Rehabilitation of brain damage: Brain plasticity and principles of guided recovery

Rehabilitation of the damaged brain can foster reconnection of damaged neural circuits; Hebbian learning mechanisms play an important part in this. The authors propose a triage of post-lesion states, depending on the loss of connectivity in particular circuits. A small loss of connectivity will tend to lead to autonomous recovery, whereas a major loss of connectivity will lead to permanent loss of function; for such individuals, a compensatory approach to recovery is required. The third group have potentially rescuable lesioned circuits, but guided recovery depends on providing precisely targeted bottom–up and top–down inputs, maintaining adequate levels of arousal, and avoiding activation of competitor circuits that may suppress activity in target circuits. Empirical data are implemented in a neural network model, and clinical recommendations for the practice of rehabilitation following brain damage are made.