Déjà Vu and Neuroplasticity in Parkinson’s

“Continuous effort – not strength or intelligence – is the key to unlocking our potential.” Winston S. Churchill

“…remember that what has once been done may be done again.” Alexandre Dumas

Introducing the terms:
D
éjà vu: “A feeling of having already experienced the present situation.” (http://www.oxforddictionaries.com/us/definition/american_english/)

Neuroplasticity: “The brain’s ability to reorganize itself by forming new neural connections throughout life. Neuroplasticity allows the neurons (nerve cells) in the brain to compensate for injury and disease and to adjust their activities in response to new situations or to changes in their environment.” (http://www.medicinenet.com/script/main/art.asp?articlekey=40362 )

Do you remember learning how to ride a bike, throw/catch a baseball, and/or hit a golf ball? Yes, yes, yes; when I was a child with my father.
Learning to ride a bicycle
–  training wheels, then two wheels with support from my dad going down the street, and then he let me go on my own; never to forget how to balance and pedal the bicycle.
Learning how to catch and throw a baseball– wrapping up the ball in the mitt to get it conditioned, the  correct throwing motion, watching the thrown ball into the mitt and working on my hand-to-eye coordination.
Learning the basics of the golf swing– the complexity and intricate timing of swinging a golf club with my dad showing me how to do it from grip, set-up, back swing to follow through.
We likely all have childhood memories of activities where our brain and body were trained/taught to do something.

“Neurons that fire together wire together. Mental states become neural traits. Day after day, your mind is building your brain. This is what scientists call experience-dependent neuroplasticity,” Rick Hanson

Déjà vu and physical activity with Parkinson’s: As someone who has loved to exercise almost every day for most of my life, Parkinson’s is a most disagreeable disorder. Why? Let me give you an example of playing golf. I think about playing golf almost every day although I play maybe once a week and try to practice a couple of times per week. It used to be, every time I addressed the golf ball, my body remembered what it’s supposed to do while waiting for the signals from the brain. Now today, approaching the golf ball I remind myself this is a golf shot. As Yogi Berra said “It’s like déjà vu, all over again” and I remember I’ve been here many times before. It’s as if a short circuit exists and I’m realigning this circuitry every time I swing the golf club. For the most part, my brain-body connection still works and I successfully hit the golf ball; but not every time (maybe I just need to practice more?). This might be analogous to a car running very low on transmission fluid (i.e., in my case low on dopamine); the gears are still working but just not working very smoothly.

“Never give up. It’s like breathing—once you quit, your flame dies letting total darkness extinguish every last gasp of hope. You can’t do that. You must continue taking in even the shallowest of breaths, continue putting forth even the smallest of efforts to sustain your dreams. Don’t ever, ever, ever give up.” Richelle E. Goodrich

Neuroplasticity and physical activity: Kleim and Jones (2008) and Petzinger et al. (2013) describe neuroplasticity as a process where the brain encodes experiences and is able to learn new behavior. They define neuroplasticity as the modification of existing neural networks by adding or modifying synapses in response to changes in behavior or environment, especially when done with exercise. Thus, neuroplasticity can help repair and strengthen the circuitry of the brain.  There is substantial evidence in human studies and in rodent-experimental models that have validated numerous exercise-associated effects on “brain health”.  A regular aerobic exercise program likely helps to promote the appropriate conditions for the injured brain to undergo neuroplasticity. 

“Among other things, neuroplasticity means that emotions such as happiness and compassion can be cultivated in much the same way that a person can learn through repetition to play golf and basketball or master a musical instrument, and that such practice changes the activity and physical aspects of specific brain areas.” Andrew Weil

Neuroplasticity and physical activity in Parkinson’s: [Please remember I am not a physician; I’m not making recommendations for you to do something.  Please talk with your neurologist and/or family practitioner before beginning any of these exercise programs.]  Balance, gait-improvement and flexibility are some of the obvious things a person with Parkinson’s needs to address on a frequent basis, in fact, on a daily basis. Clearly this needs to be self-motivated in the interest of possible neuro-rehabilitation. Most experts suggest that the exercise program should be repetitive, intense, and challenging.   Of course, you must enjoy the exercise program.   Ultimately, exercising should hopefully improve motor functions  and also assist  in improving cognitive function.

The exercises that have been most widely studied and proven to be the most beneficial in promoting neuroplasticity are  treadmill training, amplitude training, tai chi, tango dancing, boxing and cycling  (there are many other exercises to consider, don’t be limited by these above). In my opinion, it’s doing the aerobic exercise you enjoy on a daily and sustained basis,  it’s getting range of motion, and its challenging to you mentally.  As a scientist, I’m impressed by the data in rodent Parkinson’s models and the ability of exercise to promote neuroplasticity, to provide neuroprotection, and even offer neurorestoration. In human studies, the results are remarkably strong as well; showing that sustained aerobic exercise induces neuroplasticity in a damaged brain to improve overall brain health.

“Things don’t go wrong and break your heart so you can become bitter and give up. They happen to break you down and build you up so you can be all that you were intended to be.” Charles Jones

Neuroplasticity and physical activity on overall brain health in Parkinson’s. There is substantial scientific evidence that goal-directed aerobic exercise can improve and strengthen motor circuitry. This is due to structural modifications of synapses and overall improved brain health (increased blood flow, enhanced innate immune system and possibly neurogenesis). Overall brain health initiated by exercise-dependent neuroplasticity alters behavior (affecting many areas of the brain, e.g., the basal ganglia,  cortex, thalamus, and cerebellum). Ultimately, the net effect of sustained exercise and neuroplasticity results in improved motor skills, executive function, cognitive function and mood and motivation.  The diagram below illustrates the changes that can occur with exercise-induced neuroplasticity in Parkinson’s.

