1
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Kerr AL. Contralesional plasticity following constraint-induced movement therapy benefits outcome: contributions of the intact hemisphere to functional recovery. Rev Neurosci 2021; 33:269-283. [PMID: 34761646 DOI: 10.1515/revneuro-2021-0085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 10/15/2021] [Indexed: 11/15/2022]
Abstract
Stroke is a leading cause of death and disability worldwide. A common, chronic deficit after stroke is upper limb impairment, which can be exacerbated by compensatory use of the nonparetic limb. Resulting in learned nonuse of the paretic limb, compensatory reliance on the nonparetic limb can be discouraged with constraint-induced movement therapy (CIMT). CIMT is a rehabilitative strategy that may promote functional recovery of the paretic limb in both acute and chronic stroke patients through intensive practice of the paretic limb combined with binding, or otherwise preventing activation of, the nonparetic limb during daily living exercises. The neural mechanisms that support CIMT have been described in the lesioned hemisphere, but there is a less thorough understanding of the contralesional changes that support improved functional outcome following CIMT. Using both human and non-human animal studies, the current review explores the role of the contralesional hemisphere in functional recovery of stroke as it relates to CIMT. Current findings point to a need for a better understanding of the functional significance of contralesional changes, which may be determined by lesion size, location, and severity as well stroke chronicity.
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Affiliation(s)
- Abigail L Kerr
- Departments of Psychology and Neuroscience, Illinois Wesleyan University, 1312 Park Street, Bloomington, IL 61701, USA
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2
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Hirsch T, Barthel M, Aarts P, Chen YA, Freivogel S, Johnson MJ, Jones TA, Jongsma MLA, Maier M, Punt D, Sterr A, Wolf SL, Heise KF. A First Step Toward the Operationalization of the Learned Non-Use Phenomenon: A Delphi Study. Neurorehabil Neural Repair 2021; 35:383-392. [PMID: 33703971 DOI: 10.1177/1545968321999064] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The negative discrepancy between residual functional capacity and reduced use of the contralesional hand, frequently observed after a brain lesion, has been termed Learned Non-Use (LNU) and is thought to depend on the interaction of neuronal mechanisms during recovery and learning-dependent mechanisms. OBJECTIVE Albeit the LNU phenomenon is generally accepted to exist, currently, no transdisciplinary definition exists. Furthermore, although therapeutic approaches are implemented in clinical practice targeting LNU, no standardized diagnostic routine is described in the available literature. Our objective was to reach consensus regarding a definition as well as synthesize knowledge about the current diagnostic procedures. METHODS We used a structured group communication following the Delphi method among clinical and scientific experts in the field, knowledge from both, the work with patient populations and with animal models. RESULTS Consensus was reached regarding a transdisciplinary definition of the LNU phenomenon. Furthermore, the mode and strategy of the diagnostic process, as well as the sources of information and outcome parameters relevant for the clinical decision making, were described with a wide range showing the current lack of a consistent universal diagnostic approach. CONCLUSIONS The need for the development of a structured diagnostic procedure and its implementation into clinical practice is emphasized. Moreover, it exists a striking gap between the prevailing hypotheses regarding the mechanisms underlying the LNU phenomenon and the actual evidence. Therefore, basic research is needed to bridge between bedside and bench and eventually improve clinical decision making and further development of interventional strategies beyond the field of stroke rehabilitation.
