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New Year, New Connections: The Power of Neuroplasticity

It's like a séance in your brain!

Neuroplasticity has become a buzzword in the medical world, self-help realm, and the like. It's your nervous system's ability to change, grow, and adapt, whether that's rewiring pathways in the wake of an injury or creating a brand-new network as you're learning skill. Your nervous system is constantly changing and learning as you go through life. And while yes, brain cells can and do die, there are BILLIONS of them in that head of yours and they have crafty ways of reorganizing things to keep operations smooth.

This magical ability is critically important when we talk about recovery after a neurologic injury, such as a stroke or brain injury, as well as degenerative diseases like Multiple Sclerosis and Parkinson's Disease. Even when there's a substantial blow to the nervous system's neuron population, under the right conditions miraculous rewiring and growth occurs. The surviving neurons get together, join hands, and perform a séance to contact their dead brethren so they can take over their old job.* "If you can hear us, just tell us what to do- we'll take it from here!"- your neurons

*While this isn't a totally scientifically accurate analogy, it's kind of cute right?

If you're not creeped out yet picturing your brain cells using a Ouija board, thanks for sticking with me because now we're going to get to the useful-application-part of this post. So what exactly are those "right conditions" for neuroplasticity that were mentioned earlier? The nervous system is extremely complex so naturally, there are specifics that need to be taken into account to maximize its full potential. Presenting... the 10 research-based principles of neuroplasticity. While this article is geared towards rehabilitation, most of these principles can be used in your daily life to promote brain function!

1. Use It or Lose It

Your brain has billions of different neural pathways. Kind of like snowflakes, each pathway is unique and triggered by specific thoughts, actions, movements, stimuli, etc. Pathways that are consistently used will strengthen over time, and those that aren't will weaken. This isn't always a bad thing either; it's also your brain's way of prioritizing power and energy to the circuits that are most needed or frequently used.

Example: You take the same route to work every day, to the point where you just put on a podcast, start driving, and the next thing you know, you're there! You didn't have to think about which road to take, how many miles between turns, or which way you needed to exit out of your driveway. That's because it's "engrained" in your brain. You've done it so many times, it's like autopilot. This is an example of a strong neural circuit. But what if your job switches to a new location? Pretty soon you'll get used to the new commute and the old one will slowly fade out, because you're not driving it anymore. In a few months, you might need to resort to using Google Maps to get to your old office.

Take-away: It you neglect a neural pathway, it will fade away and die just like your old Tamagotchi pet.

2. Use It and Improve It

This is just the flipside of use it or lose it, and it sounds less threatening. Remember, the more you use a specific neural circuit, the stronger it gets.

Take-away: If you're learning a new skill or re-learning an old one, it's important to practice and use those neural pathways even if it's challenging at first.

3. Specificity Matters

If you were training for a marathon, you wouldn't spend an hour every day arm wrestling your roommate, would you?* Well, to reach your brain's maximum potential, you have to train it specifically for what you want it to do. Set it up for success!

*Admittedly, I am no marathon runner so maybe you do need to be good at arm wrestling for such an achievement. What do I know?

Take-away: Ask a physical therapist for targeted exercises to focus on the desired skill you're trying to learn. Trust me, we know what we're doing.

4. Repetition Matters

Insanity is doing the same thing over and over... but not when you're talking about neuroplasticity! Some studies have shown that is takes upwards of 500 repetitions of a motor task for changes to occur in the brain.

Example: This is one of the reasons why motor recovery occurs faster in the legs vs. the arms after a stroke . Gait training (i.e. walking) naturally results in hundreds of repetitions (i.e. steps) and is something functional we can retrain more easily than repeating the same amount of fine motor tasks, like writing or grasping. Not to say that motor recovery can't happen in the upper extremities- it just takes more focus and targeted intervention.

Take-away: You're not going to re-learn how to walk by taking one step and expecting results. A high number of repetitions is needed for neuroplasticity to occur- but too much can be a thing too, so consult your therapist.

5. Intensity Matters

Just like with repetition, your nervous system requires a sweet spot when it comes to intensity. If a task is too easy, your brain stays on autopilot... but if it's too challenging, it can result in injury or overwhelm.

Take-away: Rehabilitation shouldn't be easy. Find a therapist who pushes you, but make sure to communicate with them how your body responds the next day or so after a session.

