CHALLENGING THE CONCEPTS OF LOCALIZATION AND RECOVERY OF BRAIN FUNCTION ReCBIR – Research Centre for Brain Injury Rehabilitation UCN - The Unit for Cognitive Neuroscience ReCBIR – Research Centre for Brain Injury Rehabilitation UCN - The Unit for Cognitive Neuroscience Neuroplasticitet og rehabilitering efter hjerneskade – hjerneskadens mekanismer og behandling Jesper Mogensen, Professor Head of UCN (The Unit for Cognitive Neuroscience), Dep. of Psychol., University of Copenhagen Director of ReCBIR (Research Centre for Brain Injury Rehabilitation)

UCN - The Unit for Cognitive Neuroscience ReCBIR – Research Centre for Brain Injury Rehabilitation 2 Den regionale specialisering af hjernen – funktionel lokalisation

UCN - The Unit for Cognitive Neuroscience ReCBIR – Research Centre for Brain Injury Rehabilitation 3 FULD FUNKTIONEL GENOPRETNING TRODS KOMPLET SKADE AF HJERNESTRUKTURER (ALLOCENTRISK PLACE LEARNING) Mogensen et al. Brain Research Bulletin, 2004

UCN - The Unit for Cognitive Neuroscience ReCBIR – Research Centre for Brain Injury Rehabilitation 4 ELLER GENOPRETNING? LOKALISATION ELLER? …

UCN - The Unit for Cognitive Neuroscience ReCBIR – Research Centre for Brain Injury Rehabilitation 5 ALGORITHMIC STRATEGIES ELEMENTARY FUNCTIONS NEURAL SUBSTRATES BEHAVIOUR X UNDERLYING COGNITIVE MECHANISMS AS A AS C EF 1 EF 2 EF 3 EF 4 EF 5 EF 6 EF 7 EF 8 EF 9 EF 10 EF 1 1 EF 12 EF 13 EF 14 EF 15 I II III IVV VI VII VIII IX X XI XII XIII XIV XV Brain structure α Brain structure β Brain structure γ UNDERLYING NEURAL MECHANISMS

UCN - The Unit for Cognitive Neuroscience ReCBIR – Research Centre for Brain Injury Rehabilitation 6 BDNF (Brain-Derived Neurotrophic Factor) samt andre trofiske faktorer …

UCN - The Unit for Cognitive Neuroscience ReCBIR – Research Centre for Brain Injury Rehabilitation 7 TROFISKE FAKTORER

UCN - The Unit for Cognitive Neuroscience ReCBIR – Research Centre for Brain Injury Rehabilitation 8 SPROUTING

UCN - The Unit for Cognitive Neuroscience ReCBIR – Research Centre for Brain Injury Rehabilitation 9 MEKANISMER for NEURONDØD

UCN - The Unit for Cognitive Neuroscience ReCBIR – Research Centre for Brain Injury Rehabilitation 10 BDNF og antidepressiva

UCN - The Unit for Cognitive Neuroscience ReCBIR – Research Centre for Brain Injury Rehabilitation 11 HVAD PÅVIRKER HJERNENS PLASICITET? BDNF?

UCN - The Unit for Cognitive Neuroscience ReCBIR – Research Centre for Brain Injury Rehabilitation 12 BDNF (Brain-Derived Neurotrophic Factor) samt andre trofiske faktorer ved hjerneskade Betydning i den akutte fase Betydning for langsigtet reorganisering

UCN - The Unit for Cognitive Neuroscience ReCBIR – Research Centre for Brain Injury Rehabilitation 13 SKADER ved BLODPROP

UCN - The Unit for Cognitive Neuroscience ReCBIR – Research Centre for Brain Injury Rehabilitation 14 MEKANISMER for NEURONSKADE ved TBI

UCN - The Unit for Cognitive Neuroscience ReCBIR – Research Centre for Brain Injury Rehabilitation 15 BDNF (Brain-Derived Neurotrophic Factor) samt andre trofiske faktorer ved hjerneskade Betydning i den akutte fase Betydning for langsigtet reorganisering

UCN - The Unit for Cognitive Neuroscience ReCBIR – Research Centre for Brain Injury Rehabilitation 16 Hvordan kan BDNF fremmes ?

