FNE senhjerneskades kursusdag

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1 CHALLENGING THE CONCEPTS OF LOCALIZATION AND RECOVERY OF BRAIN FUNCTION Neuroplasticitet og rehabilitering efter hjerneskade Glostrup Hospital Depts. of Neurol. and Neurosurg. The (UCN) The Center for of Brain Injury, Copenhagen Jesper Mogensen Head of UCN (The ), Dep.. of Psychol., University of Copenhagen Director of ReCBIR ( ) The Unit of the Dep. of Neurorehabilitation Laboratory of Neuroplasticity, Nencki Medical Council, Cognition, Institute, Warsaw, PL and Brain Sciences Unit, UK University of Turku, FIN Trinity College Institute of Department of, Trinity College, Medicine, Charles University, Prag, Dublin, IR CZ 2 BEHANDLING af og STØTTE til patienterne: - større og bedre indsats nu - OG en forskning, som lægger grunden for fremtidens behandling Hvad står i vejen for den bedre fremtid? - dårlig økonomi - politisk modstand (ledende til økonomiske hindringer) 4 5 Er rehabilitering efter hjerneskade uvidenskabelig? -nej Den regionale specialisering af hjernen funktionel lokalisation - men hvordan kan hjernens funktioner både være lokaliserede og genoprettes efter en skade? 6 7 Odense 18 november

2 FULD FUNKTIONEL GENOPRETNING TRODS KOMPLET SKADE AF HJERNESTRUKTURER (ALLOCENTRISK PLACE LEARNING) LOKALISATION ELLER GENOPRETNING? ELLER? Mogensen et al. Brain Bulletin, Netværk Odense 18 november

3 MEKANISMER for NEURONDØD NEUROGENESE I DEN VOKSNE HJERNE BDNF (Brain-Derived Neurotrophic Factor) samt andre trofiske faktorer SPROUTING Odense 18 november

4 ERFARINGS-ASSOCIERET SYNAPTISK PLASTICITET hos mennesker HVAD PÅVIRKER HJERNENS PLASICITET? HPA-Aksen Stress? Odense 18 november

5 Faktorer, som påvirker HPA-Aksen Atrofi p.g.a. Cortisol BDNF s Rolle HPA-akse-aktivitet ved depression Faktorer med betydning for cortisol-receptorer i hippocampus og dermed HPA-akse-aktivitet samt for depression 1. Genetik 2. Opvækst-betingelser 3. Akut stress Virkninger af antidepressiva SKADER ved BLODPROP Odense 18 november

6 BDNF ved motorisk aktivitet BDNF HVAD PÅVIRKER HJERNENS PLASICITET? Motion? Aktivering/stimulation som terapeutisk metode ved hjerneskade Odense 18 november

7 Tidlig eller sen? SEN! Men Odense 18 november

8 Aktivering/stimulation som terapeutisk metode ved hjerneskade Påtvunget eller frivillig? Stress? Exercise after stress FRIVILLIG! Men Odense 18 november

9 Aktivering/stimulation som terapeutisk metode ved hjerneskade Støtte til funktionel genopretning og træning samt måske skader ved psykiske lidelser Aktivering/Stimulering Farmakologi Farmakologisk støttet rehabilitering Farmakologisk støttet rehabilitering Effekter af Erythropoietin (EPO) Odense 18 november

10 7 dage 30 dage Glutamat Betydning i den akutte fase Betydning for langsigtet reorganisering Interaktioner SKADER ved BLODPROP Glutamat - PIMSD DEN DYNAMISKE HJERNE: HÅB OG UDFORDRINGER Odense 18 november

11 Den regionale specialisering af hjernen funktionel lokalisation FULD FUNKTIONEL GENOPRETNING TRODS KOMPLET SKADE AF HJERNESTRUKTURER (ALLOCENTRISK PLACE LEARNING) Mogensen et al. Brain Bulletin, LOKALISATION ELLER GENOPRETNING? FULD FUNKTIONEL GENOPRETNING TRODS KOMPLET SKADE AF HJERNESTRUKTURER (ALLOCENTRISK PLACE LEARNING) ELLER? Mogensen et al. Brain Bulletin, Different Solution Strategies SHIFT in the NEURAL SUBSTRATE Mogensen, J., Lauritsen, K.T., Elvertorp, S., Hasman, A., Moustgaard, A. & Wörtwein, G. Place learning and object recognition by rats subjected to transection of the fimbria-fornix and/or ablation of the prefrontal cortex. Brain Bulletin, 2004, 63, Odense 18 november

12 PHENOMENA OF POSTTRAUMATIC RECOVERY 1. MODIFICATION OF DEGREE OF CONTRIBUTION TO TASK MEDIATION BY INDIVIDUAL STRUCTURES: 2. TASK-DEPENDENT AND DISSIMILAR NEURAL SUBSTRATES: 3. APPLICATION OF NEW COGNITIVE STRATEGIES: Some structures exhibit increased or decreased levels of contribution to task mediation After a given lesion the functional recovery of various cognitive tasks is mediated by unique and dissimilar neural substrates The fully posttraumatically recovered individuals solve the task by applying new strategies that are dissimilar to those applied pretraumatically 108 AS A BEHAVIOUR X ALGORITHMIC STRATEGIES ELEMENTARY FUNCTIONS AS C 11 UNDERLYING COGNITIVE MECHANISMS 12 XV II NEURAL SUBSTRATES 15 I IX XIV VIII XIII III X VII IV V XII VI XI Brain structure γ Brain structure β Brain structure α 110 UNDERLYING NEURAL MECHANISMS GENERALISERING kan vi få træningen ud i virkeligheden? og kan vi få virkeligheden ind i træningen? Odense 18 november

13 Træningen ud i virkeligheden! Virkeligheden ind i træningen! NEUROGENESE I DEN VOKSNE HJERNE Kritiske perioder under udviklingen Aktivering/stimulation som terapeutisk metode ved hjerneskade I forskning og behandling lad os gå direkte efter de optimale løsninger! Odense 18 november

HAROLD CAMPING i ii iii iv v vi vii viii ix x xi xii 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52

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