Recovery from stroke: current concepts and future perspectives
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(2020) 2:17
Neurological Research and Practice
REVIEW
Open Access
Recovery from stroke: current concepts and future perspectives Christian Grefkes1,2*
and Gereon R. Fink1,2
Abstract Stroke is a leading cause of acquired, permanent disability worldwide. Although the treatment of acute stroke has been improved considerably, the majority of patients to date are left disabled with a considerable impact on functional independence and quality of life. As the absolute number of stroke survivors is likely to further increase due to the demographic changes in our aging societies, new strategies are needed in order to improve neurorehabilitation. The most critical driver of functional recovery post-stroke is neural reorganization. For developing novel, neurobiologically informed strategies to promote recovery of function, an improved understanding of the mechanisms enabling plasticity and recovery is mandatory. This review provides a comprehensive survey of recent developments in the field of stroke recovery using neuroimaging and non-invasive brain stimulation. We discuss current concepts of how the brain reorganizes its functional architecture to overcome stroke-induced deficits, and also present evidence for maladaptive effects interfering with recovery. We demonstrate that the combination of neuroimaging and neurostimulation techniques allows a better understanding of how brain plasticity can be modulated to promote the reorganization of neural networks. Finally, neurotechnology-based treatment strategies allowing patient-tailored interventions to achieve enhanced treatment responses are discussed. The review also highlights important limitations of current models, and finally closes with possible solutions and future directions. Keywords: Neurorehabilitation, Neuroimaging, Brain stimulation, TMS, Motor
Background Stroke is the most common cause for acute hospitalization in neurology departments in high-income countries [13, 16, 60]. Like for other vascular diseases, stroke prevalence and incidence are strongly age-related. In Europe and the United States of America, the average age of all stroke patients is around 70 to 75 years (US National Center of Health Statistics, UK Stroke Association, German Medical Chamber). About two-thirds of all stroke patients are older than 65 years (e.g., CDC Stroke Statistics, Australian Stroke Foundation). The Global Burden of Disease (GBD) study group recently demonstrated that with higher age, stroke holds a * Correspondence: [email protected] 1 Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, 52425 Jülich, Germany 2 Medical Faculty, University of Cologne & Department of Neurology, University Hospital Cologne, 50924 Cologne, Germany
paramount role concerning life years lost due to mortality or morbidity (disease-adjusted life years, DALY; Fig. 1a) [20]. Both age-standardized mortality and stroke prevalence rates have significantly decreased over the last three decades owing to better prevention of cardiovascular diseas
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