by obstruction of blood flow to a portion of a monkey’s motor cortex, the part of the body that responds by movement will move when areas adjacent to the damaged brain area are stimulated. In one study, intracortical microstimulation (ICMS) mapping techniques were used in nine normal monkeys. Some underwent ischemic-infarction procedures and the others, ICMS procedures. The monkeys with ischemic infarctions retained more finger flexion during food retrieval and after several months this deficit returned to preoperative levels.[71] With respect to the distal forelimb representation, "postinfarction mapping procedures revealed that movement representations underwent reorganization throughout the adjacent, undamaged cortex."[71] Understanding of interaction between the damaged and undamaged areas provides a basis for better treatment plans in stroke patients. Current research includes the tracking of changes that occur in the motor areas of the cerebral cortex as a result of a stroke. Thus, events that occur in the reorganization process of the brain can be ascertained. Nudo is also involved in studying the treatment plans that may enhance recovery from strokes, such as physiotherapy, pharmacotherapy, and electrical-stimulation therapy.
Jon Kaas, a professor at Vanderbilt University, has been able to show "how somatosensory area 3b and ventroposterior (VP) nucleus of the thalamus are affected by longstanding unilateral dorsal-column lesions at cervical levels in macaque monkeys."[72] Adult brains have the ability to change as a result of injury but the extent of the reorganization depends on the extent of the injury. His recent research focuses on the somatosensory system, which involves a sense of the body and its movements using many senses. Usually when people damage the somatosensory cortex, impairment of the body perceptions are experienced. He is trying to see how these systems (somatosensory, cognitive, motor systems) are plastic as a result of injury.[72]
One of the most recent applications of neuroplasticity involves work done by a team of doctors and researchers at Emory University, specifically Dr. Donald Stein (who has been in the field for over three decades)[73] and Dr. David Wright. This is the first treatment in 40 years that has significant results in treating traumatic brain injuries while also incurring no known side effects and being cheap to administer.[17] Dr. Stein noticed that female mice seemed to recover from brain injuries better than male mice. Also in females, he noticed that at certain points in the estrus cycle females recovered even more. After lots of research, they attributed this difference due to the levels of progesterone. The highest level of progesterone present led to the fastest recovery of brain injury in these mice.
History
Origin
The term "plasticity" was first applied to behavior in 1890 by William James in The Principles of Psychology.[74] The first person to use the term neural plasticity appears to have been the Polish neuroscientist Jerzy Konorski.[1][75]
In 1793, Italian anatomist Michele Vicenzo Malacarne described experiments in which he paired animals, trained one of the pair extensively for years, and then dissected both. He discovered that the cerebellums of the trained animals were substantially larger. But, these findings were eventually forgotten.[76] The idea that the brain and its functions are not fixed throughout adulthood was proposed in 1890 by William James in The Principles of Psychology, though the idea was largely neglected.[74] Until around the 1970s, neuroscientists believed that brain's structure and function was essentially fixed throughout adulthood.[77]
The term has since seen broadly applied:
Given the central importance of neuroplasticity, an outsider would be forgiven for assuming that it was well defined and that a basic and universal framework served to direct current and future hypotheses and experimentation. Sadly, however, this is not the case. While many neuroscientists use the word neuroplasticity as an umbrella term it means different things to different researchers in different subfields ... In brief, a mutually agreed upon framework does not appear to exist.[78]
Research and discovery
In 1923, Karl Lashley conducted experiments on rhesus monkeys which demonstrated changes in neuronal pathways, which he concluded to be evidence of plasticity, although despite this, as well as further examples of research suggesting this, the idea of neuroplasticity was not widely accepted by neuroscientists.