UCN - The Unit for Cognitive Neuroscience ReCBIR – Research Centre for Brain Injury Rehabilitation 17 BDNF og antidepressiva

UCN - The Unit for Cognitive Neuroscience ReCBIR – Research Centre for Brain Injury Rehabilitation 18 Hvordan kan BDNF fremmes ? – andre muligheder?

UCN - The Unit for Cognitive Neuroscience ReCBIR – Research Centre for Brain Injury Rehabilitation 19 BDNF ved motorisk aktivitet

UCN - The Unit for Cognitive Neuroscience ReCBIR – Research Centre for Brain Injury Rehabilitation 20 BDNF

UCN - The Unit for Cognitive Neuroscience ReCBIR – Research Centre for Brain Injury Rehabilitation 21

UCN - The Unit for Cognitive Neuroscience ReCBIR – Research Centre for Brain Injury Rehabilitation 22

UCN - The Unit for Cognitive Neuroscience ReCBIR – Research Centre for Brain Injury Rehabilitation 23 Food for Thought …

UCN - The Unit for Cognitive Neuroscience ReCBIR – Research Centre for Brain Injury Rehabilitation 24

UCN - The Unit for Cognitive Neuroscience ReCBIR – Research Centre for Brain Injury Rehabilitation 25

UCN - The Unit for Cognitive Neuroscience ReCBIR – Research Centre for Brain Injury Rehabilitation 26 HVAD PÅVIRKER HJERNENS PLASICITET? Motion?

UCN - The Unit for Cognitive Neuroscience ReCBIR – Research Centre for Brain Injury Rehabilitation 27 Aktivering/stimulation som terapeutisk metode ved hjerneskade

UCN - The Unit for Cognitive Neuroscience ReCBIR – Research Centre for Brain Injury Rehabilitation 28

UCN - The Unit for Cognitive Neuroscience ReCBIR – Research Centre for Brain Injury Rehabilitation 29

UCN - The Unit for Cognitive Neuroscience ReCBIR – Research Centre for Brain Injury Rehabilitation 30 Tidlig eller sen ?

UCN - The Unit for Cognitive Neuroscience ReCBIR – Research Centre for Brain Injury Rehabilitation 31

UCN - The Unit for Cognitive Neuroscience ReCBIR – Research Centre for Brain Injury Rehabilitation 32

UCN - The Unit for Cognitive Neuroscience ReCBIR – Research Centre for Brain Injury Rehabilitation 33

UCN - The Unit for Cognitive Neuroscience ReCBIR – Research Centre for Brain Injury Rehabilitation 34 SEN ! Men …

UCN - The Unit for Cognitive Neuroscience ReCBIR – Research Centre for Brain Injury Rehabilitation 35 Aktivering/stimulation som terapeutisk metode ved hjerneskade

UCN - The Unit for Cognitive Neuroscience ReCBIR – Research Centre for Brain Injury Rehabilitation 36 Påtvunget eller frivillig ? Stress ?

UCN - The Unit for Cognitive Neuroscience ReCBIR – Research Centre for Brain Injury Rehabilitation 37

UCN - The Unit for Cognitive Neuroscience ReCBIR – Research Centre for Brain Injury Rehabilitation 38

UCN - The Unit for Cognitive Neuroscience ReCBIR – Research Centre for Brain Injury Rehabilitation 39 Exercise after stress

UCN - The Unit for Cognitive Neuroscience ReCBIR – Research Centre for Brain Injury Rehabilitation 40 FRIVILLIG ! Men …

UCN - The Unit for Cognitive Neuroscience ReCBIR – Research Centre for Brain Injury Rehabilitation 41 Aktivering/stimulation som terapeutisk metode ved hjerneskade

UCN - The Unit for Cognitive Neuroscience ReCBIR – Research Centre for Brain Injury Rehabilitation 42

UCN - The Unit for Cognitive Neuroscience ReCBIR – Research Centre for Brain Injury Rehabilitation 43

UCN - The Unit for Cognitive Neuroscience ReCBIR – Research Centre for Brain Injury Rehabilitation 44 Betydningen af stress

UCN - The Unit for Cognitive Neuroscience ReCBIR – Research Centre for Brain Injury Rehabilitation 45

UCN - The Unit for Cognitive Neuroscience ReCBIR – Research Centre for Brain Injury Rehabilitation 46

UCN - The Unit for Cognitive Neuroscience ReCBIR – Research Centre for Brain Injury Rehabilitation 47 Støtte til funktionel genopretning og træning – samt måske ”skader” ved psykiske lidelser Farmakologi Aktivering/Stimulering

