Stroke rehabilitation

Abstract

After acute stroke, rehabilitation process induces recruitment of non-used brain cells to form a new network to restore the lost function. However, pattern of recruitment varies among individuals although brain cells from ipsilateral and contralateral hemisphere and cerebella could be recruited to form the network. Inhibitory effect from contralateral hemisphere on the damaged hemisphere, resulting in imbalance between inhibition and excitation, has been shown. Different modalities of intervention such as mirror therapy and brain stimulation were shown to have effects on reduction of imbalance between hemispheres after stroke. New modalities of intervention to enhance neuroplasticity have been developed in last decade. Although most randomized controlled studies were of small sample size, the effectiveness of these modalities such as robotic gait training, mirror therapy and mental imagery is well summarized by some meta-analysis. The task-specific and repetitive training is basically an important factor for enhancing neuroplasticity. Nevertheless, some training modalities such as mental imagery have been shown to have generalization of training effect even after task-specific training. What would be the optimal training with traditional approach combined with various new training modalities is still not yet fully explored. After acute stroke, rehabilitation process induces recruitment of non-used brain cells to form a new network to restore the lost function. However, pattern of recruitment varies among individuals although brain cells from ipsilateral and contralateral hemisphere and cerebella could be recruited to form the network. Inhibitory effect from contralateral hemisphere on the damaged hemisphere, resulting in imbalance between inhibition and excitation, has been shown. Different modalities of intervention such as mirror therapy and brain stimulation were shown to have effects on reduction of imbalance between hemispheres after stroke. New modalities of intervention to enhance neuroplasticity have been developed in last decade. Although most randomized controlled studies were of small sample size, the effectiveness of these modalities such as robotic gait training, mirror therapy and mental imagery is well summarized by some meta-analysis. The task-specific and repetitive training is basically an important factor for enhancing neuroplasticity. Nevertheless, some training modalities such as mental imagery have been shown to have generalization of training effect even after task-specific training. What would be the optimal training with traditional approach combined with various new training modalities is still not yet fully explored.