We all know that brain plasticity plays a major role in recovery after a neurological event.
But how do you actually use it in your practice? What practical steps can you take to maximize neuroplasticity in the brains of your adult speech therapy patients?
In this post, you’ll find the 10 principles of neuroplasticity as outlined by Kleim and Jones—plus practical treatment tips, based on the evidence.
And for everything you need to assess, treat, and document, check out The Adult Speech Therapy Starter Pack!
Real Quick: What Is Neuroplasticity?
Neuroplasticity is the central nervous system’s ability to reorganize and make new connections in response to experiences.
In the everyday brain, this is how the brain learns. And in the injured brain, this is how it relearns what was lost.
10 Principles of Neuroplasticity
The 10 principles of neuroplasticity (as outlined by Kleim and Jones) are, in their words, “highlights” of the factors most relevant to brain damage recovery.
Let’s review these highlights below. And go over practical ways they can improve your patient’s quality of life!
1. Use It—Or Lose It
Function can be lost if the associated part of the brain isn’t activated.
For example, let’s say that a person with expressive aphasia consistently uses compensations such as gestures, writing, or AAC instead of speaking.
This person risks losing the function of speaking because they aren’t using that part of their brain.
Use It Or Lose It Tips
- Aphasia: Consider constraint-induced language therapy to improve verbal speech
- Dysphagia: Consider swallowing drills without a bolus for patients with oropharyngeal dysphagia and life-threatening aspiration
- Memory: Train your patient to use the memory strategies “repeat repeat repeat” and “grouping” in addition to using compensatory visual aids
2. Use It And Improve It
As the saying goes, “Practice makes perfect.” Of course, this saying isn’t exactly true!
But it does support the point that the more you practice a specific brain function, the more that function will improve.
Use It And Improve It Tips
- Visual neglect: Use bright painter’s tape, post-its, etc. to encourage attention to the affected side. Encourage caregivers to sit on the affected side. Have objects of interest (window, television, etc.) on their neglected side
- Dysphagia: Provide increasingly challenging boluses by changing the texture, amount, or both
- Provide homework & caregiver training to encourage more practice
The amount and intensity of practice matter, too. Keep scrolling to learn more!
Brain changes will occur in the parts of the brain being used during an action. We all know this!
But here’s the rub: Specificity implies that these brain changes don’t necessarily generalize to other functions.
For example, lip-strengthening exercises may not result in improved speech production. It may just improve lip movement! If explained by specificity, this is because the part of the brain responsible for lip movement is not the same part responsible for speech production.
This principle can be confusing because generalization does often occur during therapy!
So to keep it patient-centered (and to save yourself from a headache!) focus on function.
Specificity Tips: Keep It Functional!
- Dysphagia: The best exercise for swallowing is swallowing! Even dry swallows or swallows with small boluses can be functional
- Executive Functioning: Use functional, patient-led goals to rebuild executive functioning skills after a brain injury
- Aphasia: Use vocabulary that the patient actually uses on a daily basis
Not surprisingly, the research shows that practicing a movement a lot and over an extended period of time leads to superior learning of that movement.
What Is Distributed vs Massed Practice?
Let’s say that a patient’s insurance will pay for 20 speech therapy sessions.
Distributed practice would be less sessions per week extended over more weeks (e.g. 2 sessions per week for 10 weeks).
Massed practice is more sessions per week consolidated into fewer weeks (5 sessions per week for 4 weeks).
- Voice: LSVT is an effective, high-repetition voice treatment
- Aphasia: Aphasia research suggests that massed practice is better
- Motor Speech: Have your patient repeat challenging speech sounds over and over in a variety of contexts (bisyllabic words, multisyllabic words, word-final position, word medial position, etc). Rehab-therapy research suggests that distributed practice is best for motor learning in the long term
- Memory: Distributed practice results in better retention of learning for memory patients
A certain threshold of intensity (e.g., length of exercise, number of sessions) needs to be reached in order to induce neuroplasticity.
But for speech rehabilitation, we do need to find the right balance, based on our patients’ unique factors.
- Motor Speech: Aim for 50 repetitions per target
- Dysphagia: Aim to elicit at least 50 swallows per session
- When deciding on intensity, be aware of each patient’s limitations, needs, and contraindications:
- Neuromuscular diseases (ALS, etc.): Patients with neuromuscular diseases are not appropriate for high-intensity treatment
- Acquired brain injury: For some in the very acute post-brain-injury phase, high-intensity treatment may be contraindicated. Once patients are medically stable, higher intensity training has been shown to lead to better results
6. Time Matters
Different forms of neuroplasticity happen at different times during the recovery process.
