Neuroplasticity and Potential Implications for Healthcare Administration
Part 1
In the world of medical research, in particular the nervous system, it’s an exciting time to be alive. Recent studies have found the central nervous system (CNS) is capable of creating new neurons and pathways and is able to adapt to the environment. One of these is considered neurogenesis and the other neuroplasticity. We’ll get into the differences and similarities later. If you do a simple web search of neuroplasticity you will find many recent news articles on the subject https://bigthink.com/mind-brain/psilocybin-therapy and https://www.healthline.com/health/rewiring-your-brain. Once we are able to understand neuroplasticity better we can apply the principles to healthcare administration and become better leaders.
In this blog post we’ll be discussing what neuroplasticity is, how it can be facilitated, and how it can be hindered.
If we break up the word neuroplasticity we get neuro- and –plasticity. Neuro will of course mean the nervous system in our body. In this paper we’ll be more specific and will be referring to the CNS. –plasticity on the other hand describes the malleability of neuronal connectivity and circuitry. To translate, this means our nervous system has the ability to change. Neuroplasticity is all about adaptations to the environment for survival. This means, as we age our CNS is constantly being reorganized for optimal performance and subsequently better survival. The important thing for us to understand is neuroplasticity is lesion induced and need driven. Injuries to our CNS (trauma, CVA, SCI) can heal but even within that we have to provide a means for healing by addressing the need driven aspect. One research study on neuroplasticity compared the process to the delivery of emergency care to an earthquake zone.
1. A severe injury in an earthquake zone induces (lesion-induced plasticity) the need to call the service.
2. The service responds to the call by sending out a rescue team to clear the ruins (clearance of debris) to make the injury site approachable.
3. The ambulance has to navigate itself (sprouting-pathfinding) to reach the correct destination (sprouting-address selection).
4. The ambulance service only saves the patient’s life (short-term potentiation), whereas the follow-up medical attention further improves the condition steadily (long-term potentiation).
Neuroplasticity can be facilitated and hindered by certain lifestyle choices. For example, after CVA a patient has to practice with the affected side for it to improve or they could develop learned non-use. This means specificity of practice/training ad repetition are critical in facilitation. A healthy diet and regular exercise is also important. It can be hindered by chronic stressors and the other side of the coin with facilitation (sedentary lifestyle and poor diet).
Neuroplasticity can be used to improve healthcare administration by understanding how the central and peripheral nervous systems adapt to change and injury through a lifelong process, certain lifestyle choices can facilitate plasticity, and the negative consequences of stress and chronic pain.
Part 2
In this next section I want to make sure everyone reading this understands 2 things; Neuroplasticity is not neurogenesis, neuroplasticity can be negative.
We have already discussed and defined neuroplasticity in the previous post. Neurogenesis is defined as the process by which new neurons are formed in the brain. For a further explanation please visit https://qbi.uq.edu.au/brain-basics/brain-physiology/what-neurogenesis. So, this means the fundamental difference between neuroplasticity and neurogenesis is that plasticity is concerned with the adaptations of connections and genesis is concerned with creating new neurons. In damaged CNS tissues both aspects work together to facilitate healing. Since both work together and are closely related there is overlap as there could be neurogenesis when the CNS is adapting to change.
Neuroplasticity can also be negative. While most recent research has discussed the implications of neuroplasticity on growth and healing we have to be sure we are appropriately stimulating the system. This year, 2020, has created more stress than ever and chronic stress can create a negative spiral. Here is an excerpt by Serge Campeau, PhD in Psychiatric Times…
“The sustained activation and neuroplasticity within and between multiple neural networks engendered by perceived stress are known to modify mood and affect, the experience of pleasure, cognition, somatic functions and, ultimately, survival.”
It’s well studied that high cortisol levels over time can be detrimental and it’s no different with the CNS. Cortisol plays an important role in our innate fight or flight response and typically after the stress leaves the hormone goes back to normal values. But, if the stress never leaves our body continues to be in a fight or flight state, not allowing the body to recover and heal.