Neuroplasticity_4.16.03.13

“Any man could, if he were so inclined, be the sculptor of his own brain.” Santiago Ramón y Cajal

Three comments on déjà vu, neuroplasticity  and physical activity in Parkinson’s:
#1,  Maybe you’re thinking that I’m 62 y.o. and just less coordinated on the golf course with or without Parkinson’s. No doubt this is true but I have my déjà vu feeling, there’s clearly some brain-body disconnect with Parkinson’s (I do need to keep practicing to get more consistent).
#2,  Exercise-induced neuroplasticity will not reverse the effects of Parkinson’s. However, many different studies suggest some restoration of brain circuitry due to exercise-induced neuroplasticity. This implies with time and effort to exercise one could somewhat improve motor learning and behavior performance.
#3, We have much to learn about neuroplasticity and yes even déjà vu. The brain is a powerful organ capable of many different changes when impacted by damage. As we further delineate the mechanism of exercise-induced neuroplasticity, we will better understand Parkinson’s.  Hopefully, from this research (some references are below), there exists the prospect of improved treatment of Parkinson’s. Always remember, a regular aerobic exercise program is good for both your heart and your brain.  Stay positive, be focused, remain hopeful and enjoy your daily exercise.

“Be patient toward all that is unsolved in your heart and try to love the questions themselves, like locked rooms and like books that are now written in a very foreign tongue. Do not now seek the answers, which cannot be given you because you would not be able to live them. And the point is, to live everything. Live the questions now. Perhaps you will then gradually, without noticing it, live along some distant day into the answer.” Rainer Maria Rilke

Cover Photo Credit: https://c1.staticflickr.com/9/8210/8205735122_25302e7cce_b.jpg

References-

Alberts JL, Linder SM, Penko AL, Lowe MJ, Phillips M. It is not about the bike, it is about the pedaling: forced exercise and Parkinson’s disease. Exerc Sport Sci Rev. 2011;39(4):177–86. [PubMed]

Combs SA, Diehl MD, Staples WH, et al. Boxing Training for Patients With Parkinson Disease: A Case Series. Phys Ther. 2010;91(1):132–42. [PubMed]

Corcos DM, Comella CL, Goetz CG. Tai chi for patients with Parkinson’s disease. N Engl J Med. 2012;366(18):1737–8. [PubMed]

Farley BG, Koshland GF. Training BIG to move faster: the application of the speed-amplitude relation as a rehabilitation strategy for people with Parkinson’s disease. Exp Brain Res. 2005;167(3):462–7. [PubMed]

Fisher BE, Wu AD, Salem GJ, et al. The effect of exercise training in improving motor performance and corticomotor excitability in people with early Parkinson’s disease. Arch Phys Med Rehabil. 2008;89(7):1221–9. [PMC free article] [PubMed]

Fox CM, Ramig LO, Ciucci MR, Sapir S, McFarland DH, Farley BG. The science and practice of LSVT/LOUD: neural plasticity-principled approach to treating individuals with Parkinson disease and other neurological disorders. Semin Speech Lang. 2006;27(4):283–99. [PubMed]

Gajewski PD, Falkenstein M. Physical activity and neurocognitive functioning in aging – a condensed updated review. European Review of Aging and Physical Activity. 2016;13:1. doi:10.1186/s11556-016-0161-3.

Hackney ME, Earhart GM. Effects of dance on movement control in Parkinson’s disease: a comparison of Argentine tango and American ballroom. J Rehabil Med. 2009;41(6):475–81. [PMC free article] [PubMed]

Heremans E, Nackaerts E, Vervoort G, Broeder S, Swinnen SP, Nieuwboer A. Impaired Retention of Motor Learning of Writing Skills in Patients with Parkinson’s Disease with Freezing of Gait. Allodi S, ed. PLoS ONE. 2016;11(2):e0148933. doi:10.1371/journal.pone.0148933.

Kleim JA, Jones TA. Principles of experience-dependent neural plasticity: implications for rehabilitation after brain damage. J Speech Lang Hear Res. 2008;51(1):S225–39. [PubMed]

Li F, Harmer P, Fitzgerald K, et al. Tai chi and postural stability in patients with Parkinson’s disease. N Engl J Med. 2012;366(6):511–9. [PMC free article] [PubMed]

Petzinger GM, Fisher BE, McEwen S, Beeler JA, Walsh JP, Jakowec MW. Exercise-enhanced neuroplasticity targeting motor and cognitive circuitry in Parkinson’s disease. Lancet Neurol. 2013; 12(7):716–726. doi: 10.1016/S1474-4422(13)70123-6 [PMC free article] [PubMed]

Voss MW, Vivar C, Kramer AF, van Praag H. Bridging animal and human models of exercise-induced brain plasticity. Trends in cognitive sciences. 2013;17(10):525-544. doi:10.1016/j.tics.2013.08.001.

 

4 thoughts on “Déjà Vu and Neuroplasticity in Parkinson’s”

  1. Great post Frank. Do you experience gait problems? I do. But when I bounce a tennisball in front of me during walking, my balance improves magically. Its like the bouncing makes me use another part of the brain. My left hand bends inward and clenches. When I hold an play with prayer beads with this hand, the stifness abates.
    There is much to learn……

    Liked by 1 person

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