In 1945, Justo Gonzalo concluded from his research of brain dynamics, that, contrary to the activity of the projection areas, the "central" cortical mass (more or less equidistant from the visual, tactile and auditive projection areas), would be a "maneuvering mass", rather unspecific or multisensory, with capacity to increase neural excitability and re-organize the activity by means of plasticity properties.[79] He gives as a first example of adaptation, to see upright with reversing glasses in the Stratton experiment,[80] and specially, several first-hand brain injuries cases in which he observed dynamic and adaptive properties in their disorders, in particular in the inverted perception disorder [e.g., see pp 260–62 Vol. I (1945), p 696 Vol. II (1950)].[79] He stated that a sensory signal in a projection area would be only an inverted and constricted outline that would be magnified due to the increase in recruited cerebral mass, and re-inverted due to some effect of brain plasticity, in more central areas, following a spiral growth.[81]
A significant evidence was produced in the 1960s and after, notably from scientists including Paul Bach-y-Rita, Michael Merzenich along with Jon Kaas, as well as several others.[77][82]
In the 1960s, Paul Bach-y-Rita invented a device that allowed blind people to read, perceive shadows, and distinguish between close and distant objects. This "machine was one of the first and boldest applications of neuroplasticity."[10] The patient sat in an electrically stimulated chair that had a large camera behind it which scanned the area, sending electrical signals of the image to four hundred vibrating stimulators on the chair against the patient’s skin. The six subjects of the experiment were eventually able to recognize a picture of the supermodel Twiggy.[10]
It must be emphasized that these people were congenitally blind and had previously not been able to see. Bach-y-Rita believed in sensory substitution; if one sense is damaged, your other senses can sometimes take over. He thought the skin and its touch receptors could act as a retina (using one sense for another[83]). In order for the brain to interpret tactile information and convert it into visual information, it has to learn something new and adapt to the new signals. The brain's capacity to adapt implied that it possessed plasticity. He thought, "We see with our brains, not with our eyes."[10]
A tragic stroke that left his father paralyzed inspired Bach-y-Rita to study brain rehabilitation. His brother, a physician, worked tirelessly to develop therapeutic measures which were so successful that the father recovered complete functionality by age 68 and was able to live a normal, active life which even included mountain climbing. "His father’s story was firsthand evidence that a ‘late recovery’ could occur even with a massive lesion in an elderly person."[10] He found more evidence of this possible brain reorganization with Shepherd Ivory Franz's work.[84] One study involved stroke patients who were able to recover through the use of brain stimulating exercises after having been paralyzed for years. "Franz understood the importance of interesting, motivating rehabilitation: ‘Under conditions of interest, such as that of competition, the resulting movement may be much more efficiently carried out than in the dull, routine training in the laboratory’(Franz, 1921, pg.93)."[85] This notion has led to motivational rehabilitation programs that are used today.
Eleanor Maguire documented changes in hippocampal structure associated with acquiring the knowledge of London’s layout in local taxi drivers.[86][87][88] A redistribution of grey matter was indicated in London Taxi Drivers compared to controls. This work on hippocampal plasticity not only interested scientists, but also engaged the public and media world-wide.
Michael Merzenich is a neuroscientist who has been one of the pioneers of neuroplasticity for over three decades. He has made some of "the most ambitious claims for the field – that brain exercises may be as useful as drugs to treat diseases as severe as schizophrenia – that plasticity exists from cradle to the grave, and that radical improvements in cognitive functioning – how we learn, think, perceive, and remember are possible even in the elderly."[10] Merzenich’s work was affected by a crucial discovery made by David Hubel and Torsten Wiesel in their work with kittens. The experiment involved sewing one eye shut and recording the cortical brain maps. Hubel and Wiesel saw that the portion of the kitten’s brain associated with the shut eye was not idle, as expected. Instead, it processed visual information from the open eye. It was "…as though the brain didn’t want to waste any ‘cortical real estate’ and had found a way to rewire itself."[10]
This implied neuroplasticity during the critical period. However, Merzenich argued that neuroplasticity could occur beyond the critical period. His first encounter with adult plasticity came when he was engaged in a postdoctoral study with Clinton Woosley. The experiment was based on observation of what occurred in the brain when one peripheral nerve was cut and subsequently regenerated. The two scientists micromapped the hand maps of monkey brains before and after cutting a peripheral nerve and sewing the ends together. Afterwards, the hand map in the brain that was expected to be jumbled was nearly normal. This was a substantial breakthrough. Merzenich asserted that "if the brain map could normalize its structure in response to abnormal input, the prevailing view that we are born with a hardwired system had to be wrong. The brain had to be plastic."[10]
Notable studies
Hubel and Wiesel had demonstrated that ocular dominance columns in the lowest neocortical visual area, V1, remained largely immutable after the critical period in development.[89] Researchers also studied critical periods with respect to language; the resulting data suggested that sensory pathways were fixed after the critical period. However, studies determined that environmental changes could alter behavior and cognition by modifying connections between existing neurons and via neurogenesis in the hippocampus and in other parts of the brain, including in the cerebellum.[13]
Decades of research have shown that substantial changes occur in the lowest neocortical processing areas, and that these changes can profoundly alter the pattern of neuronal activation in response to experience. Neuroscientific research indicates that experience can actually change both the brain's physical structure (anatomy) and functional organization (physiology). As of 2014[update], neuroscientists are engaged in a reconciliation of critical-period studies (demonstrating the immutability of the brain after development) with the more recent research showing how the brain can, and does, change in response to hitherto unsuspected stimuli.[90]
See also
- Activity-dependent plasticity
- Environmental enrichment (neural)
- Neural backpropagation
- Neuroplastic effects of pollution
- Kinesiology
References
- ^ a b Livingston, R.B. (1966) Brain mechanisms in conditioning and learning. Neurosciences Research Program Bulletin 4(3):349-354.