Neuroplasticity is all about adapting to the environment. A lot of patients I see on a weekly basis (I’m a Physical Therapist) live with chronic pain. Along with research on neuroplasticity there has been research on chronic pain. One thing researchers have found in chronic pain is neural sensitization. So what does this mean for people in pain? Pain is first simply defined as a perceived threat to the body. People with chronic pain have fundamental changes in their CNS and peripheral nervous system (PNS). These fundamental changes increase the brains receptiveness to the perceived threat. Two examples are hyperalgesia and allodynia. An increased sensitivity to pain is hyperalgesia. What this means is that something that is normally painful will be very painful. Allodynia is pain to a stimulus that normally doesn’t cause pain. Both of these terms can happen with chronic pain and both are adaptations to the environment. And, as we discussed earlier this is the definition of neuroplasticity.
Next, we’ll briefly review the CNS and PNS anatomy as well as discuss the potential and implications for people.
Part 3
So far we have discussed what neuroplasticity is, what it isn’t, and how it can be detrimental for us. Now, we’re going to review nervous system anatomy and the different kinds of cells. We’ll wrap up this blog by discuss the implications for people.
Our nervous system is highly complex and the brain, in particular, is one of the least understood organs in the body. The CNS is composed of the brain and spinal cord. Within the CNS one way it can be divided is by white matter and grey matter. White matter is mainly myelinated axons. It’s found on the inside of the brain and outside of the spinal cord. Grey matter is mainly neuron cell bodies and glial cells. It’s found mainly on the superficial part of the brain and interior of the spinal cord. Our nervous system is very complex and this is a very simplified way of reviewing. It could have been reviewed in different ways but neuroplasticity is concerned with pathways and this means white matter.
We have discussed what neuroplasticity is but not what it means for us. Neuroplasticity means we can heal from injuries once thought to be permanent. It means we can recover from injuries such as stroke, traumatic brain injury, and spinal cord injury. I’m not saying recoveries are always 100% but any recovery is really hopeful. These were all things once thought to be permanent. This process isn’t during a certain time of our lives either. It can occur across the lifespan. When talking about injuries the acute stage is critical for recovery. D. Wang and T. Sun found, “The constructive or reparative process based on neural plasticity starts only three weeks later (after injury) and may continue up to 18 months”. In my world of Physical Therapy it’s also well established the first few months are critical for the most recovery from a stroke.
Part 4
In this post I want to discuss 3 components of neuroplasticity and how we can implement these in healthcare administrators and be better leaders now and in the long run. The 3 pieces we’ll discuss are adapting to change, responding appropriately to stress, and having a perpetual cycle of growth and healing.
When we find something that works in healthcare we usually make it the status quo. We have to be able to change in healthcare. In the US, government policy changes frequently and something that worked previously may not always work. For example, healthcare consumers are being smart about who they select for their care so being transparent is important. Consumerism has also led to the increase in ambulatory clinics. Consumers are also living longer and longer and this means the type of healthcare utilized will be different. Technology, and healthcare technology, is changing at a rapid pace. Utilizing this technology can lead to better quality of care but we have to be able to adapt to the changing atmosphere.
In healthcare administration I would consider a threat any issue/event/person/competition/etc. that causes strain to a healthcare system. The COVID-19 pandemic is a good example of a threat because of the many challenges it has brought to healthcare organizations across the world. As was discussed in a previous post an early component of neuroplasticity is clearing debris. In healthcare administration this means neutralizing the threat. I would also add the threat needs to be addressed as soon as possible to limit any further destruction. Once the threat is identified and neutralized healing and growth can then take place. In healthcare this can mean hiring new employees, changing policies/procedures, implementing suggestions, adding/removing locations.
