Predicting and accelerating motor recovery after stroke.

Abstract

This review presents recent developments in the prediction of motor recovery after stroke; explores whether rehabilitation interventions delivered during the spontaneous recovery process can improve outcomes; and identifies the first trials to focus on the rate rather than extent of motor recovery (Supplementary Digital Content 1). Two recent studies have attempted to accelerate the rate of motor recovery during the first few weeks after stroke, with neuromodulation techniques designed to facilitate excitability of the ipsilesional motor cortex. One trial using transcranial direct current stimulation was negative, and the other trial using bilateral priming was positive. These contrasting results may be explained by important differences in trial design. This new focus on modifying rate, rather than extent, of motor recovery is in line with accumulating evidence that the motor recovery plateau is largely determined by the extent of damage to descending motor pathways, which is currently untreatable. Interventions that facilitate neural plasticity and reorganization may accelerate recovery of motor function during the spontaneous recovery period, without affecting final outcome. This may represent a useful new approach for future trials conducted during rehabilitation at the subacute stage of stroke.