Title : Unlocking neuroplasticity: A comprehensive review of stroke rehabilitation strategies and future direction
Abstract:
Background: Stroke, the second-leading cause of mortality and the third-leading cause of mortality and disability, imposes a substantial financial burden, exceeding $721 billion1. Addressing underlying causes and mitigating stroke-related consequences are crucial aspects of stroke management. Recent studies confirm the effectiveness of stroke rehabilitation in enhancing neuroplasticity post-incident. Neuroplasticity, involving cellular, molecular, and synaptic changes, is boosted by non-invasive brain stimulation, motor rehabilitation, and cognitive rehabilitation3. This literature review explores modalities like motor and cognitive rehabilitation, assessing their successes and failures, and delves into future research directions aimed at improving the quality of life for stroke survivors.
Methods: The assessment of different therapeutic modalities on brain plasticity was thoroughly analyzed in recent studies. A comprehensive search of PubMed databases and the Cochrane Library yielded relevant papers that were published between 2016 to 2023. To conduct the literature review, the search terms included “stroke patients,” “brain plasticity,” and “therapeutic modalities OR rehabilitation.”
Results: This study focused on functional electrical stimulation (FES) to improve gait patterns in stroke patients within 48 subjects. Randomly allocated into a four-channel FES group, a dual-channel FES group, or a placebo group, the four-channel FES group exhibited increased fibers in the region of interest (ROI), with an enlarged diameter in and around lesions. New corticospinal tract (CST) fibers were found progressively closer to the motor cortex5.
A study involving eight patients with chronic lacunar stroke and residual leg paresis enrolled in a 5-week training program focusing on mobility, endurance, and coordination. Results showed increased activations in specific brain areas after training, emphasizing the positive role of physical therapy in altering brain plasticity in stroke patients4.
This study investigated the impact of Motor Imagery-based Brain-Computer Interface (MI-BCI) training with transcranial Direct Current Stimulation (tDCS) or sham-tDCS on brain plasticity in 19 subjects with unilateral subcortical stroke. Post-training, both groups showed improved motor function without significant differences. The tDCS group exhibited increased fractional anisotropy (FA) in diffusion tensor imaging (DTI) compared to the sham group. Cerebral blood flow (CBF) analysis revealed baseline reductions, with varied post-training changes between groups. Positive correlations were found between CBF changes and motor function improvement in both groups. Ipsilesional resting motor threshold decreased after MI-BCI training in the tDCS group, correlating positively with CBF in the ipsilesional primary motor cortex2.
Discussion/Conclusion: In summary, the in-depth literature analysis highlights neuroplasticity's pivotal role in stroke rehabilitation. Various interventions, including FES, targeted training programs, and innovative combinations like MI-BCI with tDCS, offer valuable insights for post-stroke recovery. While proving constructive for motor function and neural plasticity, diverse outcomes underscore the intricate nature of stroke rehabilitation. Individual response heterogeneity emphasizes the need for nuanced, personalized approaches. Future research should focus on understanding determinants like lesion characteristics and patient demographics, shaping more effective, personalized stroke rehabilitation protocols to enhance the overall quality of life for stroke survivors.
