Activation Therapy/Brain Fitness

Neuroplasticity is the ability of the brain to adapt and reconfigure itself. It does so not only when it is traumatized, but also as it ages. However, brain cells, especially those engaged in memory, need to be stimulated or exercised in order to remain viable, adaptive and healthy.
By Janusz Kaleta

Combatting memory loss

Brain fitness activities/exercises to optimize resident functioning and well-being in LTC
fl I(
e-emerging knowledge on brain prartillty giu"s new horizons to Seniors residing in both retirement
residences and long-term care homes

memory loss in the elderly.

(See www.brainconnection.com)

seniors confronted with fears of

memory loss and neuro-degenerative diseases affecting cognitive function. Disturbance in brain functioning, de-

often battle degenerative diseases like

cline

in

Alzheimer's, and other types of dementia, but also strive to preserve cognitive function that directly relates to their sense of control.

Maintaining memory functions eliminates threats to self-esteem

among seniors and promotes significant improvements in quality of life that may be continued in retirement and long-term care homes. Seniors who are unable to recall the names of loved ones, of care givers and events are not only prone to depression, but also loss of control and independence. The additional stress is often passed on to family members

memory, and inability to

maintain independence in community settings cause an excess of disability among seniors, and frequently high
stress on their families.

A recently published book, "The Brain that Changes ltself," by Dr. Norman Doidge, M.D., provides an extensive review of neuroplasticity and paints a new image of the brain
and mind.

New research
Until recently, medical professionals as well as the general public perceived decline in brain functioning as a normal part of aging. The decade-long revolution within the field of medicine

and care-givers who need

to

adapt

Brain exercises vs. drugs

According to Dr. Michael Merzenich, one of the leaders in brain neuroplasticity, brain exercises may be as successful as medications in the treatment of brain-related diseases; this is

(paticularly neurology) resulted in the establishment of neuroplasticians equipped with newly discovered, research-based science that changed
forever the way we view our brains. Canadian Nursing Home

brain plasticity allows for significant improvements in cognitive functioning and prevention of
because

to new challenges. The proper understanding and application of new research may lead to improvement and/or preservation of memory among seniors and, subsequently, quality of life and enjoyment of activities of daily living.

Long-term care homes located in large urban centres often have a di17

Researchers can now observe creation of new memories soon learned their way around it. Another group was Scientists have witnessed a new memory being formed given a drug that is known to block the formation of for the first time, a breakthrough that's expected to pave
the way for mapping memories across the brain. Highresolution images show how connections between neighbouring brain cells changed when a memory was laid
down. memories. The last group was used as a control.

After the rats had time to learn their way around the

Ateam of psychologists from the University of California Irvine witnessed the memory being formed when a rat learned to navigateamaze andthe memory was 'written'

in

in the brain by changes to 1o,ooo synapses, the microscopic connections that allow nerve cells in the brain to
communicate. A synapse is roooth of a mm across. Three groups ofrats were used in the study. One group was let loose in a maze for periods of half an hour and

tiny part of the hippocampus, a region of the brain linked to memory and navigation. Within this region they were able to use fluorescent antibodies tohighlight nerve connections that had recently been strengthened. The scientists used a new technique called restorattue deconuolution microscopy to focus on one million slmapses. They found that t%" were enlarged, and had formed stronger connections with neighbouring brain
cells. (Journal ofNeuroscience - July 25,

maze, the scientists examined sections

of

tissue

in

zoo7).

of clients who require a unique approach and who bring a richness of life experiences and skills. Lincoln Place (Long-Term
verse population
Care Home) located in Toronto, recognized both the need to develop

clients were bilingual or multilingual including English, French, Hebrew, Yiddish, Polish, Russian, Ukrainian,
Hungarian, Spanish, Chinese (Mandarin and Cantonese), Filipino (Tagalog), Japanese, Urdu, Arabic, Greek and Portuguese, to name a few

resident was identified. Other residents, feeling nostalgic because of limited opportunity to use French, were more than happY to share and instruct in that language.
Today, established groups of residents enjoy weekly language activities, having fun trying to pronounce new words and memorizing simPle phrases. Other programs, like "Basy with A, B, C" and "Let's Spelll' use

brain fitness activities to build on relatively preserved memory subsystems, as well as the unique skills
that residents were willing to share with others. This was complemented by the willingness of other clients to leam something completely new. The Programs staff at Lincoln Place, while designing new brain fitness ac-

Sharing resident resources A number of clients expressed

willingness to teach others their language. After a short debate, clients participating in the Brain Fitness Program expressed a willingness to learn
French. With ease, a French-speaking

linguistic tools designed to assist with phonological processing and retention.

tivities, quickly realized that several

Simple mental activities were also introduced before and during other
programs, such as baking, where residents, while waiting for their creations to cook, would play with word origins, rhymes and word associations.

