http://stroke.ahajournals.org/content/48/3/813?etoc=
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Introduction
Stroke
is the second leading cause of death and the third leading cause of
disability-adjusted life years worldwide. Although numerous therapies
have been developed over the past 10 years to treat acute ischemic
stroke, the stark reality remains that only 5% of these patients are so
treated in the United States,1
in part, because of treatment window times <3 to 6 hours post-onset,
and many of these 5% nonetheless have significant long-term disability.
Acute treatment options after hemorrhagic stroke remain limited.2
In
parallel with efforts to further develop acute stroke interventions,
researchers are studying recovery and rehabilitation treatments, which
can have a treatment time window measured in days, weeks, or months
poststroke. To achieve this goal, therapies aim to maximize function in
brain areas that survive the stroke or provide compensatory approaches
to improve overall function. Strategies targeting recovery and
rehabilitation must be seen as distinct from acute stroke therapies,
such as reperfusion or neuroprotection, where the strategy is to limit
the severity of ischemic injury, including preserving penumbral tissue
and reducing infarct size.
Preclinical and translational
research have successfully identified numerous molecular and
physiological events spontaneously arising in the nervous system during
the days-to-weeks after an infarct, and, subsequently, potential
restorative therapies that target these events to improve long-term
behavioral outcomes.3,4
In parallel, a burgeoning volume of data from human subjects has
emerged regarding mechanisms of recovery from stroke. Together, these
efforts inform translation into clinical studies for several classes of
therapy, including small molecules, growth factors, stem cells,
monoclonal antibodies, brain stimulation, robotics and other devices,
cognitive strategies, intensive training, and telerehabilitation.5,6
The
majority of patients with stroke survive the initial event but go on to
live with significant disability for many years. Indeed, there are >7 million stroke survivors …
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