During motor skills treatment, for example, gene expression happens before synapses are formed. This is one reason why it’s so important to spend enough time on treatment.
Also, spending enough time on treatment is required for brain changes to be stable and long-lasting.
- Acquired brain injury: Neuronal changes are more likely to happen during the early, spontaneous recovery period
- Aphasia: Although treatment is most effective in the acute stages of recovery, research has shown remarkable gains even years after the onset of aphasia!
- Dysphagia: Add compensatory strategies to your treatment to improve safety during the early phases of recovery
The function being treated must be meaningful to the patient in order to maximize neuroplasticity.
For example, in voice and language treatment, use real words (salient and meaningful) versus non-words (not salient and not meaningful) in order to target certain sounds.
- Keep treatment functional! For voice treatment, try substituting strength exercises for meaningful communication
- Listen to your patient: What matters to them? What motivates them? Not only is this person-centered care, but it improves neuroplasticity. Yay!
Although younger brains have more neuroplasticity, older brains can still change, although at a slower rate
- Encourage a healthy lifestyle that slows down the effects of aging. This includes eating right, physical exercise, mental exercise, and socializing
- Be aware of age-related changes that impact neuroplasticity. For example, decreased oral sensory awareness may result in compensations in the older brain
Neuroplasticity from one training experience (e.g. loud speech) can sometimes transfer to or enhance related skills (swallowing).
While this appears to contradict the principle of specificity, in reality, it just shows that there’s a lot that we still don’t know about the brain!
- Again, keep treatment functional and person-centered
- Motor Learning: Treat more complex sounds, like consonant clusters
- Voice: LSVT Loud has been shown to improve articulation and swallowing ability
- Aphasia: Semantic feature analysis research shows some improvement in the generalization of naming ability
- Memory: Spaced retrieval leads to generalization for certain patients
- Enrich The Environment: Enrich the environment, as appropriate. Patients with visual neglect, for example, may benefit from bright painter’s tape and post-its that direct attention to their neglected side. While patients with dementia benefit from fewer visual and auditory distractions
Not all neuroplasticity is desirable! An example is a compensatory behavior that interferes with regaining the desired function.
For this, let’s go back to the example of a patient with expressive aphasia who uses compensations such as gestures, writing, or AAC much more often than she attempts to speak.
These strengthened compensatory neural pathways may interfere with the function of speaking.
- Be aware of the negative power of neuroplasticity!
- Encourage patients to nip “bad habits” that undermine their progress in the bud
- Find ways to add more practice of the desired function into a patient’s daily routine:
- Voice: Encourage LSVT patients to “THINK BIG!” not just when speaking, but also when dressing, walking, and even sitting upright in their chair
- Memory: Post visual reminders to reinforce memory strategies (For example, a laminated sign on their wheelchair that says “What should I do before standing?” to reinforce spaced retrieval. Or a calendar posted on the refrigerator)
- Aphasia: Consider constraint-induced language therapy
- Provide homework & caregiver training to encourage more practice of the desired function
Evidence-Based Speech Therapy Materials
Visit our shop for pre-made handouts, worksheets, goals banks, and much more!
- Donovan, J. J., & Radosevich, D. J. (1999). A meta-analytic review of the distribution of practice effect: Now you see it, now you don’t. Journal of Applied Psychology, 84, 795–805
- Kleim JA, Jones TA. Principles of experience-dependent neural plasticity: implications for rehabilitation after brain damage. J Speech Lang Hear Res. 2008 Feb;51(1):S225-39
- Ludlow CL, et al. Translating principles of neural plasticity into research on speech motor control recovery and rehabilitation. J Speech Lang Hear Res. 2008 Feb;51(1):S240-58
- Raymer AM, et al. Translational research in aphasia: from neuroscience to neurorehabilitation. J Speech Lang Hear Res. 2008 Feb;51(1):S259-75. mass
- Robbins J, et al. Swallowing and dysphagia rehabilitation: translating principles of neural plasticity into clinically oriented evidence. J Speech Lang Hear Res. 2008 Feb;51(1):S276-300