Maladaptive vs Adaptive Neuroplasticity
Neuroplasticity is the brain and nervous systems ability to change in response to experience.
It doesn’t inherently mean ‘good’ or ‘bad’ - just ‘different’.
I find it useful to understand that there are 2 main types of neuroplasticity:
Maladaptive plasticity is any change in nervous system structure or function that is unwanted or unhelpful. Neurological conditions such as multiple sclerosis and motor neurone disease would both be examples of maladaptive plasticity that occur due to structural damage within the nervous system, such as lesions or motor neurone necrosis respectively. However, even in cases of structurally driven maladaptive plasticity, there will also be an element of non-structural, functional changes to how the brain is working, as the nervous system seeks to compensate and reorganise around its new biological constraints. This ‘functional maladaptive plasticity’ is what we see in conditions such as functional neurological disorder (FND), cases of chronic pain, or after an injury - even when no structural damage to the nervous system has occurred.*
*although I acknowledge that technically structural changes do occur within the brain and spinal cord in cases of functional maladaptive plasticity, as the nervous system alters synaptic connections - however, these structural changes are not driving the maladaptive plasticity itself
During the rehab process, I believe that we’re fundamentally trying to achieve 2 things:
Drive physiological adaptation
Facilitate neuroplasticity
When talking about facilitating neuroplasticity, what I actually mean is creating ‘adaptive plasticity’, to counteract any ‘maladaptive’ plasticity that has occurred - whether structural, functional, or both.
For example, in something like multiple sclerosis, a certain percentage of the symptoms you’re experiencing will be due to structural changes in the nervous system (demyelination of axons) vs functional changes (changes in how brain areas are communicating with each other and the body). If you’re experiencing weakness, gait dysfunction, and spasticity, it might be that 60% of those symptoms are being caused by the nerve demyelination. However, 40% may be a result of how the brain is reorganising around the demyelination, as it seeks to protect you and develop compensation strategies.
In other words, the nervous systems attempted solutions to the problem can become part of the problem themselves.
Whilst working with my clients, I don’t claim that I can do anything to reverse any damage present in their nervous systems that’s occurred because of their condition. Whilst there is growing data that existing damage can be repaired, such as exciting evidence of remyelination in MS, there is no clear evidence yet to support the claim that physiotherapy interventions contribute to this.
What I do claim to be able to help with is helping rewire the nervous system around existing damage in order to improve function - creating ‘adaptive neuroplasticity’ to counteract the ‘functional’ maladaptive plasticity. In the case described above, I might not be able to do anything about the 60%, but we certainly can improve the 40% to a point where your weakness, walking and spasticity all improve significantly.
This is why results tend to come much quicker in cases of chronic pain, injury, or FND, compared to structural conditions such as MND, MS, stroke or HSP. 100% of the maladaptive plasticity present is functional and fully reversible, rather than partly morphological.
In reality, I believe that through well designed rehab combined with biology focused technology such as the Neubie device, nervous system healing is possible through physiotherapy intervention, and that any functional improvements some of my clients are able to make most likely come from a change to both nervous system structure and function. However, in neurodegenerative conditions, these structural changes may be much harder to make due to progressive neurological damage.
Therefore, if you work with me our goal is this:
“Create adaptive neuroplasticity and physiological adaptation that maximizes function within existing biological constrains”