The Promise of Neuro-Recovery After Stroke: Introduction
2013; Lippincott Williams & Wilkins; Volume: 44; Issue: 6_suppl_1 Linguagem: Inglês
10.1161/strokeaha.111.000373
ISSN1524-4628
AutoresS. Thomas Carmichael, John W. Krakauer,
Tópico(s)Botulinum Toxin and Related Neurological Disorders
ResumoHomeStrokeVol. 44, No. 6_suppl_1The Promise of Neuro-Recovery After Stroke: Introduction Free AccessResearch ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessResearch ArticlePDF/EPUBThe Promise of Neuro-Recovery After Stroke: Introduction S. Thomas Carmichael, MD, PhD and John W. Krakauer, MD S. Thomas CarmichaelS. Thomas Carmichael From the Department of Neurology, David Geffen School of Medicine, Los Angeles, CA (S.T.C.); and Department of Neurology and Neuroscience, The Johns Hopkins Hospital, Baltimore, MD (J.W.K.). and John W. KrakauerJohn W. Krakauer From the Department of Neurology, David Geffen School of Medicine, Los Angeles, CA (S.T.C.); and Department of Neurology and Neuroscience, The Johns Hopkins Hospital, Baltimore, MD (J.W.K.). Originally published1 Jun 2013https://doi.org/10.1161/STROKEAHA.111.000373Stroke. 2013;44:S103The study of brain repair and behavioral recovery after stroke continues to accelerate with points of convergence between findings in humans and results in animal models of stroke. Approaches to motor recovery after stroke can be usefully broken into 3 categories: reduction in impairment with a return to more normal patterns of motor behavior; compensatory responses with the other limb or even muscles within the same limb; and use of neurally controlled prosthetics that substitute for the affected limb. The future choice of any of these approaches to neurorehabilitation is likely to depend on both the severity of the initial impairment and the time since stroke onset.Stem cells have garnered a great deal of attention because they conjure up the possibility of neural regeneration and the possible reintegration of new neurons into damaged neural circuits. However, evidence suggests that stem/progenitor transplantation in stroke is not replacing damaged brain but instead enhancing or extending the processes of endogenous brain repair after stroke. This more indirect benefit is the subject of the perspective/review submitted by Dr Sean Savitz.1 His group has focused on bone marrow–derived mononuclear cells and how they may enhance recovery in rodent stroke models. Several studies, including his own, in rodent models have shown that intravenous or intra-arterial delivery of autologous mononuclear cells lead to reduced impairment and slower infarct maturation when given within a week of stroke. The mechanisms of these benefits are not known, but preliminary evidence suggests anti-inflammatory and neuro-protective effects, as well as effects on the endogenous repair processes of neurogenesis and angiogenesis. Dr Savitz led a study showing that harvesting autologous mononuclear cells in patients after stroke and giving them back intravenously is feasible and safe. Subsequent efficacy trials will hopefully show that the enhancement of spontaneous biological recovery demonstrated with mononuclear cells in animal models will generalize to patients after stroke.We recently argued that the focus during the time-window of maximal spontaneous recovery, which is 1 month in rodent models and 3 months in humans, should be on reduction in impairment and not on compensation.2 The reasons for this include evidence that compensatory responses may reduce the chance of reduction in impairment, either because time is spent devoted to the wrong thing or because, as suggested by some rodent models, peri-infarct plasticity might be conducive to both compensatory and recovery responses, suggesting a zero sum game. In this issue, Theresa Jones et al3 present a review of a series of experiments they have performed in a rodent stroke model showing that training the unaffected limb on a skilled prehension task blunts the responses of the affected side to rehabilitative training. Interestingly, the deleterious effect on the affected side by training the unaffected side is prevented with callosal transection. This suggests that changes that occur with learning in one hemisphere can interfere via the callosum with learning in the other hemisphere. These results are disturbing because they suggest yet another reason why it might not be a good idea to teach patients compensatory techniques with their unaffected side in the first few weeks after stroke.DisclosuresDr Carmichael has received research grant support from Biotime, Inc.FootnotesCorrespondence to S. Thomas Carmichael, MD, PhD, Department of Neurology, David Geffen School of Medicine, 710 Westwood Plaza, Los Angeles, CA 90095. E-mail [email protected]References1. Savitz S. Stem cells: careful translation from animals to patients.Stroke. 2013; 44:S107–S109LinkGoogle Scholar2. Krakauer JW, Carmichael ST, Corbett D, Wittenberg GF. Getting neurorehabilitation right: what can be learned from animal models?Neurorehabil Neural Repair. 2012; 26:923–931.CrossrefMedlineGoogle Scholar3. Jones TA, Allred RP, Jefferson SC, Kerr AL, Woodie DA, Cheng S-Y, Adkins DL. Animal Behavioral/Stroke Recovery Studies and Plasticity.2013; 44:S104–S106Google Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Grau-Sánchez J, Münte T, Altenmüller E, Duarte E and Rodríguez-Fornells A (2020) Potential benefits of music playing in stroke upper limb motor rehabilitation, Neuroscience & Biobehavioral Reviews, 10.1016/j.neubiorev.2020.02.027, 112, (585-599), Online publication date: 1-May-2020. Israely S, Leisman G and Carmeli E (2020) Impaired Coordination and Recruitment of Muscle Agonists, But Not Abnormal Synergies or Co-contraction, Have a Significant Effect on Motor Impairments After Stroke Health and Medicine, 10.1007/5584_2020_528, (37-51), . Tang Y, Li M, Zhang X, Jin X, Liu J and Wei P (2019) Delayed exposure to environmental enrichment improves functional outcome after stroke, Journal of Pharmacological Sciences, 10.1016/j.jphs.2019.05.002, 140:2, (137-143), Online publication date: 1-Jun-2019. Ramos-Murguialday A, Curado M, Broetz D, Yilmaz Ö, Brasil F, Liberati G, Garcia-Cossio E, Cho W, Caria A, Cohen L and Birbaumer N (2019) Brain-Machine Interface in Chronic Stroke: Randomized Trial Long-Term Follow-up, Neurorehabilitation and Neural Repair, 10.1177/1545968319827573, 33:3, (188-198), Online publication date: 1-Mar-2019. Winters C, Heymans M, van Wegen E and Kwakkel G (2016) How to design clinical rehabilitation trials for the upper paretic limb early post stroke?, Trials, 10.1186/s13063-016-1592-x, 17:1, Online publication date: 1-Dec-2016. Cruz V, Bento V, Ruano L, Ribeiro D, Fontão L, Mateus C, Barreto R, Colunas M, Alves A, Cruz B, Branco C, Rocha N and Coutinho P (2014) Motor task performance under vibratory feedback early poststroke: single center, randomized, cross-over, controled clinical trial, Scientific Reports, 10.1038/srep05670, 4:1, Online publication date: 1-May-2015. Corbett D, Nguemeni C and Gomez-Smith M (2014) How Can You Mend a Broken Brain? - Neurorestorative Approaches to Stroke Recovery, Cerebrovascular Diseases, 10.1159/000368887, 38:4, (233-239), . June 2013Vol 44, Issue 6_suppl_1 Advertisement Article InformationMetrics © 2013 American Heart Association, Inc.https://doi.org/10.1161/STROKEAHA.111.000373PMID: 23709697 Manuscript receivedDecember 3, 2012Manuscript acceptedFebruary 28, 2013Originally publishedJune 1, 2013Manuscript revisedFebruary 27, 2013 Keywordsrehabilitationstem cellcompensationimpairmentneural repairregenerationPDF download Advertisement SubjectsAnimal Models of Human DiseaseTreatment
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