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Affiliation(s)
- Theresa Hirsch
- University of Applied Sciences and Arts Hildesheim/Holzminden/Goettingen, Faculty of Social Work and Health, Hildesheim, Germany
| | - Maria Barthel
- University of Applied Sciences and Arts Hildesheim/Holzminden/Goettingen, Faculty of Social Work and Health, Hildesheim, Germany.,University of Applied Sciences and Arts Hildesheim/Holzminden/Goettingen, Faculty of Engineering and Health, Goettingen, Germany
| | - Pauline Aarts
- Sint Maartenskliniek, Department of Pediatric Rehabilitation, Nijmegen, The Netherlands
| | - Yi-An Chen
- Georgia State University, Department of Occupational Therapy, Atlanta, GA, USA
| | - Susanna Freivogel
- Danube University Krems, Department for Clinical Neurosciences and Preventive Medicine, Krems an der Donau, Austria
| | - Michelle J Johnson
- University of Pennsylvania, Department of Physical Medicine and Rehabilitation, Philadelphia, PA, USA
| | - Theresa A Jones
- University of Texas at Austin, Psychology Department and Neuroscience Institute, Austin, TX, USA
| | | | - Martina Maier
- The Barcelona Institute of Science and Technology, Laboratory of Synthetic, Perceptive, Emotive and Cognitive Systems (SPECS), Institute for Bioengineering of Catalonia (IBEC), Barcelona, Spain
| | - David Punt
- University of Birmingham, School of Sport, Exercise & Rehabilitation Sciences, Birmingham, UK
| | - Annette Sterr
- University of Surrey, School of Psychology, Guildford, UK.,Center for Postacute Neurorehabilitation, Berlin, Germany
| | - Steven L Wolf
- Emory University School of Medicine, Department of Rehabilitation Medicine, Atlanta, GA, USA
| | - Kirstin-Friederike Heise
- KU Leuven, Research Center for Movement Control and Neuroplasticity, Department of Movement Sciences, Leuven, Belgium
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3
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Nemchek V, Haan EM, Mavros R, Macuiba A, Kerr AL. Voluntary exercise ameliorates the good limb training effect in a mouse model of stroke. Exp Brain Res 2021; 239:687-697. [PMID: 33388904 DOI: 10.1007/s00221-020-05994-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 11/19/2020] [Indexed: 12/24/2022]
Abstract
Stroke is the leading cause of long-term disability in the United States, making research on rehabilitation imperative. Stroke rehabilitation typically focuses on recovery of the impaired limb, although this process is tedious. Compensatory use of the intact limb after stroke is more efficient, but it is known to negatively impact the impaired limb. Exercise may help with this problem; research has shown that exercise promotes neuronal growth and prevents cell death. This study used a mouse model to investigate if post-stroke exercise could prevent deterioration of the function of the impaired limb despite compensatory training of the intact limb. Results showed that mice that exercised, in combination with intact limb training, demonstrated improved functional outcome compared to mice that received no training or compensatory limb training only. These findings suggest that exercise can prevent the deterioration of impaired limb functional outcome that is typically seen with intact limb use.
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Affiliation(s)
- Victoria Nemchek
- Neuroscience Program, Illinois Wesleyan University, Bloomington, IL, USA
| | - Emma M Haan
- Department of Psychology, Illinois Wesleyan University, Bloomington, IL, USA
| | - Rachel Mavros
- Department of Psychology, Illinois Wesleyan University, Bloomington, IL, USA
| | - Amanda Macuiba
- Department of Psychology, Illinois Wesleyan University, Bloomington, IL, USA
| | - Abigail L Kerr
- Department of Psychology, Illinois Wesleyan University, Bloomington, IL, USA.
- Neuroscience Program, Illinois Wesleyan University, Bloomington, IL, USA.
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4
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Nemchek V, Haan EM, Kerr AL. Intermittent Skill Training Results in Moderate Improvement in Functional Outcome in a Mouse Model of Ischemic Stroke. Neurorehabil Neural Repair 2020; 35:79-87. [PMID: 33317421 DOI: 10.1177/1545968320975423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Stroke is a leading cause of disability worldwide. Focused training of the impaired limb has been shown to improve its functional outcome in animal models. However, most human stroke survivors exhibit persistent motor deficits, likely due to differences in rehabilitation intensity between experimental (animal) and clinical (human) settings. OBJECTIVE The current study investigated the effect of training intensity on behavioral outcome in a mouse model of stroke. METHODS Mice were trained preoperatively on a skilled reaching task. After training, mice received a unilateral photothrombotic stroke. Postoperatively, animals received either daily rehabilitative training (traditional intensity), intermittent rehabilitative training (every other day), or no rehabilitative training (control). Assessment of the impaired limb occurred after 14 training sessions (14 days for the Traditional group; 28 days for the Intermittent group). RESULTS Assessment of the impaired limb illustrated that traditional, daily training resulted in significantly better performance than no training, while intermittent training offered moderate performance gains. Mice receiving intermittent training performed significantly better than control mice but did not exhibit reaching performance as strong as that of animals trained daily. CONCLUSIONS The intensity of rehabilitation is important for optimal recovery. Although intermediate intensity offers some benefit, it is not intensive enough to mimic the performance gains traditionally observed in animal models. These results suggest that intensive training, which is often unavailable for human stroke survivors, is necessary to achieve an optimal functional outcome. The lower bounds of training intensity for functional benefit still need to be determined.