- ^ a b Rakic, P. (January 2002). "Neurogenesis in adult primate neocortex: an evaluation of the evidence". Nature Reviews Neuroscience. 3 (1): 65–71. doi:10.1038/nrn700. PMID 11823806.
- ^ Pascual-Leone A., Amedi A., Fregni F., Merabet L. B. (2005). "The plastic human brain cortex". Annual Review of Neuroscience. 28: 377–401. doi:10.1146/annurev.neuro.27.070203.144216.
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: CS1 maint: multiple names: authors list (link) - ^ a b Pascual-Leone A., Freitas C., Oberman L., Horvath J. C., Halko M., Eldaief M.; et al. (2011). "Characterizing brain cortical plasticity and network dynamics across the age-span in health and disease with TMS-EEG and TMS-fMRI". Brain Topography. 24: 302–315. doi:10.1007/s10548-011-0196-8.
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: CS1 maint: multiple names: authors list (link) - ^ "The Greek Era and the Beginning Disagreements between Science and Religion". Spafer. Spafer.
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(help) - ^ Tarumi T, Zhang R (January 2014). "Cerebral hemodynamics of the aging brain: risk of Alzheimer disease and benefit of aerobic exercise". Front Physiol. 5: 6. doi:10.3389/fphys.2014.00006. PMC 3896879. PMID 24478719.
Exercise-related improvements in brain function and structure may be conferred by the concurrent adaptations in vascular function and structure. Aerobic exercise increases the peripheral levels of growth factors (e.g., BDNF, IFG-1, and VEGF) which cross the blood-brain barrier (BBB) and stimulate neurogenesis and angiogenesis (Trejo et al., 2001; Lee et al., 2002; Fabel et al., 2003; Lopez-Lopez et al., 2004).
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: CS1 maint: unflagged free DOI (link) - ^ Szuhany KL, Bugatti M, Otto MW (October 2014). "A meta-analytic review of the effects of exercise on brain-derived neurotrophic factor". J Psychiatr Res. 60C: 56–64. doi:10.1016/j.jpsychires.2014.10.003. PMC 4314337. PMID 25455510.
Consistent evidence indicates that exercise improves cognition and mood, with preliminary evidence suggesting that brain-derived neurotrophic factor (BDNF) may mediate these effects. The aim of the current meta-analysis was to provide an estimate of the strength of the association between exercise and increased BDNF levels in humans across multiple exercise paradigms. We conducted a meta-analysis of 29 studies (N = 1111 participants) examining the effect of exercise on BDNF levels in three exercise paradigms: (1) a single session of exercise, (2) a session of exercise following a program of regular exercise, and (3) resting BDNF levels following a program of regular exercise. Moderators of this effect were also examined. Results demonstrated a moderate effect size for increases in BDNF following a single session of exercise (Hedges' g = 0.46, p < 0.001). Further, regular exercise intensified the effect of a session of exercise on BDNF levels (Hedges' g = 0.59, p = 0.02). Finally, results indicated a small effect of regular exercise on resting BDNF levels (Hedges' g = 0.27, p = 0.005). ... Effect size analysis supports the role of exercise as a strategy for enhancing BDNF activity in humans
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: CS1 maint: multiple names: authors list (link) - ^ a b c d Gomez-Pinilla F, Hillman C (January 2013). "The influence of exercise on cognitive abilities". Compr Physiol. 3 (1): 403–428. doi:10.1002/cphy.c110063. PMC 3951958. PMID 23720292.
