Reorganization of human cerebral cortex: the range of changes following use and injury

Animal and human research over the past decades have increasingly detailed the brain's capacity for reorganization of neural network architecture to adapt to environmental needs. In this article, the authors outline the range of reorganization of human representational cortex, encompassing 1) reconstruction in concurrence with enhanced behaviorally relevant afferent activity (examples include skilled musicians and blind Braille readers); 2) injury-related response dynamics as, for instance, driven by loss of input (examples include stroke, amputation, or in blind individuals); and 3) maladaptive reorganization pushed by the interaction between neuroplastic processes and aberrant environmental requirements (examples include synchronicity of input nurturing focal hand dystonia). These types of neuroplasticity have consequences for both understanding pathological dynamics and therapeutic options. This will be illustrated in examples of motor and language rehabilitation after stroke, the treatment of focal hand dystonia, and concomitants of injury-related reorganization such as phantom limb pain.