Could neuroplasticity for Parkinson’s (PD) be developed by following the same principles that have been effective for recovery from stroke, spinal cord injury, memory decline, loss of use of a limb, hearing impairments, blindness, severe vertigo, and obsessive-compulsive disorder?1
Much of Parkinson’s research has mostly been on drug or surgical options to slow the rate of decline, or to protect the remaining brain cells and their connections. This is called neuroprotection. Neuroplasticity has to do with what you can do to change your own brain.1 Much neuroplasticity research has been about sensory circuits–for example, to use movement or sensation, electrical stimulation, or other therapies to rewire to the brain’s receptor sites for sound, touch, or vision, even when there is sensory loss in the original circuits. Functional changes follow principles of the patient’s conscious effort, novelty, variety, appropriateness to age and ability, intensity, reinforcement, and reward. These principles are discussed by physical therapists in Umphred, et al’s Neurological Rehabilitation. Is it possible that those principles could stimulate neuroplasticity for Parkinson’s?
Changing Picture of Parkinson’s
Most people picture a person with Parkinson’s as having tremors or limitations in movement. This is caused by diminished dopamine in structures of the brain called basal ganglia. Basal ganglia communicate with multiple areas of the brain and brainstem. They have to do with pleasure, memory, learning, initiating and controlling movement, fine motor control, the motivation/rewards system, and the placebo effect, or anticipation of positive benefit. Dopamine circuits are hardwired even in insect brains, as there is a survival value to initiate movement towards what is perceived as beneficial. They are intrinsically related to the emotional circuits of the brain.
Multi-Modal Approach for Complex Disorder?
However, other neurotransmitters besides dopamine are also decreased in PD, and other brain areas are also affected. In fact, Parkinson’s is now considered a multi-system neuro degenerative disorder. Research on massage, exercise, and meditation have shown benefits separately for nearly all the brain areas, emotional issues and neurotransmitters impacted by Parkinson’s. Could these three be combined as a multi-modal therapy to change the brain circuits of PD? Would they meet the criteria discussed by Umphred, et al, as principles of neuroplasticity for Parkinson’s?
September 18, 2013 update.
- Neuroprotective benefits have not been proven for any medical or alternative therapy. That doesn’t mean there aren’t promising leads. Exercises such as Tai Chi, Chi Gung, Tango, Irish dance, Pilates, boxing, forced cycling have shown improved quality of life (QoL), better balance, decreased fall risk, and perhaps neuroprotective benefit. More study is ongoing.
- There is now a review study published in the Annals of the NY Academy of Sciences, by Andrew B. Newberg, that indicates benefits of Meditation for Neurodegenerative conditions.1 He used imaging studies to show the brain areas most affected by meditation, and has been able to show meditation benefits for people with memory loss and Alzheimer’s. Some of those brain areas have parallel functions to the dopamine circuits. He concludes meditation might have benefits even for Parkinson’s.
October 15, 2013 update.
Is there benefit in looking for brain plasticity if you can’t demonstrate protective benefits first? When there’s an ongoing decline, don’t we need to stem the tide before before we rebuild? I had doubts, and have returned to the consideration of neuroplasticity.
- When you stimulate existing neurons to fire, they increase their connections with neighboring neurons. “Neurons that wire together, fire together.”2, 3
- There is a mapping of certain sensory body areas in the basal ganglia.4
Theoretically, then, sensory input from movement, exercise and/or massage could stimulate any remaining cells in the basal ganglia circuits. Intense exercise and sustained pressure of massage to certain areas seems to have a calming effect on PD clients, and seems to improve symptoms, and these two points make a plausible explanation.
January 26, 2016 update
- Brain structures adjacent to the basal ganglia that have to do with motivation, memory, learning and emotions are called the limbic,5 system. Continuing research has shown that these areas can change from sensory input.
- These changes improve with interoceptive awareness, not a new concept, but one that has received more attention recently.6 Practice in interoceptive awareness, mindfulness in movement, that incorporates emotional awareness is being researched for benefits in changing the brain, for example after frontal lobe TBI, traumatic brain injury.7
I am doing ongoing research using a combination of those three approaches for Parkinson’s. Your opinions and questions are welcomed.
1 The Brain that Changes Itself, by Norman Doidge. “It is a plastic, living organ that can actually change its own structure and function, even into old age. Arguably the most important breakthrough in neuroscience since scientists first sketched out the brain’s basic anatomy, this revolutionary discovery, called neuroplasticity, promises to overthrow the centuries-old notion that the brain is fixed and unchanging.”
2 Andrew Newberg research
3 Neurons that Wire Together Fire Together and Buddha’s Brain: The Practical Neuroscience of Happiness, Love and Wisdom
5 What is the limbic system?
6 Interoceptive inference, emotion, and the embodied self
7 Trial of Mind-Body and Interoceptive Awareness Training for Vets with mTBI “Two closely related constructs, body awareness and interoceptive awareness are suggested as potential mediators of the health benefits of mind-body therapies, including, mindfulness meditation, Tai Chi and yoga.“