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      Exploring the transformative influence of neuroplasticity on stroke rehabilitation: a narrative review of current evidence

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          Abstract

          This review aims to assess the role of neuroplasticity in facilitating stroke recovery and identify the challenges and limitations associated with its implementation. A comprehensive literature search was conducted to identify relevant studies, which were meticulously evaluated to determine the potential solutions for effectively harnessing neuroplasticity. The results indicate that neuroplasticity holds significant promise in stroke rehabilitation; however, individual variability in response to interventions, timing and duration of interventions and sociocultural and clinical factors pose challenges. Tailoring interventions to individual patient characteristics is crucial for optimising the impact of neuroplasticity. Despite challenges and limitations, the transformative potential of neuroplasticity in stroke rehabilitation is undeniable. The abstract concludes by emphasising the importance of a comprehensive understanding of individual variability, optimising intervention timing and duration and considering sociocultural and clinical factors. Future research and clinical practice should prioritise personalised interventions and interdisciplinary collaborations to fully exploit the vast potential of neuroplasticity in stroke recovery.

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          World Stroke Organization (WSO): Global Stroke Fact Sheet 2022

          Valery L. Feigin, Michael Brainin, Bo Norrving … (2022)
          Stroke remains the second-leading cause of death and the third-leading cause of death and disability combined (as expressed by disability-adjusted life-years lost – DALYs) in the world. The estimated global cost of stroke is over US$721 billion (0.66% of the global GDP). From 1990 to 2019, the burden (in terms of the absolute number of cases) increased substantially (70.0% increase in incident strokes, 43.0% deaths from stroke, 102.0% prevalent strokes, and 143.0% DALYs), with the bulk of the global stroke burden (86.0% of deaths and 89.0% of DALYs) residing in lower-income and lower-middle-income countries (LMIC). This World Stroke Organisation (WSO) Global Stroke Fact Sheet 2022 provides the most updated information that can be used to inform communication with all internal and external stakeholders; all statistics have been reviewed and approved for use by the WSO Executive Committee as well as leaders from the Global Burden of Disease research group.
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            Resting interhemispheric functional magnetic resonance imaging connectivity predicts performance after stroke.

            Alex Carter, Serguei Astafiev, Catherine E. Lang … (2010)
            Focal brain lesions can have important remote effects on the function of distant brain regions. The resulting network dysfunction may contribute significantly to behavioral deficits observed after stroke. This study investigates the behavioral significance of changes in the coherence of spontaneous activity in distributed networks after stroke by measuring resting state functional connectivity (FC) using functional magnetic resonance imaging. In acute stroke patients, we measured FC in a dorsal attention network and an arm somatomotor network, and determined the correlation of FC with performance obtained in a separate session on tests of attention and motor function. In particular, we compared the behavioral correlation with intrahemispheric FC to the behavioral correlation with interhemispheric FC. In the attention network, disruption of interhemispheric FC was significantly correlated with abnormal detection of visual stimuli (Pearson r with field effect = -0.624, p = 0.002). In the somatomotor network, disruption of interhemispheric FC was significantly correlated with upper extremity impairment (Pearson r with contralesional Action Research Arm Test = 0.527, p = 0.036). In contrast, intrahemispheric FC within the normal or damaged hemispheres was not correlated with performance in either network. Quantitative lesion analysis demonstrated that our results could not be explained by structural damage alone. These results suggest that lesions cause state changes in the spontaneous functional architecture of the brain, and constrain behavioral output. Clinically, these results validate using FC for assessing the health of brain networks, with implications for prognosis and recovery from stroke, and underscore the importance of interhemispheric interactions.
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              Constraint-induced movement therapy after stroke.

              Gert Kwakkel, Janne Veerbeek, Erwin van Wegen … (2015)
              Constraint-induced movement therapy (CIMT) was developed to overcome upper limb impairments after stroke and is the most investigated intervention for the rehabilitation of patients. Original CIMT includes constraining of the non-paretic arm and task-oriented training. Modified versions also apply constraining of the non-paretic arm, but not as intensive as original CIMT. Behavioural strategies are mostly absent for both modified and original CIMT. With forced use therapy, only constraining of the non-paretic arm is applied. The original and modified types of CIMT have beneficial effects on motor function, arm-hand activities, and self-reported arm-hand functioning in daily life, immediately after treatment and at long-term follow-up, whereas there is no evidence for the efficacy of constraint alone (as used in forced use therapy). The type of CIMT, timing, or intensity of practice do not seem to affect patient outcomes. Although the underlying mechanisms that drive modified and original CIMT are still poorly understood, findings from kinematic studies suggest that improvements are mainly based on adaptations through learning to optimise the use of intact end-effectors in patients with some voluntary motor control of wrist and finger extensors after stroke.
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                Author and article information

                Contributors
                Nicholas Aderinto
                Muili O. AbdulBasit
                Gbolahan Olatunji
                Temilade Adejumo
                Journal
                Journal ID (nlm-ta): Ann Med Surg (Lond)
                Journal ID (iso-abbrev): Ann Med Surg (Lond)
                Journal ID (publisher-id): MS9
                Title: Annals of Medicine and Surgery
                Publisher: Lippincott Williams & Wilkins (Hagerstown, MD )
                ISSN (Electronic): 2049-0801
                Publication date Collection: September 2023
                Publication date (Electronic): 7 August 2023
                Volume: 85
                Issue: 9
                Pages: 4425-4432
                Affiliations
                [a ]Department of Medicine and Surgery, Ladoke Akintola University of Technology, Ogbomoso
                [b ]Department of Medicine and Surgery, University of Ilorin, Ilorin, Nigeria
                Author notes
                [* ]Corresponding author. Address: Ladoke Akintola University of Technology, Ogbomoso 210252, Nigeria.Tel.: +816 772 4987 E-mail: Nicholasoluwaseyi6@ 123456gmail.com (N. Aderinto).
                Article
                Publisher ID: AMSU-D-23-01256 Accession ID: 00038
                DOI: 10.1097/MS9.0000000000001137
                PMC ID: 10473303
                PubMed ID: 37663728
                SO-VID: 1d6aa246-1dda-4149-b74e-cc32df4e77e8
                Copyright © Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.
                License:

                This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0/

                History
                Date received : 10 June 2023
                Date accepted : 28 July 2023
                Categories
                Subject: Review Articles
                Custom metadata
                OPEN-ACCESS TRUE

                Keywords: neuroplasticity,rehabilitation,stroke,transformation
                Data availability:
                Keywords: neuroplasticity, rehabilitation, stroke, transformation

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