59 Interventions to Improve Recovery after Stroke

'Improve' is not good enough. 

59 Interventions to Improve Recovery after Stroke

 Steven C. Cramer
KEY POINTS
• Neural repair is a therapeutic strategy that is separate from acute stroke strategies such as reperfusion and neuroprotection, and has distinct biological targets, time windows for therapeutic efficacy, and issues to address in clinical trial design.• Many classes of therapy are under study to improve stroke recovery including small molecules, growth factors, monoclonal antibodies, stem cells, robotic devices, brain stimulation, activity-based therapies, telerehabilitation, and cognitive-based strategies.• Some repair-based therapies are introduced within days of stroke onset, in an attempt to amplify innate repair mechanisms, while other therapies are offered to patients from months to years after stroke onset, where the goal is to stimulate new forms of neural repair.• Restorative therapies improve behavioral outcomes on the basis of experience-dependent brain plasticity – a drug may galvanize the brain for repair, but behavioral reinforcement is also needed to achieve maximal gains. This is an important difference as compared to neuroprotective, reperfusion, and preventative stroke therapies, where the patient generally does not need to engage in any particular behavioral regimen to derive treatment benefit.• Several positive late-phase clinical trials of restorative therapies have been published, e.g., for activity-based therapies and for small molecules such as serotonergic drugs.