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(Stroke. 2000;31:223.)
© 2000 American Heart Association, Inc.
Special Report |
Brain Plasticity and Stroke Rehabilitation
The Willis Lecture
Presented as the Willis Lecture at the 24th American Heart Association International Conference on Stroke and Cerebral Circulation, Nashville, Tenn, February 4, 1999. The opinions expressed in this article are not necessarily those of the editors or of the American Heart Association.
From the Division for Experimental Neurology, Wallenberg Neuroscience Center, University Hospital, Lund, Sweden.
Correspondence to Barbro B. Johansson, MD, PhD, Division for Experimental Neurology, Wallenberg Neuroscience Center, University Hospital, S-221 85 Lund, Sweden. E-mail Barbro.Johansson{at}neurol.lu.se
Abstract—Neuronal connections and cortical maps are continuously remodeled by our experience. Knowledge of the potential capabilityof the brain to compensate for lesions is a prerequisite for optimal stroke rehabilitation strategies. Experimental focal cortical lesions induce changes in adjacent cortex and in the contralateral hemisphere. Neuroimaging studies in stroke patients indicate altered poststroke activation patterns, which suggest some functional reorganization. To what extent functional imaging data correspond to outcome data needs to be evaluated. Reorganization may be the principle process responsible for recovery of function after stroke, but what are the limits, and to what extent can postischemic intervention facilitate such changes? Postoperative housing of animals in an enriched environment can significantly enhance functional outcome and can also interact with other interventions, including neocortical grafting. What role will neuronal progenitor cells play in future rehabilitation—stimulated in situ or as neural replacement? And what is the future for blocking neural growth inhibitory factors? Better knowledge of postischemic molecular and neurophysiological events, and close interaction between basic and applied research, will hopefully enable us to design rehabilitation strategies based on neurobiological principles in a not-too-distant future.
Key Words: neuronal plasticity • recovery • rehabilitation • stroke
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