UCN - The Unit for Cognitive Neuroscience ReCBIR – Research Centre for Brain Injury Rehabilitation 48 Farmakologisk støttet rehabilitering

UCN - The Unit for Cognitive Neuroscience ReCBIR – Research Centre for Brain Injury Rehabilitation 49

UCN - The Unit for Cognitive Neuroscience ReCBIR – Research Centre for Brain Injury Rehabilitation 50 Farmakologisk støttet rehabilitering Effekter af Erythropoietin (EPO)

UCN - The Unit for Cognitive Neuroscience ReCBIR – Research Centre for Brain Injury Rehabilitation 51 EPO og BDNF

UCN - The Unit for Cognitive Neuroscience ReCBIR – Research Centre for Brain Injury Rehabilitation 52 7 dage 30 dage Interaktioner

UCN - The Unit for Cognitive Neuroscience ReCBIR – Research Centre for Brain Injury Rehabilitation 53 EPO og BDNF

UCN - The Unit for Cognitive Neuroscience ReCBIR – Research Centre for Brain Injury Rehabilitation 54 Glutamat Betydning i den akutte fase Betydning for langsigtet reorganisering

UCN - The Unit for Cognitive Neuroscience ReCBIR – Research Centre for Brain Injury Rehabilitation 55 SKADER ved BLODPROP

UCN - The Unit for Cognitive Neuroscience ReCBIR – Research Centre for Brain Injury Rehabilitation 56

UCN - The Unit for Cognitive Neuroscience ReCBIR – Research Centre for Brain Injury Rehabilitation 57 Glutamat - PIMSD

UCN - The Unit for Cognitive Neuroscience ReCBIR – Research Centre for Brain Injury Rehabilitation 58 DEN DYNAMISKE HJERNE: HÅB OG UDFORDRINGER

UCN - The Unit for Cognitive Neuroscience ReCBIR – Research Centre for Brain Injury Rehabilitation 59 Får vi en kopi af det mistede?

UCN - The Unit for Cognitive Neuroscience ReCBIR – Research Centre for Brain Injury Rehabilitation MODIFICATION OF DEGREE OF CONTRIBUTION TO TASK MEDIATION BY INDIVIDUAL STRUCTURES: Some structures exhibit increased or decreased levels of contribution to task mediation 2. TASK-DEPENDENT AND DISSIMILAR NEURAL SUBSTRATES: After a given lesion the functional recovery of various cognitive tasks is mediated by unique and dissimilar neural substrates 3. APPLICATION OF NEW COGNITIVE STRATEGIES: The fully posttraumatically recovered individuals solve the task by applying new strategies that are dissimilar to those applied pretraumatically PHENOMENA OF POSTTRAUMATIC RECOVERY

UCN - The Unit for Cognitive Neuroscience ReCBIR – Research Centre for Brain Injury Rehabilitation 61 ALGORITHMIC STRATEGIES ELEMENTARY FUNCTIONS NEURAL SUBSTRATES BEHAVIOUR X UNDERLYING COGNITIVE MECHANISMS AS A AS C EF 1 EF 2 EF 3 EF 4 EF 5 EF 6 EF 7 EF 8 EF 9 EF 10 EF 1 1 EF 12 EF 13 EF 14 EF 15 I II III IVV VI VII VIII IX X XI XII XIII XIV XV Brain structure α Brain structure β Brain structure γ UNDERLYING NEURAL MECHANISMS

UCN - The Unit for Cognitive Neuroscience ReCBIR – Research Centre for Brain Injury Rehabilitation 62

UCN - The Unit for Cognitive Neuroscience ReCBIR – Research Centre for Brain Injury Rehabilitation 63 Får vi en kopi af det mistede? NEJ! Men kunne vi få det?

UCN - The Unit for Cognitive Neuroscience ReCBIR – Research Centre for Brain Injury Rehabilitation 64 Hvordan er de basale netværk dannet oprindeligt?

UCN - The Unit for Cognitive Neuroscience ReCBIR – Research Centre for Brain Injury Rehabilitation 65

UCN - The Unit for Cognitive Neuroscience ReCBIR – Research Centre for Brain Injury Rehabilitation 66

UCN - The Unit for Cognitive Neuroscience ReCBIR – Research Centre for Brain Injury Rehabilitation 67 ”Kritiske” perioder under udviklingen

UCN - The Unit for Cognitive Neuroscience ReCBIR – Research Centre for Brain Injury Rehabilitation 68 CSPGs - stoffer fra gliaceller … CSPGs – chondroitin sulphate proteoglycans

UCN - The Unit for Cognitive Neuroscience ReCBIR – Research Centre for Brain Injury Rehabilitation 69 Og så er der låst … … eller er der?!