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Affiliation(s)
| | - Emma M Haan
- Illinois Wesleyan University, Bloomington, IL, USA
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5
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Dutcher AM, Truong KV, Miller DD, Allred RP, Nudi E, Jones TA. Training in a cooperative bimanual skilled reaching task, the popcorn retrieval task, improves unimanual function after motor cortical infarcts in rats. Behav Brain Res 2020; 396:112900. [PMID: 32941880 DOI: 10.1016/j.bbr.2020.112900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/02/2020] [Accepted: 09/03/2020] [Indexed: 10/23/2022]
Abstract
Disuse of the paretic hand after stroke is encouraged by compensatory reliance on the nonparetic hand, to exacerbate impairment and potentially constrain motor rehabilitation efficacy. Rodent stroke model findings support that learning new unimanual skills with the nonparetic forelimb diminishes functional improvements that can be driven by rehabilitative training of the paretic forelimb. The influence of learning new ways of skillfully using the two hands together on paretic side function is much less clear. To begin to explore this, we developed a new cooperative bimanual skilled reaching task for rats, the Popcorn Retrieval Task. After motor cortical infarcts impaired an established unimanual reaching skill in the paretic forelimb, rats underwent a 7 week period of de novo bimanual training (BiT) or no-training control procedures (Cont). Probes of paretic forelimb unimanual performance revealed significant improvements during and after the training period in BiT vs. Cont. We additionally observed a striking change in the bimanual task strategy over training days: a switch from the paretic to the nonparetic forelimb for initiating reach-to-grasp sequences. This motivated another study to test whether rats that established the bimanual skill prior to the infarcts would similarly switch handedness, which they did not, though paretic paw use for manipulative movements diminished. These results indicate that unimanual function of the paretic side can be improved by novel bimanual skill practice, even when it involves compensatory reliance on the nonparetic hand. They further support the suitability of the Popcorn Retrieval Task for studying bimanual skill learning effects in rats.
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Affiliation(s)
| | | | | | | | - Evan Nudi
- Psychology Department, United States
| | - Theresa A Jones
- Institute for Neuroscience, United States; Psychology Department, United States.
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6
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Fragopoulou AF, Qian Y, Heijtz RD, Forssberg H. Can Neonatal Systemic Inflammation and Hypoxia Yield a Cerebral Palsy-Like Phenotype in Periadolescent Mice? Mol Neurobiol 2019; 56:6883-6900. [PMID: 30941732 PMCID: PMC6728419 DOI: 10.1007/s12035-019-1548-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 03/12/2019] [Indexed: 12/16/2022]
Abstract
Cerebral palsy (CP) is one of the most common childhood-onset motor disabilities, attributed to injuries of the immature brain in the foetal or early postnatal period. The underlying mechanisms are poorly understood, rendering prevention and treatment strategies challenging. The aim of the present study was to establish a mouse model of CP for preclinical assessment of new interventions. For this purpose, we explored the impact of a double neonatal insult (i.e. systemic inflammation combined with hypoxia) on behavioural and cellular outcomes relevant to CP during the prepubertal to adolescent period of mice. Pups were subjected to intraperitoneal lipopolysaccharide (LPS) injections from postnatal day (P) 3 to P6 followed by hypoxia at P7. Gene expression analysis at P6 revealed a strong inflammatory response in a brain region-dependent manner. A comprehensive battery of behavioural assessments performed between P24 and P47 showed impaired limb placement and coordination when walking on a horizontal ladder in both males and females. Exposed males also displayed impaired performance on a forelimb skilled reaching task, altered gait pattern and increased exploratory activity. Exposed females showed a reduction in grip strength and traits of anxiety-like behaviour. These behavioural alterations were not associated with gross morphological changes, white matter lesions or chronic inflammation in the brain. Our results indicate that the neonatal double-hit with LPS and hypoxia can induce subtle long-lasting deficits in motor learning and fine motor skills, which partly reflect the symptoms of children with CP who have mild gross and fine motor impairments.
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Affiliation(s)
- Adamantia F Fragopoulou
- Department of Neuroscience, Biomedicum, Karolinska Institutet, 171 77, Stockholm, Sweden. .,Department of Women's and Children's Health, Karolinska Institutet, 171 76, Stockholm, Sweden.
| | - Yu Qian
- Department of Neuroscience, Biomedicum, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Rochellys Diaz Heijtz
- Department of Neuroscience, Biomedicum, Karolinska Institutet, 171 77, Stockholm, Sweden.,INSERM U1239, University of Rouen Normandy, 76130, Mont-Saint-Aignan, France
| | - Hans Forssberg
- Department of Women's and Children's Health, Karolinska Institutet, 171 76, Stockholm, Sweden.
