Question
What are the core principles of neuroplasticity that inform effective therapeutic intervention design?
Answer
Therapists working with individuals who have experienced acquired brain injuries rely on foundational principles of neuroplasticity to design effective, occupation-based interventions. One of the most central tenets is “use it or lose it”—if an affected limb or function is not used, the neural pathways associated with it weaken. Conversely, the principle of “use it and improve it” suggests that with consistent and focused use, these pathways can be strengthened and reorganized to support improved performance.
Repetition and intensity are essential for driving neuroplastic change. Functional gains are unlikely without thousands of meaningful repetitions, and most patients do not reach this threshold during therapy sessions alone. Integrating high-frequency, high-challenge practice both in the clinic and at home is necessary. Specificity also matters—training must reflect the actual movements and objects the client uses daily to ensure that the learned motor patterns are applicable and transferable.
Other key principles include salience (the relevance and meaningfulness of the task to the client), timing (earlier interventions typically lead to faster gains), and transference (where learned skills can carry over to new contexts). Therapists must also consider potential barriers such as interference, particularly learned non-use, which can block neuroplastic changes if the patient overly relies on the unaffected limb. By applying these principles, therapists can maximize the therapeutic benefit and tailor interventions to each client's unique needs and goals.
This Ask the Expert is an edited excerpt from the course, "Changing The Brain: Using The Principles Of Neuroplasticity And Motor Learning To Improve Functional Outcomes In Acquired Brain Injury," presented by Angela Reimer, OTD, MOT, OTR, CBIST.
