Abstract
Spasticity and weakness (spastic paresis) are the primary motor impairments after stroke and impose significant challenges for treatment and patient care. Spasticity emerges and disappears in the course of complete motor recovery. Spasticity and motor recovery are both related to neural plasticity after stroke. However, the relation between the two remains poorly understood among clinicians and researchers. Recovery of strength and motor function is mainly attributed to cortical plastic reorganization in the early recovery phase, while reticulospinal (RS) hyperexcitability as a result of maladaptive plasticity, is the most plausible mechanism for poststroke spasticity. It is important to differentiate and understand that motor recovery and spasticity have different underlying mechanisms. Facilitation and modulation of neural plasticity through rehabilitative strategies, such as early interventions with repetitive goal-oriented intensive therapy, appropriate non-invasive brain stimulation, and pharmacological agents, are the keys to promote motor recovery. Individualized rehabilitation protocols could be developed to utilize or avoid the maladaptive plasticity, such as RS hyperexcitability, in the course of motor recovery. Aggressive and appropriate spasticity management with botulinum toxin therapy is an example of how to create a transient plastic state of the neuromotor system that allows motor re-learning and recovery in chronic stages.
Highlights
According to the CDC, approximately 800,000 people have a stroke every year in the United States
Spasticity is present in about 20–40% stroke survivors [2]
Animal studies have strongly supported the possible role of RS pathways in motor recovery [20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36], while recent studies with stroke survivors have demonstrated that RS pathways may not always be beneficial [37, 38]
Summary
According to the CDC, approximately 800,000 people have a stroke every year in the United States. Animal studies have strongly supported the possible role of RS pathways in motor recovery [20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36], while recent studies with stroke survivors have demonstrated that RS pathways may not always be beneficial [37, 38]. The relation between spasticity and motor recovery and the role of plastic changes after stroke in this relation, RS hyperexcitability, remain poorly understood among clinicians and researchers. Management of spasticity and facilitation of motor recovery remain clinical challenges. Possible roles of RS hyperexcitability in motor recovery An example of spasticity reduction for facilitation of motor recovery
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