Forming new neural connections and pathways

Neuroplasticity is 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. Brain reorganization takes place by mechanisms such as "axonal sprouting"inwhich undamaged axons grow new endings to reconnect neurons whose links were injured or severed. Undamaged axons can also sprout nerve endings and connect with other undamaged nerve cells, forming new neural pathways to accomplish a needed function. For example, if one hemisphere of the brain is damaged, the intact hemisphere may take over some of its functions. The brain compensates for damage in effect by reorganizing and forming new connections between intact neurons. In order to reconnect, the neurons need to be stimulated through some cognitive activity. Neuroplasticity may also contribute to impairment. For example, people who are deaf may experience a continual ringing in their ears (tinnitus). This is a result of the rewiring of brain cells starved for sound' For neurons to form beneficial connections in the brain, they must be T correctly stimulated.
Volume 18, Number3, Septemberloctober, 2007

Cognitive programming
One of the important indications for designing cognitiveprogramming is

to learn something completely new. Whereas repetition of tasks mastered in the past (like playing a piano) may be beneficial in maintenance of that skill, it is the learning of something comto encourage clients

pletely new that delivers

stimulation to the brain.

needed

The formerly held view that the brain was not a muscle and becomes somehow fixed after a period of
critical development, has been over-

I8

turned. The current view is that, what

applies to other muscles of the body, namely "use it or loose itrtt also applies to the brain.

How the brain protects itself

Until recently, scientists thought that the brain's ability to repair itself after injury or neuro-degeneration was limited or non-existent. With new discoveries about brain anatomy and function and the emerging concepts of
neurogenesis, neuroplasticity and cognitive reserve, scientists have changed

Among many different activities

that are recommended, learning of a new language seems to be very effective since it involves the need for intense concentration, repetition and memory utilization. Living in a diverse community, such as Toronto (or any other multi-ethnic
Canadian

their views dramatically.

New neurons generated

One exciting recent development is the discovery that the brain can, in fact, generate new neurons in a process called neurogenesis. ln the adult, this process occurs in two areas of the brain, the hippocampus and the subventricular zone, and possibly in others as well.
These brain areas contain special cells called stem cells, which can divide

city)

makes it easier than in

other ethno-specific countries.

Program assessment Ongoing review of the effectiveness of these programs is based on

residents' expressed satisfaction, on

conditions. These adult neural stem cells can make new neurons and glial cells. This discovery raises the prospect that neural stem cells could be hamessed to replace dying cells or to repair damaged neural circuits in the aging or diseased brain.

and migrate

to other areas of the brain under certain

their willingness to join the group

and their continuous attendance, as observed improvements in cognition and memory. For some residents, there are no

well as

Many researchers are studying the fundamental biology of neurogenesis it may be linked to Alzheimer's disease. For example, researchers are currently examining whether abnormalities in neural stem cells might contribute to human disorders of leaming and memory including AD. If neurogenesis is impaired in AD, then it may be possible to develop
and how

therapeutic approaches that enhance neurogenesis.

observable major changes, while in others there are marked improvements. For some residents, maintaining memory functioning is the main

Protecting and compensating

Scientists theoize that cognitive activities are protective in some way. Some speculate that repetition (as in learning a new language, or leaming a new dance, especially the Tango), might improve the efficacy of certain cognitive skills and make them less vulnerable to the brain damage in AD. Others speculate that it is compensatory mechanisms at work strengthening information processing skills to help compensate for declines in other cognitive a.reas - the primary one being that associated with the
hippocampus . (See JAMA, February

objective, while others are able to demonstrate their ability, not only to learn new things, but to show significant improvement.

Increasingly, nursing home residents are looking for something completely new, something that, perhaps because ofabusypast lifestyle (or any other

13,2003).

reason), never had the opportunity to try. When these opportunities are provided on a regular basis, and sup-

Damaged blood vessels in the brain increase risk for AD

Adults with damaged blood vesbrain are more likely to develop Alzheimer's disease. Older adults with signs of this damagewere 7 times more likelyto
sels in the because

author Caterina Rosano. "This study, it focused on healthy, cog-

ported with new scientific research, the potential and on-going success

of

the program is well

founded. I

develop AD than their peers, said

About the author

Janusz Kaleta, R.P.N., A.A.S., C.P.T.A.,

the study reported in lhe Journal o1f Neuroimaging (July 6, zooT).

is

Programs Manager, Lincoln Place

The author wishes to acknowledge the

Other risk factors

Alzheimer's disease is already associated with other risk factors such
as poor cognitive scores, education

nitively normal adults, shows that there are other risk factors we need to consider." It was pointed out that blood vessel damage in the brain is more likely to occur in those with high BP, high cholesterol or diabetes. "Since we know that prevention of
these conditions can lower risk of heart attack and stroke," she said, "it is likely that it would also lower
the risk of developing

Long-Term Care Home, Toronto, Ontario.

exceptional work

of the

Nursing

and

Programs staff at Lincoln Place.

or health conditions, said study

AD."

I
19

Canadian Nursing Home