Cognitive and Neurological – 3 Articles

Exercise Helps Nerve Pain

ScienceDaily (June 1, 2012) — Exercise helps to alleviate pain related to nerve damage (neuropathic pain) by reducing levels of certain inflammation-promoting factors, suggests an experimental study in the June issue of Anesthesia & Analgesia, official journal of the International Anesthesia Research Society (IARS).

The results support exercise as a potentially useful nondrug treatment for neuropathic pain, and suggest that it may work by reducing inflammation-promoting substances called cytokines. The lead author was Yu-Wen Chen, PhD, of China Medical University, Taichung, Taiwan.

Exercise Reduces Nerve Pain and Cytokine Expression in Rats Neuropathic pain is a common and difficult-to-treat type of pain caused by nerve damage, seen in patients with trauma, diabetes, and other conditions. Phantom limb pain after amputation is an example of neuropathic pain.

Dr Chen and colleagues examined the effects of exercise on neuropathic pain induced by sciatic nerve injury in rats. After nerve injury, some animals performed progressive exercise — either swimming or treadmill running — over a few weeks. The researchers assessed the effects of exercise on neuropathic pain severity by monitoring observable pain behaviors.

The results suggested significant reductions in neuropathic pain in rats assigned to swimming or treadmill running. Exercise reduced abnormal responses to temperature and pressure — both characteristic of neuropathic pain.

Exercise also led to reduced expression of inflammation-promoting cytokines in sciatic nerve tissue — specifically, tumor necrosis factor-alpha and interleukin-1-beta. That was consistent with previous studies suggesting that inflammation and pro-inflammatory cytokines play a role in the development of neuropathic pain in response to nerve injury.

Exercise also led to increased expression of a protein, called heat shock protein-27, which may have contributed to the reductions in cytokine expression.

Neuropathic pain causes burning pain and numbness that is not controlled by conventional pain medications. Antidepressant and antiepileptic drugs may be helpful, but have significant side effects. Exercise is commonly recommended for patients with various types of chronic pain, but there are conflicting data as to whether it is helpful in neuropathic pain.

The new results support the benefits of exercise in reducing neuropathic pain, though not eliminating it completely. In the experiments, exercise reduced abnormal pain responses by 30 to 50 percent.

The study also adds new evidence that inflammation contributes to the development of neuropathic pain, including the possible roles of pro-inflammatory cytokines. The results provide support for exercise as a helpful, nondrug therapy for neuropathic pain — potentially reducing the need for medications and resulting side effects.

Practice Makes the Brain’s Motor Cortex More Efficient

**Repetitive motion drills are key to rehab protocol I design for animals with neurological defecits—so keep on keeping on if you are doing that, too! Blessings-RehabDeb

Aug. 4, 2013 — Not only does practice make perfect, it also makes for more efficient generation of neuronal activity in the primary motor cortex, the area of the brain that plans and executes movement, according to researchers from the University of Pittsburgh School of Medicine. Their findings, published online today in Nature Neuroscience, showed that practice leads to decreased metabolic activity for internally generated movements, but not for visually guided motor tasks, and suggest the motor cortex is “plastic” and a potential site for the storage of motor skills.

The hand area of the primary motor cortex is known to be larger among professional pianists than in amateur ones. This observation has suggested that extensive practice and the development of expert performance induces changes in the primary motor cortex, said senior investigator Peter L. Strick, Ph.D., Distinguished Professor and chair, Department of Neurobiology, Pitt School of Medicine.

Prior imaging studies have shown that markers of synaptic activity, meaning the input signals to neurons, decrease in the primary motor cortex as repeated actions become routine and an individual develops expertise at a motor skill. The researchers found that markers of synaptic activity also display a marked decrease in monkeys trained to perform sequences of movements that are guided from memory — an internally generated task — rather than from vision. They wondered whether the change in synaptic activity indicated that neuron firing also declined. To examine this issue they recorded neuron activity and sampled metabolic activity, a measure of synaptic activity in the same animals.

All the monkeys were trained on two tasks and were rewarded when they reached out to touch an object in front of them. In the visually guided task, a visual target showed the monkeys where to reach and the end point was randomly switched from trial to trial. In the internally generated task the monkeys were trained to perform short sequences of movements without visual cues. They practiced the sequences until they achieved a level of skill comparable to an expert typist.

