Professor of Cognitive Neuroscience of Ageing Gives Inaugural Lecture ‘Bringing the Damaged Brain Back Into Action: Preconceptions and Possibilities’

Apr 11, 2012

Professor of Cognitive Neuroscience of Ageing, Richard Carson at the School of Psychology and Trinity College Institute of Neuroscience gave his inaugural lecture titled: ‘Bringing the Damaged Brain Back Into Action: Preconceptions and Possibilities’  recently.  The following are extracts from his lecture:

“Worldwide, people are living longer. Consequentially, there is an increasing incidence of stroke – a prototypical disorder of ageing which affects 15 million people each year. The incidence of stroke in Europe alone is projected to rise to 1.5 million per year by 2025. National stroke strategies emphasise the requirement for specialised therapeutic assistance in the months and years following the brain injury. Currently 50% of stroke survivors are left with residual impairments of the upper limb. By compromising performance of the tasks of daily living, these lead to loss of independence, and frequently a cascade of negative social and psychological consequences. It is imperative therefore that strategies to ameliorate the functional disability are developed, with a view to enhancing the quality of life of the stroke survivor, and reducing the burden upon care givers and the community.”

“Due to reductions in the duration of acute hospital care, the opportunities available for retraining in the interval immediately following stroke are rapidly diminishing. The search for effective and efficient methods of rehabilitation that will maximise the level of recovery over the extended period following medical discharge has therefore become more pressing. There is cause for optimism. The adult brain exhibits an extensive capacity for adaptive change – a property referred to as plasticity. This is the critical precursor for recovery of movement function following brain injury.”

“The exploitation of neural plasticity can be promoted in some circumstances by the active repetitive use of the paretic limb alone in training programs such as Constraint-Induced Therapy (CIT). Unfortunately for most stroke survivors, the degree of hemiparesis is so severe that they are unable to generate levels of muscular activity sufficient to employ this strategy. The potential for upper limb recovery in these individuals is therefore often dismissed with recommendations to restrict therapy to maintaining flexibility, preventing pain, and the training of one-handed compensatory strategies.”

“In this lecture I aim to counter conventional therapeutic nihilism by demonstrating that suitably designed devices and training regimes can be used to enable intensive and repetitive reaching practice in stroke survivors with severe paresis, thereby enhancing their functional capabilities. The pivotal requirement is that the interventions encapsulate key elements that promote motor learning and skill acquisition. To address this need, we have been exploiting technological advances to develop novel therapeutic interventions for use in hospital and non-hospital environments (home and residential settings). Our objective is to develop low-cost minimally engineered systems to deliver regimes prescribed and supervised by health professionals, without a therapist needing to be present while the systems are being used. This allows home use and, within clinical settings, multiple patients to be treated by one therapist, as well as the potential for remote monitoring of treatment."

“While the benefits derived from rehabilitation therapy by the moderately impaired appear to be independent of lesion location, it is clear that this is not the case for those severely disabled by stroke. Techniques that combine neuroimaging and transcranial magnetic stimulation (TMS) now provide information that is sufficiently rich to permit therapeutic interventions to be selected on the basis of the structural (and functional) integrity of each individual’s brain network. General principles give rise to predictions concerning the characteristics of training that might best exploit the therapeutic potential for individuals with different constellations of cerebral damage. These developments offer entirely new opportunities for rehabilitation following brain injury.”