Abstract
After stroke, many patients improve spontaneously, at least to some extent, and after the acute period the principal mechanism appears to be brain plasticity. The task for rehabilitation is to improve on spontaneous recovery, and this might well be accomplished by manipulating plasticity. Body parts compete for representation in brain, and use of a body part enhances its representation. Hence, physical therapy should help, as has been demonstrated by constraint-induced movement therapy. Other techniques use the same principle such as neuromuscular electrical stimulation, robot-enhanced training and virtual reality training. Bilateral, symmetical arm movement training helps, possibly by enhancement of function of the undamaged hemisphere. Sensory stimulation enhances plasticity and can be delivered in a number of ways, from passive movement to cutaneous stimulation. Reduction of inhibition enhances plasticity, and this can be used in rehabilitation using deafferentation. Pharmacological agents can enhance plasticity by several mechanisms.
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