Skip to main content Accessibility help
×
Hostname: page-component-76fb5796d-2lccl Total loading time: 0 Render date: 2024-04-25T10:44:56.530Z Has data issue: false hasContentIssue false

4 - You can teach an old dog new tricks:

harnessing neuroplasticity after brain injury in older adults

Published online by Cambridge University Press:  06 December 2010

Prem S. Fry
Affiliation:
Trinity Western University, British Columbia
Corey L. M. Keyes
Affiliation:
Emory University, Atlanta
Get access

Summary

Abstract

Animal and human research has shown that the brain can reorganize and even remodel itself to restore function in response to central nervous system (CNS) injuries, such as stroke, traumatic brain injury, and spinal cord injury. This chapter will discuss the phenomenon of neuroplasticity after damage to the CNS demonstrated in animal and human experiments. Research on Constraint-Induced Movement therapy or CI therapy, which is a behaviorally based approach to physical rehabilitation, will be a major focus. This body of work, among other contributions, overthrew the reigning clinical wisdom that stroke survivors more than 1-year post-event can not benefit from additional physical rehabilitation. It also provided the first evidence that physical rehabilitation can produce large improvements in real-world arm function and change CNS organization and structure. This evidence provides a neurophysiological basis for continued plasticity in behavior among older adults.

Introduction

Clinical wisdom, and even the scientific view, until relatively recently was that older adults who suffered damage to their brain had little hope that this vital organ could repair itself or adapt how it functioned to overcome the injury. The scientific view was based on the long-held tenet that the mature central nervous system (CNS) had little capacity to repair or reorganize itself. Though contrary views were expressed (e.g., Flourens, 1842; Fritsch and Hitzig, 1870; Lashley, 1938; Munk, 1881), the mature CNS was generally believed (Kaas, 1995, p. 735) to exhibit little or no plasticity (e.g., Hubel and Wiesel, 1970; Ruch, 1960, p. 274).

Type
Chapter
Information
New Frontiers in Resilient Aging
Life-Strengths and Well-Being in Late Life
, pp. 104 - 129
Publisher: Cambridge University Press
Print publication year: 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Altman, J., and Das, G. D. (1965). Autoradiographic and histological evidence of postnatal hippocampal neurogenesis in rats. Journal of Comparative Neurology, 124, 319–335.
Azrin, N. H., and Holz, W. C. (1966). Punishment. In Honig, W. K. (ed.), Operant behavior: Areas of research and application (pp. 380–447). New York: Appleton-Century-Crofts.Google Scholar
Badan, I., Dinca, I., Buchhold, B.et al. (2004). Accelerated accumulation of N- and C-terminal beta APP fragments and delayed recovery of microtubule-associated protein 1B expression following stroke in aged rats. European Journal of Neuroscience, 19, 2270–2280.CrossRefGoogle ScholarPubMed
Baltes, M. M., Honn, S., Barton, E. M., Orzech, M., and Lago, D. (1983). On the social ecology of dependence and independence in elderly nursing home residents: A replication and extension. Journal of Gerontology, 38, 556–564.CrossRefGoogle Scholar
Baltes, M. M., Neumann, E., and Zank, S. (1994). Maintenance and rehabilitation of independence in old age: An intervention program for staff. Psychology and Aging, 9, 179–188.CrossRefGoogle ScholarPubMed
Bogdan Petcu, E., Sfredel, V., Platt, D., Herndon, J. G., Kessler, C., and Popa-Wagner, A. (2008). Cellular and molecular events underlying the dysregulated response of the aged brain to stroke: a mini-review. Gerontology, 54, 6–17.CrossRefGoogle Scholar
