Neuroplastic Changes Following Brain Ischemia and their Contribution to Stroke Recovery: Novel Approaches in Neurorehabilitation.

Claudia Alia,Fabio Vallone,Federica Bertolucci,Matteo Caleo,Angelo Di Garbo,Carmelo Chisari,Stefano Lai,Alessandro Panarese,Giuseppe Lamola,Cristina Spalletti,Silvestro Micera

doi:10.3389/fncel.2017.00076

Abstract

Ischemic damage to the brain triggers substantial reorganization of spared areas and pathways, which is associated with limited, spontaneous restoration of function. A better understanding of this plastic remodeling is crucial to develop more effective strategies for stroke rehabilitation. In this review article, we discuss advances in the comprehension of post-stroke network reorganization in patients and animal models. We first focus on rodent studies that have shed light on the mechanisms underlying neuronal remodeling in the perilesional area and contralesional hemisphere after motor cortex infarcts. Analysis of electrophysiological data has demonstrated brain-wide alterations in functional connectivity in both hemispheres, well beyond the infarcted area. We then illustrate the potential use of non-invasive brain stimulation (NIBS) techniques to boost recovery. We finally discuss rehabilitative protocols based on robotic devices as a tool to promote endogenous plasticity and functional restoration.

Highlights

Following an ischemic insult within the motor cortex, one or more body parts contralateral to the infarct result impaired or paretic
Another study conducted on a large sample of chronic stroke patients (Lo et al, 2010) showed that robotassisted upper limb training with end-effector device and intensive conventional therapy determined the same degree of clinical improvement after 12 weeks of rehabilitation, after further 24 weeks of treatment the robotic approach resulted in further improvement
It is well known that an ischemic damage leads to spontaneous neuroplasticity in perilesional tissue, promoting map reorganization observable both in human and animal models

Summary

INTRODUCTION

Following an ischemic insult within the motor cortex, one or more body parts contralateral to the infarct result impaired or paretic. The degree of the motor impairment depends on many factors, such as the extent of the infarct, the identity of the damaged region(s) and the effectiveness of the early medical care. Impairments of upper and lower limbs are disabling as they impact on the degree of independence in ADLs. Overall, a significant percentage of the patients. Plasticity and Neurorehabilitation after Stroke exhibit persistent disability following ischemic attacks. We describe non-invasive brain stimulation (NIBS) techniques and robotic devices for stimulating functional recovery in humans and rodent stroke models

NEUROPLASTICITY AFTER STROKE

Changes in Interhemispheric Interactions After Stroke

Features and Advantages of Robotic Devices

Robotic Devices for Rodents

Findings

CONCLUSIONS