A second recent meta-analysis (162) corroborated Colcombe and Kramer's (30) findings, in that aerobic exercise was related to attention, processing speed, memory, and cognitive control. ... Normal aging results in the loss of brain tissue (31), with markedly larger tissue loss evidenced in the frontal, temporal, and parietal cortices (16, 58, 149). As such, cognitive functions subserved by these brain regions (such as those involved in cognitive control and memory) are expected to decay more dramatically than other aspects of cognition. Specifically, age-related decreases in gray matter volume have been associated with decrements in a variety of cognitive control processes. ... Decreases in gray matter volume may result from several factors including loss in the number of neurons, neuronal shrinkage, reduction in dendritic arborization, and alterations in glia (158). Further, decreases in white matter (brain tissue composed primarily of myelinated nerve fibers) volume, which represent changes in connectivity between neurons, also occur as a result of aging. Loss of white matter volume further relates to performance decrements on a host of cognitive tasks ... aerobic fitness relates to larger hippocampal volume (23) and better relational memory performance (24), during preadolescent childhood. ... Specifically, those assigned to the aerobic training group demonstrated increases in gray matter in the frontal lobes, including the dorsal anterior cingulate cortex (ACC), supplementary motor area, middle frontal gyrus, dorsolateral region of the right inferior frontal gyrus, and the left superior temporal lobe (32). White matter volume changes were also evidenced for the aerobic fitness group with increases in white matter tracts within the anterior third of the corpus callosum (32). ... In addition, aerobic fitness has been shown to promote better functioning of brain, especially in neural networks involved in cognitive control of inhibition and attention (33). ... In addition to BDNF, the actions of IGF-1 and vascular endothelial growth factor (VEGF) (54) are considered essential for the angiogenic and neurogenic effects of exercise in the brain. ... Randomized and crossover clinical trials demonstrate the efficacy of aerobic or resistance training exercise (2–4 months) as a treatment for depression in both young and older individuals. ... exercise seems to have both preventative and therapeutic effects on the course of depression
- ^ a b c d e Erickson KI, Leckie RL, Weinstein AM (September 2014). "Physical activity, fitness, and gray matter volume". Neurobiol. Aging. 35 Suppl 2: S20–528. doi:10.1016/j.neurobiolaging.2014.03.034. PMC 4094356. PMID 24952993. Retrieved 9 December 2014.
We conclude that higher cardiorespiratory fitness levels are routinely associated with greater gray matter volume in the prefrontal cortex and hippocampus and less consistently in other regions. We also conclude that physical activity is associated with greater gray matter volume in the same regions that are associated with cardiorespiratory fitness including the prefrontal cortex and hippocampus. ... Meta-analyses (Colcombe and Kramer, 2003; Smith et al., 2010) suggest that the effects of exercise on the brain might not be uniform across all regions and that some brain areas, specifically those areas supporting executive functions, might be more influenced by participation in exercise than areas not as critically involved in executive functions. ... The effects appear to be general in the sense that many different cognitive domains are improved after several months of aerobic exercise, but specific in the sense that executive functions are improved more than other cognitive domains. ... physical activity and exercise may reduce the risk for AD (Barnes and Yaffe, 2011; Podewils et al., 2005; Sofi et al., 2011) ... Erickson et al. (2010) reported that greater amounts of physical activity were associated with greater gray matter volume 9-years later in the prefrontal cortex, anterior cingulate, parietal cortex, cerebellum, and hippocampus. ... higher fitness levels (VO2max) were associated with larger hippocampal volumes, better executive function, and faster processing speed. ... Verstynen et al. (2012) examined the association between cardiorespiratory fitness levels (VO2max) and the size of the basal ganglia ... Verstynen et al. (2012) found that higher fitness levels were associated with greater volume of the caudate nucleus and nucleus accumbens, and in turn, greater volumes were associated with better performance on a task-switching paradigm. ... That is, higher physical activity levels mitigated the detrimental effects of lifetime stress on the size of the hippocampus. ... The few randomized interventions published thus far have found results highly overlapping with the cross-sectional studies and suggest that the prefrontal cortex and hippocampus remain pliable in late life and that moderate intensity exercise for 6 months–1 year is sufficient for changing the size of these areas.
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: CS1 maint: multiple names: authors list (link) - ^ a b c Erickson KI, Miller DL, Roecklein KA (2012). "The aging hippocampus: interactions between exercise, depression, and BDNF". Neuroscientist. 18 (1): 82–97. doi:10.1177/1073858410397054. PMC 3575139. PMID 21531985.