The researchers found neuron activity was comparable between monkeys that performed visually guided and internally generated tasks. However, metabolic activity was high for the visually guided task, but only modest during the internally generated task.

“This tells us that practicing a skilled movement and the development of expertise leads to more efficient generation of neuron activity in the primary motor cortex to produce the movement. The increase in efficiency could be created by a number of factors such as more effective synapses, greater synchrony in inputs and more finely tuned inputs,” Dr. Strick noted. “What is really important is that our results indicate that practice changes the primary motor cortex so that it can become an important substrate for the storage of motor skills. Thus, the motor cortex is adaptable, or plastic.

Exercise for Parkinson’s Patients

(With adept application, many human interventions may be crossed over to non-human animal functional rehab :))

Becky G. Farley, PhD, PT, MS, knows that exercise is about more than fitness-it is a physiological tool that encourages the body’s own endogenous brain repair mechanisms.

“Exercise promotes brain health and, thereby, may protect the remaining ‘viable’ dopamine neurons, called neuroprotection,” she said.

It also optimizes brain function through activity-dependent plasticity mechanisms that can restore function to damaged pathways, normalize interference from inefficient signaling and increase reliance on undamaged systems.

In July 2010, Dr. Farley founded NeuroFit NetWorks, a non-profit program dedicated to developing and expanding access to research-based exercise programming that is proactive, optimizes brain health/function, and changes the lives of individuals living with a neurodegenerative disease.

Exercise, she said, may at the very least slow motor deterioration in patients with Parkinson’s disease, and, if started early enough, may be able to modify disease progression.

Research, Advocacy & Education
While at the University of Arizona, Dept. of Physiology, Dr. Farley researched muscle activation mechanisms that underlie one of the primary symptoms in patients with Parkinson’s disease. This research led to the development of an exercise program called LSVT BIG™ to target bradykinesia (a slowness of movement) and an NIH-funded randomized clinical trial.

After training more than 5,000 physical and occupational therapists around the world in how to instruct people with Parkinson’s disease in LSVT BIG™ methods, Dr. Farley realized that basic and clinical science research about exercise and Parkinson’s disease is not being translated to real-world application.

“For example, continuous access to proactive neuroplasticity-principled programs that have been shown in animals to slow disease progression.are not available,” she explained. “As it stands now, patients with Parkinson’s disease rarely go to therapy, and when they do, it is usually only after they lose function and start to fall. And those that do go are rarely seen by PD-exercise experts.”

Even if they do find therapists that understand Parkinson’s disease, most patients are not implementing approaches that adhere to the principles of practice that are required to promote learning and plasticity. Instead, outdated guidelines are implemented that promote using strategies or working on secondary impairments like weakness and flexibility.

“No doubt these things help make life better for patients with Parkinson’s disease, but they don’t target the problems that got them to that level of disability. So, ultimately nothing is changed,” said Dr. Farley.

NeuroFit NetWorks plans to change that. The non-profit is advocating for translation of this research now. They have started a national Parkinson Exercise Revolution to help people get better and stay better with exercise. Dr. Farley is conducting training workshops nationally for therapists and fitness professionals to become Parkinson’s disease exercise experts and to work together in their local communities to implement early intervention and continuous access to PD-specific exercise for life.

A model neuro-fitness center in Tucson, AZ, is currently being developed to show how rehab can be accessible and integrated with community fitness programming to optimize learning and function.

“This is the infrastructure that we think offers promise to delay disease onset, slow disease progression, restore motor function, and increase longevity and quality of life for people with neurodegenerative or neurological conditions, and for those individuals at risk for these conditions,” Dr. Farley noted.

It will take advocacy; education of the medical, fitness community and lay public; and working with health care systems to change existing paradigms, demonstrate health care cost savings, and document slowing of motor deterioration.

Research-Based Exercise Programs
All exercise programs at NeuroFit NetWorks are implemented within the context of the Exercise4BrainChange™ (E4BC) model that requires therapists and fitness professionals to incorporate instructions, feedback, and research techniques that promote four essential learning constructs: prepare, activate, reflect, motivate.

These constructs can accommodate multiple exercise approaches and be customized to address a disease’s specific physical/cognitive/emotional deficits. The depth of the content can be modified to allow for a system of communication with a similar language across a variety of therapeutic disciplines and exercise professionals. This is the first time that these essential principles have been described in a manner that can help clinicians implement these concepts immediately with their patients.

