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(Stroke. 2009;40:S129.)
© 2009 American Heart Association, Inc.

Rehabilitation

Rehabilitation and Repair

Introduction

From the Departments of Neurology and Anatomy & Neurobiology (S.C.C.), University of California, Irvine; and the Landon Center on Aging and Department of Molecular and Integrative Physiology (R.J.N.), Kansas University Medical Center, Kansas City, Kans.

Correspondence to Steven Cramer, UCI Medical Center, 101 The City Drive South, Orange, CA 92868-4280. E-mail scramer@uci.edu

Key Words: rehabilitation

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Brain repair after stroke is entering an exciting stage. The four articles on this topic that follow examine a number of the forefronts, including translational efforts, new drug discovery, brain mapping to measure reorganization in humans, new national structures for expanding trials in this setting, the interplay between repair and experience, and the various therapeutic approaches under investigation.

Dr Larry Goldstein summarizes the many clinical trials conducted on the effects of d-amphetamine in stroke survivors. This drug has been repeatedly shown to be beneficial in animal models, especially when combined with behavioral experience. However, results of clinical trials have been quite variable, possibly related to differences in dosing regimens, timing with respect to physiotherapy, or other factors related to stroke severity. Dr Goldstein emphasizes the critical issues of trial design in evaluating amphetamine trials in stroke recovery, including the importance of coupling drug exposure with the experience of physiotherapy, and concludes that the effectiveness of this drug remains unanswered.

Dr Theresa Jones and colleagues review the evidence for the effects of behavioral experience on the anatomy of dendrites and synapses in the remaining intact cortical tissue after injury. Dr Jones indicates that these effects can be adaptive or detrimental, depending on the type and timing of such experience. Further, behavioral experience, in the form of increased use of the unimpaired limb after unilateral damage, produces bihemispheric effects. Combinatorial therapies, such as cortical electric stimulation, may aid the rehabilitative process by enhancing its effects. Injury, experience, plasticity, and behavioral outcome have . . . [Full Text of this Article]