Late adulthood is associated with increased hippocampal atrophy and dysfunction. ... However, there is strong evidence that decreased BDNF is associated with age-related hippocampal dysfunction, memory impairment, and increased risk for depression, whereas increasing BDNF by aerobic exercise appears to ameliorate hippocampal atrophy, improve memory function, and reduce depression. ... For example, longitudinal studies have reported between 1% and 2% annual hippocampal atrophy in adults older than 55 years without dementia ... Over a nine-year period, greater amounts of physical activity in the form of walking are associated with greater gray matter volume in several regions including prefrontal, temporal, and hippocampal areas. ... The prefrontal cortex and hippocampus deteriorate in late adulthood, preceding and leading to deficits in executive and memory function. We examined in this review the evidence that age-related changes in BDNF might at least partially explain hippocampal atrophy and increased risk for memory impairment. We can conclude that 1) decreases in BDNF protein expression are associated with poorer hippocampal function and increased rates of geriatric depression and AD. ... 3) Aerobic exercise enhances executive and memory function and reduces hippocampal atrophy in late adulthood, and this may be partially mediated through a BDNF pathway.
- ^ Lees C, Hopkins J (2013). "Effect of aerobic exercise on cognition, academic achievement, and psychosocial function in children: a systematic review of randomized control trials". Prev Chronic Dis. 10: E174. doi:10.5888/pcd10.130010. PMC 3809922. PMID 24157077.
This omission is relevant, given the evidence that aerobic-based physical activity generates structural changes in the brain, such as neurogenesis, angiogenesis, increased hippocampal volume, and connectivity (12,13). In children, a positive relationship between aerobic fitness, hippocampal volume, and memory has been found (12,13). ... Mental health outcomes included reduced depression and increased self-esteem, although no change was found in anxiety levels (18). ... This systematic review of the literature found that APA is positively associated with cognition, academic achievement, behavior, and psychosocial functioning outcomes. Importantly, Shephard also showed that curriculum time reassigned to APA still results in a measurable, albeit small, improvement in academic performance (24). ... The actual aerobic-based activity does not appear to be a major factor; interventions used many different types of APA and found similar associations. In positive association studies, intensity of the aerobic activity was moderate to vigorous. The amount of time spent in APA varied significantly between studies; however, even as little as 45 minutes per week appeared to have a benefit.
- ^ Carvalho A, Rea IM, Parimon T, Cusack BJ (2014). "Physical activity and cognitive function in individuals over 60 years of age: a systematic review". Clin Interv Aging. 9: 661–682. doi:10.2147/CIA.S55520. PMC 3990369. PMID 24748784.
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: CS1 maint: unflagged free DOI (link) - ^ Guiney H, Machado L (February 2013). "Benefits of regular aerobic exercise for executive functioning in healthy populations". Psychon Bull Rev. 20 (1): 73–86. doi:10.3758/s13423-012-0345-4. PMID 23229442.
Executive functions are strategic in nature and depend on higher-order cognitive processes that underpin planning, sustained attention, selective attention, resistance to interference, volitional inhibition, working memory, and mental flexibility ... Data to date from studies of aging provide strong evidence of exercise-linked benefits related to task switching, selective attention, inhibition of prepotent responses, and working memory capacity; furthermore, cross-sectional fitness data suggest that working memory updating could potentially benefit as well. In young adults, working memory updating is the main executive function shown to benefit from regular exercise, but cross-sectional data further suggest that task-switching and post-error performance may also benefit. In children, working memory capacity has been shown to benefit, and cross-sectional data suggest potential benefits for selective attention and inhibitory control. ... Support for the idea that higher levels of aerobic activity may be associated with superior brain structure has been gained through cross-sectional studies in older adults and children (for a recent review, see Voss, Nagamatsu, et al., 2011). ... only those in the aerobic exercise group exhibited improved connectivity between the left and right prefrontal cortices, two areas that are crucial to the effective functioning of the fronto-executive network. ... Together, these studies provide evidence that regular aerobic exercise benefits control over responses during selective attention in older adults. ... aerobic fitness is a good predictor of performance on tasks that rely relatively heavily on inhibitory control over prepotent responses (e.g., Colcombe et al., 2004, Study 1; Prakash et al., 2011) and also that regular aerobic exercise improves performance on such tasks ... Overall, the results from the span and Sternberg tasks suggest that regular exercise can also confer benefits for the volume of information that children and older adults can hold in mind at one time.
