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Upper limb movements and cerebral plasticity in post-stroke rehabilitation

Rehabilitative interventions for the plegic/paretic upper limb of stroke survivors are more effective if they are early, intensive, and provide multisensory stimulation. Various rehabilitative approaches have been proposed to date, but little has been published on clinical efficacy. The mechanism underlying recovery of neurological injury after stroke is still incompletely understood, but more than one process is probably involved and cerebral plasticity undoubtedly plays a key role. The goal of this review was to identify which movements and type of therapeutic arm exercises may influence cerebral plasticity in plegic/paretic stroke survivors. Evidence suggests that plasticity is stimulated more by the arm's movement trajectory than by its final position in space. Rehabilitation should be based on simple, repetitive, unidirectional or, better still, complex and multidirectional movements in all spatial planes, such as circular or spiral movements. It should also incorporate a feedback system, since this seems to bring about earlier and better motor and functional outcomes.

Robot-aided intensive training in post-stroke recovery

The successful motor rehabilitation of stroke patients requires an intensive and task-specific therapy approach. The plasticity of the adult human brain provides opportunities to enhance traditional rehabilitation programs for these individuals. Intensive robot-aided sensorimotor training may have a positive effect on reducing impairment and disability and increasing reorganization of the adult brain. This approach may therefore efficaciously complement standard post-stroke multidisciplinary programs as shown by recent experimental trials.

Cortical plasticity and the development of behavior after early frontal cortical injury

It has been known for over 100 years that frontal lobe injury in children is often associated with considerably more functional recovery than after similar injury in adulthood. Systematic study of frontal cortical injury in laboratory animals has shown that this recovery is tightly tied to developmental age: There is a brief window of time during cortical development during which the brain is able to compensate. Simply being young is not sufficient because injury prior to this critical period leads to miserable behavioral outcomes. For humans, the least favorable time for cortical injury is likely at the end of the gestational period, perhaps including the 1st month or so of life whereas the most favorable time is around 1 to 2 years of age. In addition to age, the extent of behavioral recovery is influenced by age at assessment, the nature of the behavioral assessment, sex, and lesion size. Anatomical studies have shown that functional recovery following early cortical injury is correlated with a reorganization of remaining cortical circuitry, including increased dendritic arborization and increased spine density. Recovery, and the compensatory anatomical changes, can also be potentiated by application of different treatments including behavioral therapy, trophic factors, and neuromodulators. Finally, there is preliminary evidence in laboratory animals to suggest that it may be possible to induce neural regeneration in the injured brain and that the regenerated brain functions to support functional recovery.