Brant-Zawadzki, M., Atkinson, D., Detrick, M., Bradley, W. G., and Scidmore, G. (1996). Fluid-attenuated inversion recovery (FLAIR) for assessment of cerebral infarction. Initial clinical experience in 50 patients. Stroke, 27, 1187–1191.CrossRefGoogle ScholarPubMed
Brown, T., and Sherrington, C. (1912). On the instability of a cortical point. Proceedings of the Royal Society of London B, 85, 585–602.CrossRefGoogle Scholar
Burgio, L. D., Burgio, K. L., Engel, B. T., and Tice, L. M. (1986). Increasing distance and independence of ambulation in elderly nursing home residents. Journal of Applied Behavior Analysis, 19, 357–366.CrossRefGoogle ScholarPubMed
Burke, S. N., and Barnes, C. A. (2006). Neural plasticity in the ageing brain. Nature Reviews Neuroscience, 7, 30–40.CrossRefGoogle ScholarPubMed
Calautti, C., Leroy, F., Guincestre, J. Y., and Baron, J. C. (2001). Dynamics of motor network overactivation after striatocapsular stroke: A longitudinal PET study using a fixed-performance paradigm. Stroke, 32(11), 2534–2542.CrossRefGoogle ScholarPubMed
Cameron, H. A., Woolley, C. S., McEwen, B. S., and Gould, E. (1993). Differentiation of newly born neurons and glia in the dentate gyrus of the adult rat. Neuroscience, 56, 337–344.CrossRefGoogle ScholarPubMed
Candia, V., Rosset-Llobet, J., Elbert, T., and Pascual-Leone, A. (2005). Changing the brain through therapy for musicians' hand dystonia. Annals of the New York Academy of Sciences, 1060, 335–342.CrossRefGoogle ScholarPubMed
Candia, V., Wienbruch, C., Elbert, T. et al. (2003). Effective behavioral treatment of focal hand dystonia in musicians alters somatosensory cortical organization. Proceedings of the National Academy of Sciences of the United States, 100, 7942–7946.CrossRefGoogle ScholarPubMed
Catania, A. C. (1998). Learning, 4th edn. Upper Saddle River, NJ: Prentice Hall.Google Scholar
Christodoulou, C., DeLuca, J., Ricker, J. H.et al. (2001). Functional magnetic resonance imaging of working memory impairment after traumatic brain injury. Journal of Neurology, Neurosurgery and Psychiatry, 71(2), 161–168.CrossRefGoogle ScholarPubMed
Cohen, J. (1983). Statistical power analysis for the behavioral sciences, 2nd edn. Hillsdale, NJ: Erlbaum.Google Scholar
Colcombe, S., and Kramer, A. F. (2003). Fitness effects on the cognitive function of older adults; A meta-analytic study. Psychological Science: a journal of the American Psychological Society, 14, 125–130.CrossRefGoogle ScholarPubMed
Corotto, F. S., Henegar, J. R., and Maruniak, J. A. (1994). Odor deprivation leads to reduced neurogenesis and reduced neuronal survival in the olfactory bulb of the adult mouse. Neuroscience, 61, 739–744.CrossRefGoogle ScholarPubMed
Cramer, S. C., Nelles, G., Schaechter, J. D., Kaplan, J. D., Finklestein, S. P., and Rosen, B. R. (2001). A functional MRI study of three motor tasks in the evaluation of stroke recovery. Neurorehabilitation and Neural Repair, 15(1), 1–8.CrossRefGoogle ScholarPubMed
Curtis, M. A., Kam, M., Nannmark, U.et al. (2007). Human neuroblasts migrate to the olfactory bulb via a lateral ventricular extension. Science, 315(5816), 1243–1249.CrossRefGoogle Scholar
Darsalia, V., Heldmann, U., Lindvall, O., and Kokaia, Z. (2005). Stroke-induced neurogenesis in the aged rodent brain. Stroke, 36, 1790–1795.CrossRefGoogle Scholar
Draganski, B., Gaser, C., Busch, V., Schuierer, G., Bogdahn, U., and May, A. (2004). Changes in grey matter induced by training. Nature, 427(6972), 311–312.CrossRefGoogle Scholar
Draganski, B., Moser, T., Lummel, N.et al. (2006). Decrease of thalamic gray matter following limb amputation. Neuroimage, 31, 951–957.CrossRefGoogle ScholarPubMed
Edgerton, V. R., Leon, R. D., Harkema, S. J.et al. (2001). Retraining the injured spinal cord. The Journal of Physiology, 533, 15–22.CrossRefGoogle ScholarPubMed
