Shaping plasticity to enhance recovery after injury

Dancause, Numa; Nudo, Randolph J.

doi:10.1016/b978-0-444-53355-5.00015-4

Cited by 169 publications

(134 citation statements)

References 166 publications

(206 reference statements)

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“…In fact, the latter interventions were no more effective than standard housing in inducing FosB/ΔFosB expression. As cortical layer II/III neurons have extensive cortico-cortical interconnections, neuroplastic changes in this region produced by ER may be important for the neural remodeling contributing to stroke recovery [19].…”

Section: Ee Exercise and Stroke Recoverymentioning

confidence: 99%

Exercise and Environmental Enrichment as Enablers of Task-Specific Neuroplasticity and Stroke Recovery

et al. 2016

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Improved stroke care has resulted in greater survival, but >50 % of patients have chronic disabilities and 33 % are institutionalized. While stroke rehabilitation is helpful, recovery is limited and the most significant gains occur in the first 2-3 months. Stroke triggers an early wave of gene and protein changes, many of which are potentially beneficial for recovery. It is likely that these molecular changes are what subserve spontaneous recovery. Two interventions, aerobic exercise and environmental enrichment, have pleiotropic actions that influence many of the same molecular changes associated with stroke injury and subsequent spontaneous recovery. Enrichment paradigms have been used for decades in adult and neonatal animal models of brain injury and are now being adapted for use in the clinic. Aerobic exercise enhances motor recovery and helps reduce depression after stroke. While exercise attenuates many of the signs associated with normal aging (e.g., hippocampal atrophy), its ability to reverse cognitive impairments subsequent to stroke is less evident. It may be that stroke, like other diseases such as cancer, needs to use multimodal treatments that augment complimentary neurorestorative processes.

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Section: Ee Exercise and Stroke Recoverymentioning

confidence: 99%

Exercise and Environmental Enrichment as Enablers of Task-Specific Neuroplasticity and Stroke Recovery

et al. 2016

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“…The advantage of invasive cortical stimulation for rehabilitation witnessed in early clinical trials, however, failed to generalize to a subsequent pivotal phase III clinical trial [21,[23][24][25] (Table 1). The study failed to meet its primary composite end-point of efficacy at 4-week follow-up [23,25], achieving less than the required 20 % difference between investigational and control groups [21].…”

Section: State Of Evidence In Invasive Neuromodulation In Stroke Rehamentioning

confidence: 99%

“…The study failed to meet its primary composite end-point of efficacy at 4-week follow-up [23,25], achieving less than the required 20 % difference between investigational and control groups [21]. Atypical findings of phase III, compared to phase I/II and animal studies, are now attributed to numerous factors [23][24][25][26], some of which we list briefly in Table 2 and in detail below.…”

Section: State Of Evidence In Invasive Neuromodulation In Stroke Rehamentioning

confidence: 99%

“…Besides interhemispheric balance, ipsilesional areas, remote from the infarct rim such as supplementary motor area and premotor cortices, may vicariate in recovery, that is, assume the role of damaged M1 [24]. In a primate model, axons from the ventral premotor area bypassed the lesioned site [51] to establish atypical remote cortico-cortical connections [52].…”

Section: Alternate Substrates and Their Role In Recovery: Cortical Sumentioning

confidence: 99%

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Invasive Neurostimulation in Stroke Rehabilitation

Plow

Machado

2014

Neurotherapeutics

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The last decade has seen a growing interest in adjuvant treatments that synergistically influence mechanisms underlying rehabilitation of paretic upper limb in stroke. One such approach is invasive neurostimulation of spared cortices at the periphery of a lesion. Studies in animals have shown that during training of paretic limb, adjuvant stimulation targeting the peri-infarct circuitry enhances mechanisms of its reorganization, generating functional advantage. Success of early animal studies and clinical reports, however, failed to translate to a phase III clinical trial. As lesions in humans are diffuse, unlike many animal models, peri-infarct circuitry may not be a feasible, or consistent target across most. Instead, alternate mechanisms, such as changing transcallosal inhibition between hemispheres, or reorganization of other viable regions in motor control, may hold greater potential. Here, we review comprehensive mechanisms of clinical recovery and factors that govern which mechanism(s) become operative when. We suggest novel approaches that take into account a patient's initial clinical-functional state, and findings from neuroimaging and neurophysiology to guide to their most suitable mechanism for ideal targeting. Further, we suggest new localization schemes, and bypass strategies that indirectly target peri-lesional circuitry, and methods that serve to counter technical and theoretical challenge in identifying and stimulating such targets at the periphery of infarcts in humans. Last, we describe how stimulation may modulate mechanisms differentially across varying phases of recovery-a temporal effect that may explain missed advantage in clinical trials and help plan for the next stage. With information presented here, future trials would effectively be able to target patient's specific mechanism(s) with invasive (or noninvasive) neurostimulation for the greatest, most consistent benefit. [2], which remains one of the most important predictors of disability and poor quality of life [3]. Disability adds to the costs of disease management that total $74 billion/ year [4]. Developing methods to effectively alleviate residual deficits will reduce health and economic burden of stroke.Several evidence-based rehabilitative approaches have been developed with prominent ones, including neuromuscular electrical stimulation [5], motor learning [6], robotic training [7] constraint-induced movement therapy [8], and bilateral arm training [9], etc. In spite of extensive therapy, recovery is frequently incomplete [10]. There is a critical need for adjuvant strategies that augment rehabilitative outcomes of paretic hand.The last decade has seen a growing interest in the promise of adjuvant treatments that synergistically influence mechanisms associated with rehabilitation. One such approach is invasive neuromodulation, involving electrical stimulation applied to cortical or subcortical targets spared by stroke. By directly stimulating viable targets, it is believed that potential for plasticity underlying reh...

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“…The congress opened with an excellent Michael P Barnes lecture delivered by Randolph Nudo (Kansas University Medical Center, Kansas City, KS, USA). Dancause and Nudo have developed some innovative approaches for the development of new treatments to enhance neural plasticity, and hence recovery, following brain injury, building on recent work from this group [1]. One exciting new technology described involved detection of neural activity on one hemisphere of a traumatic brain injury (TBI) model that controlled neural stimulation adjacent to the injury site.…”

mentioning

confidence: 99%

Harnessing Experience-Dependent Plasticity For Cns Repair and Regeneration

2012

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The 7th World Congress of Neurorehabilitation was held from 16–19 May, 2012, in Melbourne, Australia. Melbourne produced the largest attendance of any meeting thus far for this biennial congress of the World Federation of Neurorehabilitation. The congress provided a diverse range of presentations, from environmental interventions in animal models of brain disorders, to new techniques for rehabilitation and clinical trials. While stroke, traumatic brain injury and spinal cord injury featured prominently, there were also many other presentations on rehabilitation for neurodegenerative diseases and other neurological disorders. Here, we focus on a selection of novel findings reported at this congress.

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Shaping plasticity to enhance recovery after injury

Cited by 169 publications

References 166 publications

Exercise and Environmental Enrichment as Enablers of Task-Specific Neuroplasticity and Stroke Recovery

Exercise and Environmental Enrichment as Enablers of Task-Specific Neuroplasticity and Stroke Recovery

Invasive Neurostimulation in Stroke Rehabilitation

Harnessing Experience-Dependent Plasticity For Cns Repair and Regeneration

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