“We believe to effect disease modification, proactive models of health care continuums must embrace research-based exercise approaches that are guided by the essential principles of learning and neuroplasticity,” said Dr. Farley. “We call these essential elements “Exercise4BrainChange™ principles” and we have developed a model that integrates all these elements in a way that can promote optimal brain function and skill acquisition.”

Every staff member has undergone training to learn about Parkinson’ disease and exercise and how to modify their instruction/programming to make it PD-specific and optimize the potential for learning and plasticity.

The following programs are offered at the Parkinson Wellness Recovery (PWR!) Gym:

Rehabilitation – 1:1 Exercise4BrainChange. This is where an individual comes to the gym to get a ‘PWR! PLAN.’ They work one-on-one with a therapist that is a PD-exercise expert who educates them about the research on exercise and helps them develop a proactive PD-specific “Use It Or Lose It” program that includes ongoing coaching and tune-ups for life.

Other 1:1 rehabilitation treatments address and target specific problems, such as freezing or postural instability, to “use it and improve it.”

“We integrate research techniques to target bradykinesia/rigidity/coordination/postural instability/posture, such as the training of activated large amplitude whole-body movements; focused practice on axial rotation and extension exercises; paced, rhythmical movements to augmented sensory proprioceptive feedback; rhythmical; treadmill activities for endurance, coordination for gait and balance, and more,” Dr. Farley explained. Clients are progressively challenged to work harder than then self-select. Language and cognitive activities are integrated to increase difficulty, and emotional deficits are targeted through empowerment/education/affirmations to retrain their emotional brain about what they CAN do.

Community – Group E4BC Programming. This program offers PWR! MOVES; PWR! Circuit and specialty classes (agility, strengthening, stretching) that target PD-specific symptoms; and cardio programs for brain health and to prepare the brain to learn! (mobilize neurotransmitters, cell survival and growth factors, boost the immune system, reduce inflammation).

Other enrichment programming to optimize brain health and restoration includes nutrition, stress reduction, brain fitness, and other social or general group exercise activities (drumming, dance, tai chi, etc.).

Retraining the Brain

It is not enough to simply exercise when one has a neurodegenerative disease, noted Dr. Farley.
“It is important to target the anticipated and existing problems with intensive, repetitive practice while receiving certain types of feedback to help you learn and pay attention to critical aspects of the practice,” she explained.

It is also vital that a person is ready to learn and able to manage stress, anxiety and fear to optimize the conditions for learning. That’s why NeuroFit NetWorks has specially trained therapists and fitness professionals that understand how to implement programming to optimize brain health and function for people with different types of conditions.

“Our movements and ability to learn new skills requires active engagement. So, dysfunction in emotional or cognitive systems that interferes with planning, intrinsic motivation, self-monitoring, confidence, etc., interferes with learning,” explained Dr. Farley.

The cognitive deficits in Parkinson’s disease are in the area of executive functioning and attention. These cognitive components are essential for the planning and production of complex whole-body movements; ability to adapt movements/postures to changes in the environment, and automaticity (ability to divide or focus attention for multitasking).

In addition, the loss of dopamine contributes to emotional dysfunction, such as loss of motivation, self-efficacy, anxiety, fear and learned helplessness.

“Evidence suggests that physical exercise improves not only the sensorimotor deficits, but cognitive and emotional deficits as well,” Dr. Farley stated.

She noted that NeuroFit NetWorks is helping people with Parkinson’s disease get better and stay better with exercise, enrichment, education and empowerment.

“We want to have the infrastructure in place when the definitive research emerges that exercise that begins early and is continuous in nature slows disease progression,” she said. “It requires that we advocate for change to existing rehab/health care paradigms that don’t ever see people with Parkinson’s disease until they start to fall; years after the diagnosis.”

A window of opportunity has been lost to begin proactive and disease modifying exercise programs founded in research, said Dr. Farley. It will be years before clinical trials demonstrate the best exercise and the best dosage.

“In the meantime, we are going to implement the best of the best and incorporate new information as it becomes available,” she concluded. “There are studies showing that exercise augments the response to Parkinson’s disease medications in the short term and long term, yet people are rarely empowered after they are diagnosed, and so instead they go home and withdraw.”


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