A Review of Neuroplasticity: Some Implications for Physiotherapy in the Treatment of Lesions of the Brain

Abstract

This paper reviews the literature relating to neuroplasticity within the brain and draws implications pertinent to physiotherapy practice. Developmental, functional and post-lesion evidence of neuroplasticity is presented. Using neuroplastic phenomena as a model, physiotherapeutic intervention for sensorimotor deficits following brain lesions is justified and principles of treatment are developed. It is concluded that unilateral compensatory treatments are no longer physiologically justified and that intervention should guide axonal and dendritic development and the ‘opening up’ of the ‘new pathways’. This is facilitated by active patient participation, sensory input and the normality of experience in movement. Early treatment and intensive stimulation is recommended. However, neuroplastic changes can account for ‘abnormal’ tone and physiotherapists are warned that their role includes the minimising of this potential. Also, as reorganisation of the CNS is ongoing, long-term physiotherapy (over many years) can continue to enhance recovery. The author concludes that physiotherapists must justify intervention based upon physiologic evidence and not necessarily on treatment philosophies. An eclectic approach to practice is recommended so that the therapist can utilise all weapons to combat lesion changes. © 1993, The Chartered Society of Physiotherapy. All rights reserved.