6. Time Matters

As the old adage goes, timing really is everything. After a neurologic injury, there's an ideal window for maximum recovery to occur. It's crucial to seek care immediately after an injury to optimize your nervous system's abilities. Changes to the system still occur for months and years down the line, but not at the same speed or intensity. Physical therapy provided immediately post-injury also prevents your brain from creating inefficient, maladaptive pathways that become stronger the more you trigger them (see #2).

Example: This is why some people who experience a brain (or other neurologic) injury end up walking with a funky gait pattern or don't use their injured side at all. Their brain learned early on to use their "stronger" side to complete daily tasks so any neural circuits related to "weaker" side motor patterns were slowly faded out.

Take-away: Targeting neuroplastic changes immediately after an injury is non-negotiable if you want to regain normal movement patterns.

7. Salience Matters

Salience is one of my personal favorite rehab-related words. A salient task is one that is important to you, aka fun, exciting, meaningful. Our brains want to be stimulated and tend to put less priority on tasks we find mundane or boring. The more fun and engaging a task is, the more our neurons fire and talk to each other. Some simple ways to apply this to a seemingly "boring" task include:

  • adding background music (that you actually like)

  • incorporating a meaningful topic to conversation or cognitive tasks (such as naming characters on your favorite TV show while you're walking on the treadmill)

  • pet or art therapy

  • having a family member or friend participate in treatment sessions

Take-away: F is for "Find ways to make therapy exciting", U is for "U got this!", N is for "Neuroplasticity"!

8. Age Matters

It's no secret that as we age, we tend to heal slower than we used to. While youth is advantageous to quickly springing back from a injury, it doesn't mean that recovery can't happen in older individuals. Current evidence shows that neuroplasticity can still occur in brains experiencing dementia in elderly adults!

Take-away: None of us are as young as we once were, but don't let the youths get you down. It just means that the older you are, the more important the other principles are when it comes to effective recovery.

9. Transference

Strengthening a neural pathway to accomplish one task can increase your ability to perform similar tasks, aka transfer or generalize your abilities. However, this requires challenging the brain in different scenarios.

Example: You've mastered going up and down stairs in the therapy gym- but can you navigate the stairs at your own house? Your brain learns the specific (see #3) motor pattern to easily get up the perfectly spaced therapy stairs with the nice wooden handrail, but the first time you go to walk up your rickety haunted-house stairs (that you've been meaning to redo for years), your brain is all like "Uh... you want me to do what??". If your therapist has been challenging you correctly, like having you practice on different sets of stairs with obstacles, your neurons look at each other and go, "Oh we've got this". Next thing you know, you're up those sketchy stairs and in the comfort of your own home. Time to get those fixed.

Take-away: Again, therapy is meant to be CHALLENING and your therapist should know how to maximize your brain's ability to generalize tasks outside of the clinic walls.

10. Interference

This principle goes back to the previous example of the bad side of learning maladaptive movement patterns (which happens a lot with a delay in treatment). The strong neural pathways go all Mean Girls to block other connections from getting stronger or new ones from forming. This also goes back to #2- the more you use a pathway, the stronger it gets. Learning "bad" technique during recovery can lead to more issues down the road. You and your therapist will work together to overcome the school bullies and make room for productive, healthy movement patterns!

Take-away: Not all neural connections are nice and pretty. It's important to work with an expert to help your body & brain navigate recovery and create the most efficient movement patterns possible.

In summary... your neurons are really clever and good at witchcraft.

Okay, maybe not that last part, but you get the idea. Your nervous system contains billions of neurons that are remarkably good at learning new things and bouncing back in the face of adversity. If you or someone you know has experienced a neurologic injury, be sure to seek care from a licensed physical therapist who is well versed in the principles of neuroplasticity and can get you on the most effective pathway to recovery. Happy séance-ing!



  1. Kleim JA, Jones TA. Principles of experience-dependent neural plasticity: Implications for rehabilitation after Brain Damage. Journal of Speech, Language, and Hearing Research. 2008;51(1). doi: 10.1044/1092-4388(2008/018)

  2. Mindy F. Levin & Marika Demers(2021)Motor learning in neurological rehabilitation,Disability and Rehabilitation,43:24,3445-3453,DOI: 10.1080/09638288.2020.1752317

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