The Specificity Effect- Building upon the activity element, interventions need to be specific to the particular cortical function that is the target of behavioural change. There is a relationship between the nature and type of intervention and the resulting plasticity and modifiability of functions. This requires assessment, calibration and the provision of varied activities and patterns of intervention. This has specific implications for the kinds of programs developed must be related both to theory and observations and adjusted accordingly. The research gives guidance in this regard. We are encouraged by our review of the research and the identification of critical dimensions of activity to present the Feuerstein Instrumental Enrichment (FIE) program as a paradigm to meet the specificity element (in addition to other dimensions as well), especially when we compared and contrasted to other programs that are available to promote neural plasticity.
The Repetition Effect - Repetition is required for the functional changes to be structurally implanted and manifested in behaviour. The necessary amount and duration of the repeated exposures is unpredictable, influenced by the nature of functioning, the type of interference, the readiness and skill levels of the participant, the nature of skills being acquired, and the like. However repetition alone is insufficient. There must be variation in task structure to promote plasticity-simple redoing of activities without systematic variation is not enough. It appears that repetition cannot be simply re-doing, but must have other characteristics such as novelty, challenge and multi-modality stimulation.
The Intensity Effect - Neural plasticity also requires a degree of intensity of intervention. These variable relate to the amount of time spent in practice and contact with the intervention modalities. As with other elements, the specific amount of exposure is hard to predict - some learners need more and others less. We believe that the production of structural cognitive modifiability requires durations of time and intensity of exposure that typically goes well beyond traditional and accepted patterns of frequency and time duration of sessions. In our applications (of the FIE program and other MLE related interventions), we expose learners to upwards of 20 hours per week to achieve intended effects. This contrasts to the typical one or two hours of therapeutic or instructional contact. In this way the modifiability created becomes established in the neural structures.
The Persistence Effect - Different forms of neural plasticity take place at different times, requiring the provision of both intensity and repetition, which must be reflected in a degree of persistence in treatment planning and implementation over time. That is, when immediate gains are not evident, one must not give up, but push forward knowing that there is a pace of acquisition that occurs, often latently but eventually materializing. One is often surprised at the gains that emerge after seemingly endless unproductive encounters. When they do emerge, they become catalysts for rapid and significant changes.
The Salience Effect - The intervention must be important and meaningful to the individual. Interventions that do not convey this element will not be responded to as successfully as those that are meaningful. This has been described as the salience of the intervention. In the application of the mediated learning experience (MLE) this is the mediation of meaningfulness of that to which the individual is exposed. Meaningfulness is directly related to creating awareness, which can be considered a sub-goal of the mediation of meaning in that the learner becomes aware of his/her functioning, of its value, of the changes that are experienced, and the importance (value, salience, etc.) of these changes. Research has shown that this is an important element in neuroplastic activation. Here too, the importance of assessment and observation must be emphasized to determine what is salient for the learner, and how the learner has internalized what has been learned. This knowledge guides the mediation regarding intensity, duration, modifiability of stimulation-all of the aspects included in the provision of MLE, and structured into the activities of the FIE programs.
The Optimal Timing Effect - Some kinds of and propensities for change are age related. For example, although it may be easier to induce plasticity in younger brains, the neurophysiological structures of adult brains and the elderly are also amenable to change, but may require adjustments in aspects of structure and exposure. The issue is the level of persistence, effort and the types of intervention required to promote plasticity at various ages and stages of development. In spite of the identification of this element, the research cautions us not to take the dimension of optimal timing as a reason to withhold or not initiate interventions.
The Novelty Effect - Learning experiences must be new and challenging for them to stimulate neural plasticity. If all one does is repeat familiar tasks, learning will not be facilitated. Stimulation must challenge the learner and novelty becomes an important aspect of experience. There is some research showing that simple game activities will not be effective if the interventions do not incorporate the elements of novelty, presenting some degree of challenge and complexity in the tasks. We have recognized this in the design of the FIE program and the MLE that supports novelty and challenge as learners interact with it.
The Spread of Effect - Changes in functions resulting from a particular intervention can affect changes in other functions not directly targeted by the original intervention. This has been described as a transference effect, aided by the mirror neuron systems that have been discovered and tracked in neural anatomy. Specifically, it has been shown in monkeys and humans that activation in one part of the brain will generate activities in other parts, through imitation that excites processes that activate the mirroring mechanisms, often without the individual's awareness or conscious intention. In the application of MLE, this is described as the parameter of the mediation of transference and must also be embedded in the structure and provision of the intervention.
The Selection Effect - There can be interference, whereby plasticity stimulated or experienced in one area may interfere with changes in other areas. This must be accounted for in the interventions selected, based on an analysis of the needed behaviour changes and the tasks selected for the intervention.
The Conscious/Awareness Effect - We believe that the learner's awareness of the changes that occur in the process of responding to stimulation is an important aspect of cognitive modifiability. Exposure should therefore explicitly mediate awareness, and be structured to present opportunities for the learner to reinforce the learning occurring in real time and relate it to other aspects of the learning experience. This takes the form of "what I have learned, why am I learning it, how will it contribute to further learning, how I have changed, what are my new interests," and many other similar insights. Even though the individual is not necessarily aware of mirror neuron activity, the changes that occur from such stimulation can certainly be experienced, understood, and related to larger structures of learning.
The Multi-Sensory Effect - Tasks should require perceiving and responding to stimuli from a number of modalities-seeing, hearing, touching and doing. There is considerable evidence that sensory modalities provide differential and reinforcing stimulation, and are reacted to by different neurophysiological processes, heightening salience, specificity, and selection efforts, which in turn strengthen responding and create new structures. The brain responds to different sensory experiences, and the mirror neurons activate differential processes in the neural structures, in areas not initially stimulated, but related to the activation.
Behaviourially and Neurophysiologically
The mechanisms for activation appear to be the direct exposure to stimulation, the imitation of meaningful experience established by the exposure, and a kind of residual effect in the neural system that is the consequence of learning - that is, the structural meaning of prior experience that can be genuinely considered cognitive. In this sense, these elements- to both understand and activate them-require assessment, and the selection of interventions reflective of both the known elements contributing to neural plasticity and the levels of functioning of the individual to which the interventions are directed.
Principles of Experience-Dependent Neural Plasticity: Implications for Rehabilitation After Brain Damage
The Feuerstein instrumental enrichment program : creating and enhancing cognitive modifiability