Enhancing Brain Plasticity to Promote Stroke Recovery.

Fan Su,Wendong Xu

doi:10.3389/fneur.2020.554089

Abstract

Stroke disturbs both the structural and functional integrity of the brain. The understanding of stroke pathophysiology has improved greatly in the past several decades. However, effective therapy is still limited, especially for patients who are in the subacute or chronic phase. Multiple novel therapies have been developed to improve clinical outcomes by improving brain plasticity. These approaches either focus on improving brain remodeling and restoration or on constructing a neural bypass to avoid brain injury. This review describes emerging therapies, including modern rehabilitation, brain stimulation, cell therapy, brain-computer interfaces, and peripheral nervous transfer, and highlights treatment-induced plasticity. Key evidence from basic studies on the underlying mechanisms is also briefly discussed. These insights should lead to a deeper understanding of the overall neural circuit changes, the clinical relevance of these changes in stroke, and stroke treatment progress, which will assist in the development of future approaches to enhance brain function after stroke.

Highlights

Stroke represents the leading cause of long-term disability and causes substantial medical and financial burdens
We summarize post-stroke interventions that enhance brain plasticity and functional recovery, placing emphasis on modulation of the intact hemisphere
For acute stroke patients with motor impairment, enhancing cortical activity via high frequency (HF)-transcranial magnetic stimulation (TMS) and A-transcranial direct current stimulation (tDCS) resulted in improved motor function, and stimulation-induced increased neural activity correlated with recovery [21, 72]

Summary

INTRODUCTION

Stroke represents the leading cause of long-term disability and causes substantial medical and financial burdens. The lack of effective neurorepair and limitations of functional recovery have led researchers to consider other approaches that improve the scope for recovery by enhancing brain plasticity. Changed neural activity and connectivity in terms of function and structure could be detected in the perilesional and remote regions and even in the contralateral hemisphere, which were assumed to be the mechanisms underlying spontaneous recovery [2, 3]. Plasticity and Stroke Treatment conventional therapies (i.e., physical, occupational, and speech), novel approaches have shown promising effects in clinical trials. Many of the approaches were designed to enhance plasticity in the ipsilesional hemisphere, in which increased activity/connectivity was related to better functional performance. We summarize post-stroke interventions that enhance brain plasticity and functional recovery, placing emphasis on modulation of the intact hemisphere.

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Findings

CONCLUSIONS