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: CS1 maint: year (link) - ^ Buckley J, Cohen JD, Kramer AF, McAuley E, Mullen SP (2014). "Cognitive control in the self-regulation of physical activity and sedentary behavior". Front Hum Neurosci. 8: 747. doi:10.3389/fnhum.2014.00747. PMC 4179677. PMID 25324754.
Recent theory (e.g., Temporal Self-Regulation Theory; Hall and Fong, 2007, 2010, 2013) and evidence suggest that the relation between physical activity and cognitive control is reciprocal (Daly et al., 2013). Most research has focused on the beneficial effects of regular physical activity on executive functions-the set of neural processes that define cognitive control. Considerable evidence shows that regular physical activity is associated with enhanced cognitive functions, including attention, processing speed, task switching, inhibition of prepotent responses and declarative memory (for reviews see Colcombe and Kramer, 2003; Smith et al., 2010; Guiney and Machado, 2013; McAuley et al., 2013). Recent research demonstrates a dose-response relationship between fitness and spatial memory (Erickson et al., 2011) ... The effects of physical activity on cognitive control appear to be underpinned by a variety of brain processes including: increased hippocampal volume, increased gray matter density in the prefrontal cortex (PFC), upregulation of neurotrophins and greater microvascular density ... Together, this research suggests that an improvement in control processes, such as attention and inhibition or interference control, is associated with an improvement in self-regulation of physical activity. ... Hoang et al. (2013) found that young adults who initially exhibited low levels of physical activity and remained relatively inactive for 25 years had nearly twofold greater odds of impaired executive function compared with those who exhibited higher activity levels; very-low physical activity patterns were associated with even more pronounced declines in executive functioning. … sedentary behavior indirectly led to poor executive function through depressive symptoms (Vance et al., 2005). … sedentary individuals display less capacity to quickly and accurately switch between tasks.
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Basal ganglia regions like the right globus pallidus, the right putamen, and the nucleus caudatus are structurally affected in children with ADHD. These changes and alterations in limbic regions like ACC and amygdala are more pronounced in non-treated populations and seem to diminish over time from child to adulthood. Treatment seems to have positive effects on brain structure.
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- ^ Gonzalo, J. (1952). "Las funciones cerebrales humanas según nuevos datos y bases fisiológicas. Una introducción a los estudios de Dinámica Cerebral". Trabajos del Inst. Cajal de Investigaciones Biológicas XLIV: pp. 95–157. [Facsimil edition as `Splemento I´ in Dinámica Cerebral (2010), Open Access. Complete English translation, Open Access.
- ^ Brain Science Podcast Episode #10, "Neuroplasticity"
- ^ "Wired Science . Video: Mixed Feelings". PBS. Retrieved 12 June 2010.
- ^ "Shepherd Ivory Franz". Rkthomas.myweb.uga.edu. Archived from the original on 3 February 2012. Retrieved 12 June 2010.
- ^ Colotla, Victor A.; Bach-y-Rita, Paul (2002). "Shepherd Ivory Franz: His contributions to neuropsychology and rehabilitation" (PDF). Cognitive, Affective & Behavioral Neuroscience. 2 (2): 141–148. doi:10.3758/CABN.2.2.141.
- ^ Maguire, E. A.; Frackowiak, R. S.; Frith, C. D. (1997). "Recalling routes around london: Activation of the right hippocampus in taxi drivers". The Journal of neuroscience : the official journal of the Society for Neuroscience. 17 (18): 7103–7110. PMID 9278544.
- ^ Woollett, K.; Maguire, E. A. (2011). "Acquiring "the Knowledge" of London's Layout Drives Structural Brain Changes". Current Biology. 21 (24): 2109–2114. doi:10.1016/j.cub.2011.11.018. PMC 3268356. PMID 22169537.
- ^ Maguire, E. A.; Gadian, D. G.; Johnsrude, I. S.; Good, C. D.; Ashburner, J.; Frackowiak, R. S. J.; Frith, C. D. (2000). "Navigation-related structural change in the hippocampi of taxi drivers". Proceedings of the National Academy of Sciences. 97 (8): 4398–4403. Bibcode:2000PNAS...97.4398M. doi:10.1073/pnas.070039597. PMC 18253. PMID 10716738.
- ^ Hubel, D.H.; Wiesel, T.N. (1 February 1970). "The period of susceptibility to the physiological effects of unilateral eye closure in kittens". The Journal of Physiology. 206 (2): 419–436. PMC 1348655. PMID 5498493.