Complex adaptive systems are known for a whole being made up of many smaller pieces making them complex. They also adapt to the environment. Similarly, neuroplasticity has the ability to adapt across the lifespan and this needs to be paramount in healthcare organizations. The environment is always changing in healthcare. There are threats continually and those threats can be changing. When we first enter an organization as an administrator we usually make changes we think are best for the organization. While this is hopefully positive it needs to be an ongoing process.
As a healthcare administrator when we are able to adapt to change, respond appropriately to threats, and create a perpetual cycle of growth and healing we are setting up our organization for long term success.
Part 5
Bringing it all together, what does this mean for us as administrators? Well, I think first, we need to be more fluid in practice. The physical structure of hospitals, for example, call for rigidity, but we need to be able to meet the demands of patients. In a hospital maybe this means having overlap in the capabilities of different departments to meet the changing demand of patients. We also need to be prepared for everything but to expect for plans to go wrong and be ready to respond. Policies and procedures also need to be flexible. This can be a difficult aspect in healthcare as government policy can constrict the possibilities here. Sticking to the status quo can be good in the interim but to be successful long term we need to be able to adapt constantly. The old adage “if it ain’t broke don’t fix it” needs to be thrown away in favor of “if it can be better improve it”.
In researching this topic I came across an almost unbelievable story of a person who is a fully functioning adult with half a brain and two ted talks that further discuss neuroplasticity. Thank you for taking the time to read this series. I hope you learned something new as I’ll take a lot of this with me to be a better person.
https://www.youtube.com/watch?v=f2fCY_M7Vms
https://www.ted.com/talks/michael_merzenich_growing_evidence_of_brain_plasticity
https://www.ted.com/talks/wendy_suzuki_the_brain_changing_benefits_of_exercise
References
Campeau, S. (2017). Stress, Neural Plasticity, and Major Depression. Psychiatric Times, 17–19.
Ellefsen KO, Mouret J-B, Clune J (2015). Neural Modularity Helps Organisms Evolve to Learn New Skills without Forgetting Old Skills. PLoS Comput Biol 11(4): e1004128. doi:10.1371/journal.pcbi.1004128
Fujiwara, T., Paik, N., & Platz, T. (2017). Neurorehabilitation: Neural Plasticity and Functional Recovery. Neural Plasticity, 2017. Editorial. https://doi.org/10.1155/2017/3764564
Kiltschewskij, D., & Cairns, M. J. (2019). Temporospatial guidance of activity-dependent gene expression by microRNA: Mechanisms and functional implications for neural plasticity. Nucleic Acids Research, 47(2), 533–545. doi:10.1093/nar/gky1235
Power, J. D., & Schlaggar, B. L. (2017). Neural plasticity across the lifespan. Wiley Interdiscip Rev Dev Biol, 6(1). doi:10.1002/wdev.216. National Institute of Mental Health, Bethesda, MD. Department of Neurology, Washington University School of Medicine, St. Louis, MO
Sagi, Y., Tavor, I., Hofstetter, S., Mor-Yosef, S. T., Blumenfeld-Katzir, T., & Assaf, Y. (n.d.). Learning in the Fast Lane: New Insights into Neuroplasticity. Neuron, 73, 1–16. Supplemental Information. No publish date listed
Sharma, N., Classen, J., & Cohen, L. G. (2013). Neural plasticity and its contribution to functional recovery. Handb Clin Neurol, 110, 3–12. doi:0.1016/B978–0–444–52901–5.00001–0. Human Cortical Physiology and Stroke Neurorehabilitation Section, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD, USA. Department of Neurology, University of Leipzig, Germany
Wang, D., & Sun, T. (2011). Neural plasticity and functional recovery of human central nervous system with special reference to spinal cord injury. Spinal Cord, 49, 86–492.
What is neurogenesis? (2017, May 18). Retrieved October 29, 2020, from https://qbi.uq.edu.au/brain-basics/brain-physiology/what-neurogenesis
