Getting Neurorehabilitation Right: What Can Be Learned From Animal Models?

Animal models suggest that a month of heightened plasticity occurs in the brain after stroke, accompanied by most of the recovery from impairment. This period of peri-infarct and remote plasticity is associated with changes in excitatory/inhibitory balance and the spatial extent and activation of co...

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Bibliographic Details
Published in:Neurorehabilitation and neural repair 2012-10, Vol.26 (8), p.923-931
Main Authors: Krakauer, John W., Carmichael, S. Thomas, Corbett, Dale, Wittenberg, George F.
Format: Article
Language:English
Subjects:
Animal models
Animals
Brain
Brain Infarction - etiology
Clinical trials
Disease Models, Animal
Humans
Motor skill learning
Neurology
Plasticity (cortical)
Recovery of Function
Rehabilitation
robotics
Stroke
Stroke - complications
Stroke Rehabilitation
Time Factors
Translation
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Summary:Animal models suggest that a month of heightened plasticity occurs in the brain after stroke, accompanied by most of the recovery from impairment. This period of peri-infarct and remote plasticity is associated with changes in excitatory/inhibitory balance and the spatial extent and activation of cortical maps and structural remodeling. The best time for experience and training to improve outcome is unclear. In animal models, very early (30 days) is much less effective both in terms of outcome and morphological changes associated with plasticity. In clinical practice, rehabilitation after disabling stroke involves a relatively brief period of inpatient therapy that does not come close to matching intensity levels investigated in animal models and includes the training of compensatory strategies that have minimal impact on impairment. Current rehabilitation treatments have a disappointingly modest effect on impairment early or late after stroke. Translation from animal models will require the following: (1) substantial increases in the intensity and dosage of treatments offered in the first month after stroke with an emphasis on impairment; (2) combinational approaches such as noninvasive brain stimulation with robotics, based on current understanding of motor learning and brain plasticity; and (3) research that emphasizes mechanistic phase II studies over premature phase III clinical trials.
ISSN:1545-9683
1552-6844
DOI:10.1177/1545968312440745