Abstract
Injury due to stroke and traumatic brain injury result in significant long-term effects upon behavioral functioning. One central question to rehabilitation research is whether the nature of behavioral improvement observed is due to recovery or the development of compensatory mechanisms. The nature of functional improvement can be viewed from the perspective of behavioral changes or changes in neuroanatomical plasticity that follows. Research suggests that these changes correspond to each other in a bidirectional manner. Mechanisms surrounding phenomena like neural plasticity may offer an opportunity to explain how variables such as experience can impact improvement and influence the definition of recovery. What is more, the intensity of the rehabilitative experiences may influence the ability to recover function and support functional improvement of behavior. All of this impacts how researchers, clinicians, and medical professionals utilize rehabilitation.
Highlights
The goal of rehabilitation is often focused on independence as opposed to the impairment, which may lead to improved behavioral function but prevent true behavioral recovery
If we hope to improve the efficacy of rehabilitative strategies following brain injury, it is important to distinguish between true recovery and compensation and to understand the consequences of each for long-term neural and behavioral function
This review considers how the cognitive reserve applies to functional improvement following injury and how the intensity of rehabilitation plays a role in recovery and compensation
Summary
One important question in the study of adult brain injury and repair is whether behavioral improvement reflects true behavioral recovery or whether the behavioral changes are due to the use of compensatory strategies in reaction to a disrupted nervous system. Kim and colleagues report decreased forelimb representation area in perilesion motor cortex and an increase in axodendritic synapses and multiple synaptic boutons following forced use of the unimpaired limb (i.e., compensatory limb training) [84] This synaptic density negatively correlated with functional outcome of the impaired limb, suggesting that aberrant synaptogenesis, potentially of transcallosal projections, may contribute to the poor functional outcome associated with compensatory limb use following injury. Even if the behavior is similar to preinjury conditions, the argument is that the remaining functional areas have to compensate for the loss This argument posits that in order for true recovery to occur, the neurons and their corresponding neural connections that were lost during injury need to be replaced rather than substituted [24, 150]
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