http://nnr.sagepub.com/content/early/2015/09/08/1545968315604400.abstract?
- Bruce H. Dobkin, MD1
- S. Thomas Carmichael, MD, PhD1
- S. Thomas Carmichael, Department of Neurology, David Geffen School of Medicine at UCLA, 710 Westwood Plaza, Los Angeles, CA 90095-1769, USA. Email: scarmichael@mednet.ucla.edu
Abstract
Novel molecular, cellular, and
pharmacological therapies to stimulate repair of sensorimotor circuits
after stroke are entering
clinical trials. Compared with acute
neuroprotection and thrombolysis studies, clinical trials for repair in
subacute and
chronic hemiplegic participants have a different
time course for delivery of an intervention, different mechanisms of
action
within the milieu of the injury, distinct
relationships to the amount of physical activity and skills practice of
participants,
and need to include more refined outcome measures.
This review examines the biological interaction of targeted
rehabilitation
with neural repair strategies to optimize outcomes.
We suggest practical guidelines for the incorporation of inexpensive
skills
training and exercise at home. In addition, we
describe some novel outcome measurement tools, including wearable
sensors,
to obtain the more detailed outcomes that may
identify at least some minimal level of success from cellular and
regeneration
interventions. Thus, proceeding in the shadow of
acute stroke trial designs may unnecessarily limit the mechanisms of
action
of new repair strategies, reduce their impact on
participants, and risk missing important behavioral outcomes.
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