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Semin Neurol 2021; 41(02): 167-176
DOI: 10.1055/s-0041-1725138
Review Article

Motor Recovery: How Rehabilitation Techniques and Technologies Can Enhance Recovery and Neuroplasticity

Robynne G. Braun 
1   Department of Neurology, University of Maryland School of Medicine, University of Maryland Rehabilitation & Orthopaedic Institute, Baltimore, Maryland
,
George F. Wittenberg 
2   Department of Neurology, Rehab Neural Engineering Labs, Center for the Neural Basis of Cognition, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
3   Human Engineering Research Laboratory, Geriatrics Research Education and Clinical Center, VA Pittsburgh HealthCare System, Pittsburgh, Pennsylvania
› Author Affiliations
Funding This study was supported by U.S. Department of Health and Human Services, National Institutes of Health, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Center for Medical Rehabilitation Research (HD086844 and HD092481) and Office of Research and Development, Rehabilitation Research and Development Service.
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Abstract

There are now a large number of technological and methodological approaches to the rehabilitation of motor function after stroke. It is important to employ these approaches in a manner that is tailored to specific patient impairments and desired functional outcomes, while avoiding the hype of overly broad or unsubstantiated claims for efficacy. Here we review the evidence for poststroke plasticity, including therapy-related plasticity and functional imaging data. Early demonstrations of remapping in somatomotor and somatosensory representations have been succeeded by findings of white matter plasticity and a focus on activity-dependent changes in neuronal properties and connections. The methods employed in neurorehabilitation have their roots in early understanding of neuronal circuitry and plasticity, and therapies involving large numbers of repetitions, such as robotic therapy and constraint-induced movement therapy (CIMT), change measurable nervous systems properties. Other methods that involve stimulation of brain and peripheral excitable structures have the potential to harness neuroplastic mechanisms, but remain experimental. Gaps in our understanding of the neural substrates targeted by neurorehabilitation technology and techniques remain, preventing their prescriptive application in individual patients as well as their general refinement. However, with ongoing research—facilitated in part by technologies that can capture quantitative information about motor performance—this gap is narrowing. These research approaches can improve efforts to attain the shared goal of better functional recovery after stroke.

Keywords

neuroplasticity - stimulation - motor - stroke - outcomes


Publication History

Article published online:
04 March 2021

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