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7
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Ji M, Li S, Dong Q, Hu W. Impact of Early High-protein Diet on Neurofunctional Recovery in Rats with Ischemic Stroke. Med Sci Monit 2018; 24:2235-2243. [PMID: 29654641 PMCID: PMC5912094 DOI: 10.12659/msm.906533] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Ischemic stroke, featuring high incidence, morbidity, and mortality, is one of the three major diseases troubling human beings. The purpose of the study was to examine the impact of early high-protein diet on neurofunctional recovery in rats with ischemic stroke as well as their cerebral infarct areas and molecular expressions of oxidative stress. MATERIAL AND METHODS The middle cerebral artery occlusion model (MCAO) was established, and 48 adult, male Sprague Dawley (SD) rats of clean grade aged seven to eight months (250-280 g body weight) were randomized into four groups: the MCAO group with high-protein diet (MH), the MCAO group with standard-protein diet (MS), the sham group with high-protein diet (SH), and the sham group with standard-protein diet (SS). High-protein diet intervention started on the first day of the surgery, and the rats' body weights and their neurological deficit scores were measured on each postoperative day while the scores of motors coordination and balance ability were recorded every other day. In addition, their cerebral infant areas and the molecular expressions of oxidative stress injuries were detected as well. RESULTS Compared to the MS group, the rats in the MH group gained faster weight growth (p<0.05), presented significantly lower neurological impairment scores (p<0.05), remarkably improved motor coordination and balance ability (p<0.05) as well as showed smaller cerebral infarct areas (p<0.05), increased expression of SOD (superoxide dismutase), and reduced expressions of MDA (malondialdehyde) and iNOS (inducible nitric oxide synthase). However, there was no significant difference between the SS group and the SH group (p>0.05). CONCLUSIONS Early high-protein diet facilitates the recovery of body weights and neurological functions as well the reduction of the cerebral infarct areas of rats, thus alleviating ischemic stroke-caused oxidative stress injuries.
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Affiliation(s)
- Meng Ji
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China (mainland)
| | - Shujuan Li
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China (mainland)
| | - Qian Dong
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China (mainland)
| | - Wenli Hu
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China (mainland)
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8
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Corbett D, Carmichael ST, Murphy TH, Jones TA, Schwab ME, Jolkkonen J, Clarkson AN, Dancause N, Weiloch T, Johansen-Berg H, Nilsson M, McCullough LD, Joy MT. Enhancing the Alignment of the Preclinical and Clinical Stroke Recovery Research Pipeline: Consensus-Based Core Recommendations From the Stroke Recovery and Rehabilitation Roundtable Translational Working Group. Neurorehabil Neural Repair 2017; 31:699-707. [DOI: 10.1177/1545968317724285] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Stroke recovery research involves distinct biological and clinical targets compared to the study of acute stroke. Guidelines are proposed for the pre-clinical modeling of stroke recovery and for the alignment of pre-clinical studies to clinical trials in stroke recovery.
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Affiliation(s)
- Dale Corbett
- Department of Cellular and Molecular Medicine, University of Ottawa, Canadian Partnership for Stroke Recovery, Ottawa, Canada
| | - S. Thomas Carmichael
- Department of Neurology, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA
| | - Timothy H. Murphy
- Department of Psychiatry, Kinsmen Laboratory of Neurological Research, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada
| | - Theresa A. Jones
- Department of Psychology and Neuroscience Institute, University of Texas at Austin, Austin, TX, USA
| | - Martin E. Schwab
- Institute for Brain Research, University of Zurich, Zurich, Switzerland
- Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Jukka Jolkkonen
- Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland and Neurocenter, Neurology, University Hospital of Kuopio, Kuopio, Finland
| | - Andrew N. Clarkson
- Department of Anatomy, Brain Health Research Center, and Brain Research New Zealand, University of Otago, Dunedin, New Zealand
- Faculty of Pharmacy, The University of Sydney, Sydney, Australia
| | - Numa Dancause
- Groupe de Recherche sur le Système Nerveux Central (GRSNC), Département de Neurosciences, Université de Montréal, Montréal, Canada
| | - Tadeusz Weiloch
- Department of Clinical Sciences, Laboratory for Experimental Brain Research, Lund, Sweden
| | - Heidi Johansen-Berg
- Oxford Centre for Functional MRI of the Brain, John Radcliffe Hospital, Headington, Oxford, UK
| | - Michael Nilsson
- Hunter Medical Research Institute, University of Newcastle, New Lambton, Australia
| | - Louise D. McCullough
- Department of Neurology, University of Texas Health Sciences Center at Houston, Houston, TX, USA
| | - Mary T. Joy
- Department of Neurology, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA
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9
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Corbett D, Carmichael ST, Murphy TH, Jones TA, Schwab ME, Jolkkonen J, Clarkson AN, Dancause N, Weiloch T, Johansen-Berg H, Nilsson M, McCullough LD, Joy MT. Enhancing the alignment of the preclinical and clinical stroke recovery research pipeline: Consensus-based core recommendations from the Stroke Recovery and Rehabilitation Roundtable translational working group. Int J Stroke 2017; 12:462-471. [DOI: 10.1177/1747493017711814] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Stroke recovery research involves distinct biological and clinical targets compared to the study of acute stroke. Guidelines are proposed for the pre-clinical modeling of stroke recovery and for the alignment of pre-clinical studies to clinical trials in stroke recovery.