Elbert, T., Candia, V., Altenmuller, E.et al. (1998). Alteration of digital representations in somatosensory cortex in focal hand dystonia. Neuroreport, 9(16), 3571–3575.CrossRefGoogle ScholarPubMed
Elbert, T., Flor, H., Birbaumer, N.et al. (1994). Extensive reorganization of the somatosensory cortex in adult humans after nervous system injury. Neuroreport, 5(18), 2593–2597.CrossRefGoogle ScholarPubMed
Elbert, T., Pantev, C., Wienbruch, C., Rockstroh, B., and Taub, E. (1995). Increased cortical representation of the fingers of the left hand in string players. Science, 270(5234), 305–307.CrossRefGoogle ScholarPubMed
Elbert, T., Sterr, A., Rockstroh, B., Pantev, C., Muller, M. M., and Taub, E. (2002). Expansion of the tonotopic area in the auditory cortex of the blind. The Journal of Neuroscience, 22(22), 9941–9944.CrossRefGoogle ScholarPubMed
Eriksson, P. S., Perfilieva, E., Bjork-Eriksson, T.et al. (1998). Neurogenesis in the adult human hippocampus. Nature Medicine, 4, 1313–1317.CrossRefGoogle ScholarPubMed
Estes, W. K. (1944). An experimental study of punishment. Psychological Monographs, 57 (Serial No. 263).CrossRefGoogle Scholar
Flourens, P. ( 1842). Recherches expérimentales sur les propriétés et les fonctions du système nerveux, dans les animaux vertébrés[Experiments on the properties and functions of the nervous system of vertebrate animals], 2nd edn. Paris: Bellière.Google Scholar
Fritsch, G., and Hitzig, E. (1870). Über die elektrische Erregbarkeit des Grosshirns [On the electrical excitability of the cerebral cortex]. Archiv fuer Anatomie und Physiologie, 37, 300–332.Google Scholar
Gauthier, L. V., Taub, E., Mark, V. W., Perkins, C., and Uswatte, G. (2009). Improvement after Constraint-Induced Movement therapy is independent of infarct location in chronic stroke patients. Stroke, 40, 2468–2472.CrossRefGoogle ScholarPubMed
Gauthier, L. V., Taub, E., Perkins, C., Ortmann, M., Mark, V. W., and Uswatte, G. (2008). Remodeling the brain: Plastic structural brain changes produced by different motor therapies after stroke. Stroke, 39, 1520–1525.CrossRefGoogle ScholarPubMed
Gellhorn, E., and Hyde, J. (1953). Influence of proprioception on map of cortical responses. Journal of Physiology, 122, 371–385.CrossRefGoogle ScholarPubMed
Gould, E. (2007). How widespread is adult neurogenesis in mammals?Nature Reviews Neuroscience, 8, 481–488.CrossRefGoogle ScholarPubMed
Gould, E., Cameron, H. A., Daniels, D. C., Woolley, C. S., and McEwen, B. S. (1992). Adrenal hormones suppress cell division in the adult rat dentate gyrus. Journal of Neuroscience, 12, 3642–3650.CrossRefGoogle ScholarPubMed
Hubel, D. H., and Wiesel, T. N. J. (1970). The period of susceptibility to the physiological effects of unilateral eye closure in kittens. Journal of Physiology, 206, 419–436.CrossRefGoogle ScholarPubMed
Jenkins, W. M., Merzenich, M. M., Ochs, M. T., Allard, T., and Guic-Robles, E. (1990). Functional reorganization of primary somatosensory cortex in adult owl monkeys after behaviorally controlled tactile stimulation. Journal of Neurophysiology, 63(1), 82–104.CrossRefGoogle ScholarPubMed
Kaas, J. H. (1995). Neurobiology. How cortex reorganizes [news; comment]. Nature, 375(6534), 735–736.CrossRefGoogle Scholar
Kaas, J. H., Merzenich, M. M., and Killackey, H. P. (1983). The reorganization of somatosensory cortex following peripheral nerve damage in adult and developing mammals. Annual Review of Neuroscience, 6, 325–356.CrossRefGoogle ScholarPubMed
Knapp, H. D., Taub, E., and Berman, A. J. (1963). Movements in monkeys with deafferented forelimbs. Experimental Neurology, 7, 305–315.CrossRefGoogle ScholarPubMed
Lashley, K. S. (1938). Factors limiting recovery after central nervous lesions. Journal of Nervous and Mental Diseases, 88, 733–755.CrossRefGoogle Scholar