UCN - The Unit for Cognitive Neuroscience ReCBIR – Research Centre for Brain Injury Rehabilitation 70 NEUROGENESE I DEN VOKSNE HJERNE

UCN - The Unit for Cognitive Neuroscience ReCBIR – Research Centre for Brain Injury Rehabilitation 71

UCN - The Unit for Cognitive Neuroscience ReCBIR – Research Centre for Brain Injury Rehabilitation 72

UCN - The Unit for Cognitive Neuroscience ReCBIR – Research Centre for Brain Injury Rehabilitation 73 CSPGs

UCN - The Unit for Cognitive Neuroscience ReCBIR – Research Centre for Brain Injury Rehabilitation 74 Styrkelse af BDNF? Hæmning af CSPGs?

UCN - The Unit for Cognitive Neuroscience ReCBIR – Research Centre for Brain Injury Rehabilitation 75 Fordele – og farer Hæmning af CSPGs?

UCN - The Unit for Cognitive Neuroscience ReCBIR – Research Centre for Brain Injury Rehabilitation 76 Styrkelse af BDNF?

UCN - The Unit for Cognitive Neuroscience ReCBIR – Research Centre for Brain Injury Rehabilitation 77 Aktivering/stimulation som terapeutisk metode ved hjerneskade

UCN - The Unit for Cognitive Neuroscience ReCBIR – Research Centre for Brain Injury Rehabilitation 78

UCN - The Unit for Cognitive Neuroscience ReCBIR – Research Centre for Brain Injury Rehabilitation 79 Hvad kan vi gøre for at få den bedste omformning af hjernen?

UCN - The Unit for Cognitive Neuroscience ReCBIR – Research Centre for Brain Injury Rehabilitation 80 ALGORITHMIC STRATEGIES ELEMENTARY FUNCTIONS NEURAL SUBSTRATES BEHAVIOUR X UNDERLYING COGNITIVE MECHANISMS AS A AS C EF 1 EF 2 EF 3 EF 4 EF 5 EF 6 EF 7 EF 8 EF 9 EF 10 EF 1 1 EF 12 EF 13 EF 14 EF 15 I II III IVV VI VII VIII IX X XI XII XIII XIV XV Brain structure α Brain structure β Brain structure γ UNDERLYING NEURAL MECHANISMS

UCN - The Unit for Cognitive Neuroscience ReCBIR – Research Centre for Brain Injury Rehabilitation 81

UCN - The Unit for Cognitive Neuroscience ReCBIR – Research Centre for Brain Injury Rehabilitation 82 GENERALISERING … af træning?

UCN - The Unit for Cognitive Neuroscience ReCBIR – Research Centre for Brain Injury Rehabilitation 83 GENERALISERING … og kan vi få virkeligheden ind i træningen? kan vi få træningen ud i virkeligheden?

UCN - The Unit for Cognitive Neuroscience ReCBIR – Research Centre for Brain Injury Rehabilitation 84

UCN - The Unit for Cognitive Neuroscience ReCBIR – Research Centre for Brain Injury Rehabilitation 85

UCN - The Unit for Cognitive Neuroscience ReCBIR – Research Centre for Brain Injury Rehabilitation 86

UCN - The Unit for Cognitive Neuroscience ReCBIR – Research Centre for Brain Injury Rehabilitation 87

UCN - The Unit for Cognitive Neuroscience ReCBIR – Research Centre for Brain Injury Rehabilitation 88 Virkeligheden ind i træningen! Træningen ud i virkeligheden!

UCN - The Unit for Cognitive Neuroscience ReCBIR – Research Centre for Brain Injury Rehabilitation 89 DEN DYNAMISKE HJERNE: HÅB OG UDFORDRINGER

UCN - The Unit for Cognitive Neuroscience ReCBIR – Research Centre for Brain Injury Rehabilitation 90 I forskning og behandling – lad os gå direkte efter de optimale løsninger!

UCN - The Unit for Cognitive Neuroscience ReCBIR – Research Centre for Brain Injury Rehabilitation 91 TAK FOR I DAG!