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Affiliation(s)
- Dale Corbett
- Department of Cellular and Molecular Medicine, University of Ottawa, Canadian Partnership for Stroke Recovery, Ottawa, Canada
| | - S Thomas Carmichael
- Department of Neurology, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA
| | - Timothy H Murphy
- Department of Psychiatry, Kinsmen Laboratory of Neurological Research, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada
| | - Theresa A Jones
- Department of Psychology and Neuroscience Institute, University of Texas at Austin, Austin, TX, USA
| | - Martin E Schwab
- Institute for Brain Research, University of Zurich
- Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Jukka Jolkkonen
- Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland and Neurocenter, Neurology, University Hospital of Kuopio, Kuopio, Finland
| | - Andrew N Clarkson
- Department of Anatomy, Brain Health Research Center, and Brain Research New Zealand, University of Otago, Dunedin, New Zealand
- Faculty of Pharmacy, The University of Sydney, Sydney, Australia
| | - Numa Dancause
- Groupe de Recherche sur le Système Nerveux central (GRSNC), Département de Neurosciences, Université de Montréal, Montréal, Canada
| | - Tadeusz Weiloch
- Department of Clinical Sciences, Laboratory for Experimental Brain Research, Lund, Sweden
| | - Heidi Johansen-Berg
- Oxford Centre for Functional MRI of the Brain, John Radcliffe Hospital, Headington, Oxford, UK
| | - Michael Nilsson
- Hunter Medical Research Institute, University of Newcastle, New Lambton, Australia
| | - Louise D McCullough
- Department of Neurology, University of Texas Health Sciences Center at Houston, Houston, TX, USA
| | - Mary T Joy
- Department of Neurology, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA
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10
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Abstract
Stroke instigates a dynamic process of repair and remodelling of remaining neural circuits, and this process is shaped by behavioural experiences. The onset of motor disability simultaneously creates a powerful incentive to develop new, compensatory ways of performing daily activities. Compensatory movement strategies that are developed in response to motor impairments can be a dominant force in shaping post-stroke neural remodelling responses and can have mixed effects on functional outcome. The possibility of selectively harnessing the effects of compensatory behaviour on neural reorganization is still an insufficiently explored route for optimizing functional outcome after stroke.
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Affiliation(s)
- Theresa A Jones
- Department of Psychology and Institute for Neuroscience, University of Texas at Austin, Texas 78712, USA
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11
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Hylin MJ, Kerr AL, Holden R. Understanding the Mechanisms of Recovery and/or Compensation following Injury. Neural Plast 2017; 2017:7125057. [PMID: 28512585 PMCID: PMC5415868 DOI: 10.1155/2017/7125057] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 02/24/2017] [Accepted: 03/26/2017] [Indexed: 11/30/2022] Open
Abstract
Injury due to stroke and traumatic brain injury result in significant long-term effects upon behavioral functioning. One central question to rehabilitation research is whether the nature of behavioral improvement observed is due to recovery or the development of compensatory mechanisms. The nature of functional improvement can be viewed from the perspective of behavioral changes or changes in neuroanatomical plasticity that follows. Research suggests that these changes correspond to each other in a bidirectional manner. Mechanisms surrounding phenomena like neural plasticity may offer an opportunity to explain how variables such as experience can impact improvement and influence the definition of recovery. What is more, the intensity of the rehabilitative experiences may influence the ability to recover function and support functional improvement of behavior. All of this impacts how researchers, clinicians, and medical professionals utilize rehabilitation.
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Affiliation(s)
- Michael J. Hylin
- Neurotrauma and Rehabilitation Laboratory, Department of Psychology, Southern Illinois University, Carbondale, IL, USA
| | - Abigail L. Kerr
- Department of Psychology, Illinois Wesleyan University, Bloomington, IL, USA
| | - Ryan Holden
- Neurotrauma and Rehabilitation Laboratory, Department of Psychology, Southern Illinois University, Carbondale, IL, USA
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