Liepert, J., Bauder, H., Wolfgang, H. R., Miltner, W. H., Taub, E., and Weiller, C. (2000). Treatment-induced cortical reorganization after stroke in humans. Stroke, 31, 1210–1216.CrossRefGoogle ScholarPubMed
Liepert, J., Miltner, W. H., Bauder, H.et al. (1998). Motor cortex plasticity ­during Constraint-Induced Movement therapy in stroke patients. Neuroscience Letters, 250(1), 5–8.CrossRefGoogle ScholarPubMed
Liepert, J., Tegenthoff, M., and Malin, J. P. (1995). Changes of cortical motor area size during immobilization. Electroencephalograhy and Clinical Neurophysiology, 97(6), 382–386.CrossRefGoogle ScholarPubMed
Lois, C., and Alvarez-Buylla, A. (1994). Long-distance neuronal migration in the adult mammalian brain. Science, 264(5162), 1145–1148.CrossRefGoogle Scholar
MacDonald, M. L., and Butler, A. K. (1974). Reversal of helplessness: Producing walking behavior in nursing home wheelchair residents using behavior modification procedures. Journal of Gerontology, 29, 97–101.CrossRefGoogle ScholarPubMed
Maguire, E. A., Gadian, D. G., Johnsrude, I. S.et al. (2000). Navigation-related structural change in the hippocampi of taxi drivers. Proceedings of the National Academy of Sciences USA, 97, 4398–4403.CrossRefGoogle ScholarPubMed
Mahncke, H. W., Connor, B. B., Appelman, J.et al. (2006). Memory enhancement in healthy older adults using a brain plasticity-based training program: A randomized, controlled study. Proceedings of the National Academy of Sciences of the United States of America, 103, 12523–12528.CrossRefGoogle ScholarPubMed
Mark, V., Taub, E., and Morris, D. M. (2006). Neuroplasticity and Constraint-Induced Movement Therapy. Europa Medicophysica, 42(2), 269–284.Google ScholarPubMed
Mark, V. W., Taub, E., Perkins, C., Gauthier, L. V., and Uswatte, G. (2008). MRI infarction load and CI therapy outcomes for chronic post-stroke hemiparesis. Restorative Neurology and Neuroscience, 26, 13–33.Google ScholarPubMed
Marshall, R. S., Perera, G. M., Lazar, R. M., Krakauer, J. W., Constantine, R. C., and DeLaPaz, R. L. (2000). Evolution of cortical activation during recovery from corticospinal tract infarction. Stroke, 31(3), 656–661.CrossRefGoogle ScholarPubMed
Merzenich, M. M., Nelson, R. J., Stryker, M. P., Cynader, M. S., Schoppmann, A., and Zook, J. M. (1984). Somatosensory cortical map changes following digit amputation in adult monkeys. Journal of Comparative Neurology, 224(4), 591–605.CrossRefGoogle ScholarPubMed
Mott, F. W., and Sherrington, C. S. (1895). Experiments upon the influence of sensory nerves upon movement and nutrition of the limbs. Proceedings of the Royal Society of London, 57, 481–488.CrossRefGoogle Scholar
Munk, H. (1881). Über die Funktionen der Grosshirnrinde. Gesammelte Mitteilungen aus den Jahren 1877–1880 [On the functions of the cerebral cortex, collected writing from the years 1877–1880]. Berlin: Hirschwald.Google Scholar
Nudo, R. J., and Milliken, G. W. (1996). Reorganization of movement representations in primary motor cortex following focal ischemic infarcts in adult squirrel monkeys. Journal of Neurophysiology, 75(5), 2144–2149.CrossRefGoogle ScholarPubMed
, Ottawa Panel, Khadilkar, A., Phillips, K., et al. (2006). Ottawa Panel evidence-based clinical practice guidelines for post-stroke rehabilitation. Topics in Stroke Rehabilitation, 2006, 1–269.Google Scholar
Pons, T. P., Garraghty, P. E., Ommaya, A. K., Kaas, J. H., Taub, E., and Mishkin, M. (1991). Massive cortical reorganization after sensory deafferentation in adult macaques. Science, 252(5014), 1857–1860.CrossRefGoogle ScholarPubMed
Popa-Wagner, A., Schroder, E., Schmoll, H., Walker, L., and Kessler, C. (1999). Upregulation of MAP1B and MAP2 in the rat brain following middle cerebral artery occlusion: Effect of age. Journal of Cerebral Blood Flow and Metabolism, 19, 425–434.CrossRefGoogle Scholar
