Post stroke restorative therapies: Drugs, devices and robotics

Abstract

Restorative therapies in neurology aim to improve outcome and function by promoting plasticity within a therapeutic time window between days to weeks to years. In this article, the mechanisms by which cell-based, pharmacological and robotic treatments stimulate endogenous brain remodeling after stroke, particularly neurogenesis, axonal plasticity, and white-matter integrity, are described with a brief outline of the potential of neuroimaging (functional magnetic resonance imaging) techniques. Stem cells aid stroke recovery through mechanisms depending on the type of cells used. Transplanted embryonic stem cells, induced pluripotent cells, and neural stem cells can replace the missing brain cells in the infarcted area, whereas adult stem cells, such as multipotent stromal cells and mononuclear cells, provide trophic support to enhance self-repair systems such as endogenous neurogenesis. Noninvasive brain stimulation provides a valuable tool for interventional neurophysiology by modulating brain activity in a specific distributed, corticosubcortical network. Elucidating the underlying mechanisms of cell-based, pharmacological and rehabilitative therapies is of primary interest and crucial for translation of treatments to clinical use. This will provide an impetus for the development of superior, advanced, and cost-effective neurorestorative interventions that will enhance stroke recovery.