http://journals.lww.com/co-neurology/Abstract/publishahead/Promoting_neuroplasticity_and_recovery_after.99643.aspx
Abstract
Purpose of review: The purpose is to establish a
theoretical framework by which new interventions for poststroke
rehabilitation may be developed incorporating knowledge of
neuroplasticity and the critical ingredients of rehabilitation.
Recent findings: Large phase III randomized controlled
trials (RCTs) are rare in neurorehabilitation, and the results of those
that have been completed are perplexing because the experimental and
control treatments were not different when matched for activity level.
In addition, the outcome measures used to define treatment effects
reflected behavioral endpoints, but did not reveal how neuroplastic
mechanisms or other mechanistic factors may have contributed to the
treatment response. Knowledge of both the neurophysiologic basis of
recovery and key elements of interventions that drive motor learning,
such as intensity and task progression, are critical for optimizing
future poststroke motor rehabilitation clinical trials.
Summary: Future neurorehabilitation RCTs require a better
understanding of the interaction of interventions and
neurophysiological recovery in order to target interventions at specific
neurophysiologic substrates, develop a more clear understanding of the
impact of intervention parameters (e.g. dose, intensity), and advance
discussions regarding optimal ways to partner medical and rehabilitation
interventions in order to improve outcomes.
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