Pulvermüller, F., Neininger, B., Elbert, T.et al. (2001). Constraint-induced therapy of chronic aphasia after stroke. Stroke, 32(7), 1621–1626.CrossRefGoogle ScholarPubMed
Rakic, P. (1985). Limits of neurogenesis in primates. Science, 227(4690), 1054–1056.CrossRefGoogle Scholar
Rantanen, T., Guralnik, J. M., Sakari-Rantala, R. . et al. (1999). Disability, physical activity, and muscle strength in older women: The Women's Health and Aging Study. Archives of Physical Medicine and Rehabilitation, 80, 130–135.CrossRefGoogle ScholarPubMed
Ruch, T. C. (1960). The cerebral cortex: its structure and motor functions. In Ruch, T. C. and Fulton, J. F. (eds.), Medical Physiology and Biophysics, 18th edn. (pp. 249–276). Philadelphia, PA: W. B. Saunders.Google Scholar
Sachs, D. (1975). Behavioral techniques in a residential nursing home facility. Journal of Behavior Therapy and Experimental Psychiatry, 6, 123–127.CrossRefGoogle Scholar
Salthouse, T. A. (2004). What and when of cognitive aging. Current Directions in Psychological Science, 13, 140–144.CrossRefGoogle Scholar
Schaechter, J. D. (2004). Motor rehabilitation and brain plasticity after hemiparetic stroke. Progress in Neurobiology, 73(1), 61–72.CrossRefGoogle ScholarPubMed
Scheff, S. W., Price, D. A., Hicks, R. R., Baldwin, S. A., Robinson, S., and Brackney, C. (2005). Synaptogenesis in the hippocampal CA1 field following traumatic brain injury. Journal of Neurotrauma, 22(7), 719–732.CrossRefGoogle ScholarPubMed
Shaw, S. E., Morris, D. M., Uswatte, G., McKay, S., Meythaler, J. M., and Taub, E. (2005). Constraint-Induced Movement therapy for recovery of upper-limb function following traumatic brain injury. Journal of Rehabilitation Research and Development, 42, 769–778.CrossRefGoogle ScholarPubMed
Skinner, B. F. (1968). The technology of teaching. New York: Appleton-Century-Crofts.Google Scholar
Sperbeck, D. J., and Whitbourne, S. K. (1981). Dependency in the institutional setting: a behavioral training program for geriatric staff. The Gerontologist, 21, 268–275.CrossRefGoogle ScholarPubMed
Sterr, A., Muller, M. M., Elbert, T., Rockstroh, B., Pantev, C., and Taub, E. (1998). Changed perceptions in Braille readers. Nature, 391(6663), 134–135.CrossRefGoogle ScholarPubMed
Taub, E. (1977). Movement in nonhuman primates deprived of somatosensory feedback. Exercise and Sports Sciences Reviews, 4, 335–374.Google Scholar
Taub, E. (1980). Somatosensory deafferentation research with monkeys: implications for rehabilitation medicine. In Ince, L. P. (ed.), Behavioral psychology in rehabilitation medicine: clinical applications (pp. 371–401). New York: Williams & Wilkins.Google Scholar
Taub, E., and Berman, A. J. (1968). Movement and learning in the absence of sensory feedback. In Freedman, S. J. (ed.), The neuropsychology of spatially oriented behavior (pp. 173–192). Homewood, IL: Dorsey Press.Google Scholar
Taub, E., Miller, N. E., Novack, T. A.et al. (1993). Technique to improve chronic motor deficit after stroke. Archives of Physical Medicine and Rehabilitation, 74(4), 347–354.Google ScholarPubMed
Taub, E., Ramey, S. L., DeLuca, S., and Echols, K. (2004). Efficacy of constraint-induced movement therapy for children with cerebral palsy with asymmetric motor impairment. Pediatrics, 113(2), 305–312.CrossRefGoogle ScholarPubMed
Taub, E., and Uswatte, G. (2003). Constraint-Induced Movement therapy: Bridging from the primate laboratory to the stroke rehabilitation laboratory. Journal of Rehabilitation Medicine, Suppl. 41, 34–40.CrossRefGoogle Scholar
Taub, E., Uswatte, G., and Elbert, T. (2002). New treatments in neurorehabilitation founded on basic research. Nature Reviews Neuroscience, 3(3), 228–236.CrossRefGoogle ScholarPubMed
Taub, E., Uswatte, G., King, D. K., Morris, D., Crago, J., and Chatterjee, A. (2006a). A placebo controlled trial of Constraint-Induced Movement therapy for upper extremity after stroke. Stroke, 37, 1045–1049.CrossRefGoogle ScholarPubMed
