What Is the Evidence for Use Dependent Learning After Stroke?

Abstract

Our laboratory has been interested in the patterns of synaptic plasticity after cortical stroke in animal models.1 These protein expression studies suggest that regions both ipsilateral and contralateral to the stroke are involved during the recovery period. An emerging issue of interest is whether the recovered function is indeed normal or reflects some compensatory function.2 One approach to resolving these questions is to assess different patterns of functional recovery in patients who do and do not recover function with and without therapy and compare them to normal patterns. Investigation of the molecular mechanisms of brain plasticity after injury suggests that functional activity stimulates this recovery and guides the development of functional pathways.3,4 Several investigators postulate that recovery from stroke resembles “use-dependent” learning.5 For this report, we review pertinent literature related to this phenomenon, assess how recovery of language resembles normal language function, and provide examples from our own research on functional imaging that assess patterns of activation related to recovery. The primary treatment modality that we review is constraint-induced language therapy (CILT), in which stroke patients are restricted to using verbal communication.6 CILT is based on principles of constraint-induced therapy for other conditions.6 CILT is performed in chronic stroke …