- ^ Bos, I; De Boever, P; Int Panis, L; Meeusen, R (August 2014). "Physical Activity, Air Pollution and the Brain". Sports Medicine. 44: 1505–18. doi:10.1007/s40279-014-0222-6. PMID 25119155.
Further reading
- Pinaud, Raphael; Tremere, Liisa A.; De Weerd, Peter, eds. (2006). Plasticity in the visual system: from genes to circuits. New York: Springer. ISBN 978-0-387-28190-2.
- Pinaud, Raphael; Tremere, Liisa A., eds. (2006). Immediate early genes in sensory processing, cognitive performance and neurological disorders. New York: Springer. ISBN 978-0-387-33603-9.
- Begley, Sharon (5 November 2004). "Scans of Monks' Brains Show Meditation Alters Structure, Functioning". The Wall Street Journal. Washington D.C. p. B1. Archived from the original on 2 February 2008.
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(help) - Donoghue, John P. (2002). "Connecting cortex to machines: recent advances in brain interfaces" (PDF). Nature Neuroscience. 5: 1085–1088. doi:10.1038/nn947. PMID 12403992. Retrieved 1 February 2010.
- Flor, H. (July 2002). "Phantom-limb pain: characteristics, causes, and treatment". The Lancet Neurology. 1 (3). Elsevier: 182–189. doi:10.1016/S1474-4422(02)00074-1.
- Ramachandran, Vilayanur S.; Hirstein, William (1998). "The perception of phantom limbs. The D. O. Hebb lecture" (PDF). Brain. 121 (9): 1603–1630. doi:10.1093/brain/121.9.1603. PMID 9762952. Retrieved 31 January 2010.
- Cohen, Wendy; Hodson, Ann; O'Hare, Anne; Boyle, James; Durrani, Tariq; McCartney, Elspeth; Mattey, Mike; Naftalin, Lionel; Watson, Jocelynne (June 2005). "Effects of Computer-Based Intervention Through Acoustically Modified Speech (Fast ForWord) in Severe Mixed Receptive-Expressive Language Impairment: Outcomes From a Randomized Controlled Trial". Journal of Speech, Language, and Hearing Research. 48 (3): 715–729. doi:10.1044/1092-4388(2005/049).
- Giszter, Simon F. (January 2008). "SCI: Present and Future Therapeutic Devices and Prostheses". Neurotherapeutics. 5 (1). Elsevier: 147–162. doi:10.1016/j.nurt.2007.10.062. PMC 2390875. PMID 18164494.
- Mahncke, Henry W.; Connor, Bonnie B.; Appelman, Jed; Ahsanuddin, Omar N.; Hardy, Joseph L.; Wood, Richard A.; Joyce, Nicholas M.; Boniske, Tania; et al. (15 August 2006). "Memory enhancement in healthy older adults using a brain plasticity-based training program: A randomized, controlled study". Proceedings of the National Academy of Sciences of the United States of America. 103 (33): 12523–12528. doi:10.1073/pnas.0605194103. PMC 1526649. PMID 16888038.
- Stein, Donald G.; Hoffman, Stuart W. (July–August 2003). "Concepts of CNS Plasticity in the Context of Brain Damage and Repair". Journal of Head Trauma Rehabilitation. 18 (4): 317–341. doi:10.1097/00001199-200307000-00004. PMID 16222128.
- Nudo, Randolph J.; Milliken, Garrett W. (1996). "Reorganization of Movement Representations in Primary Motor Cortex Following Focal Ischemic Infarct in Adult Squirrel Monkeys". Journal of Neurophysiology. 75 (5): 2144–149. PMID 8734610.
- Wieloch, Tadeusz; Nikolich, Karoly (June 2006). "Mechanisms of neural plasticity following brain injury". Current Opinion in Neurobiology. 16 (3): 258–264. doi:10.1016/j.conb.2006.05.011. PMID 16713245.
- Videos
- Ramachandran. Phantom Limb Syndrome. about consciousness, mirror neurons, and phantom limb syndrome
- Other readings
- Chorost, Michael (2005). Rebuilt: how becoming part computer made me more human. Boston: Houghton Mifflin. ISBN 0-618-37829-4.
External links
- Neuroplasticity at the U.S. National Library of Medicine Medical Subject Headings (MeSH)
- Neuro Myths: Separating Fact and Fiction in Brain-Based Learning by Sara Bernard