Taub, E., Uswatte, G., Mark, V. W., and Morris, D. M. (2006b). The learned nonuse phenomenon: Implications for rehabilitation. Europa Medicophysica, 42, 241–255.Google ScholarPubMed
Taub, E., Uswatte, G., and Pidikiti, R. (1999). Constraint-Induced Movement Therapy: a new family of techniques with broad application to physical rehabilitation – a clinical review. Journal of Rehabilitation Research and Development, 36, 237–251.Google ScholarPubMed
Tillakaratne, N. J. K., Mouria, M., Ziv, N. B., Roy, R. R., Edgerton, V. R., and Tobin, A. (2000). Increased expression of glutamate decarboxylase (GAD(67)) in feline lumbar spinal cord after complete thoracic spinal cord transection. Journal of Neuroscience Research, 60, 219–230.3.0.CO;2-F>CrossRefGoogle ScholarPubMed
Uswatte, G., Foo, W. L., Olmstead, H., Lopez, K., Holand, A., and Simms, M. L. (2005a). Ambulatory monitoring of arm movement using accelerometry: An objective measure of upper-extremity rehabilitation in persons with chronic stroke. Archives of Physical Medicine and Rehabilitation, 86, 1498–1501.CrossRefGoogle ScholarPubMed
Uswatte, G. and Taub, E. (2005). Implications of the learned nonuse formulation for measuring rehabilitation outcomes: Lessons from Constraint-Induced Movement therapy. Rehabilitation Psychology, 50, 34–42.CrossRefGoogle Scholar
Uswatte, G., Taub, E., Mark, V. W., Perkins, C., and Gauthier, L. V. (2010). CNS plasticity and rehabilitation. In Frank, R. G., Caplan, B. and Rosenthal, M. (eds.), Handbook of rehabilitation psychology (2nd edn., pp. 391–406). Washington, DC: American Psychological Association.Google Scholar
Uswatte, G., Taub, E., Morris, D., Light, K., and Thompson, P. (2006). The Motor Activity Log-28: A method for assessing daily use of the hemiparetic arm after stroke. Neurology, 67, 1189–1194.CrossRefGoogle ScholarPubMed
Uswatte, G., Taub, E., Morris, D., Vignolo, M., and McCulloch, K. (2005b). Reliability and validity of the upper-extremity Motor Activity Log-14 for measuring real-world arm use. Stroke, 36, 2493–2496.CrossRefGoogle ScholarPubMed
Praag, H., Kempermann, G., and Gage, F. H. (2000). Neural consequences of environmental enrichment. Nature Reviews Neuroscience, 1, 191–198.CrossRefGoogle ScholarPubMed
Wall, P. D., and Egger, M. D. (1971). Formation of new connections in adult rat brains following partial deafferentation. Nature, 232(5312), 542–545.CrossRefGoogle Scholar
Weimar, C., Ziegler, A., Konig, I. R., and Diener, H.-C. (2002). Predicting functional outcome and survival after acute ischemic stroke. Journal of Neurology, 249, 888–895.CrossRefGoogle ScholarPubMed
Weiss, T., Miltner, W., Liepert, J., Meissner, W., and Taub, E. (2004). Rapid functional plasticity in the primary somatomotor cortex and perceptual changes after nerve block. European Journal of Neuroscience, 20, 3413–3423.CrossRefGoogle ScholarPubMed
Willis, S. L., Tennstedt, S. L., Marsiske, M.et al. (2006). Long-term effects of cognitive training on everyday functional outcomes in older adults. The Journal of the American Medical Association, 296, 2805–2814.CrossRefGoogle ScholarPubMed
Wolf, S. L., Winstein, C., Miller, J. P.et al. (2006). Effect of Constraint Induced Movement therapy on upper extremity function among patients 3–9 months following stroke: the EXCITE randomized clinical trial. The Journal of the American Medical Association, 296(17), 2095–2104.CrossRefGoogle Scholar
Zelinski, E. M., Yaffe, K., Ruff, R. M., Kennison, R. K., and Smith, G. E. (2007, November). The IMPACT study: A randomized controlled trial of a brain plasticity-based training program for age-related cognitive decline. The Gerontological Society of America Meeting. San Francisco, CA.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×