And Dale Corbett is one of the authors.
Getting Neurorehabilitation Right What Can Be Learned From Animal Models?
Abstract
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 (<5 and="and" conversely="conversely" damage.="damage." days="days" from="from" histological="histological" increased="increased" intense="intense" late="late" lead="lead" may="may" onset="onset" rehabilitation="rehabilitation" to="to" training="training">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.
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