[Brain plasticity after stroke--implications for post-stroke rehabilitation]

Abstract

Background: In the last ten years, increased understanding of the brain's plasticity has opened up new possibilities for post-stroke rehabilitation.

Material and methods: The article is based on a literature search in Medline, my own research and clinical experience.

Results: Post-stroke brain plasticity includes synaptogenesis, change of function in pre-existing synapses, cortical reorganization and probably neurogenesis. All these changes are stimulated by activity. The brain may be more susceptible to plasticity changes shortly after damage has occurred. Clinical studies have shown that intensive rehabilitation training is better than moderate training to recover motoric functions. Cortex contralateral to the lesion is activated in post-stroke motor training, but the pattern of cortical activation is normalized as function is regained. The prognosis is better if some of the relevant motor circuits are left undamaged. Sensory stimulation may also enhance motor recovery.

Interpretation: The ideal form of rehabilitation training is still unclear, but we do know that post-stroke rehabilitation should start as soon as possible, with good motivation, sufficient intensity and quantity, and should be maintained over a long time.