Plasticity and motor recovery after stroke: Implications for physiotherapy

Abstract

Despite advances in prevention and acute management of stroke and a proliferation of motor rehabilitation trials over the last decade, disability rates after stroke remain high. This commentary considers recent evidence, which suggests that it is time to extend our thinking beyond the model of cortical use-dependent plasticity that has underpinned much of physiotherapy stroke rehabilitation for the last 20 years. The discovery of a fixed, proportional recovery of impairment has led to a renewed focus on how rehabilitation may interact with spontaneous biological recovery. There is also increasing interest in use-dependent plasticity in the white matter as a possible mechanism for improving motor recovery after stroke. These emerging areas in stroke rehabilitation research have yet to be fully investigated, but provide some promise for future trials. In the interim, becoming familiar with all aspects of neural plasticity after stroke may help to equip physiotherapists with greater understanding of the mechanisms of stroke recovery and enable critical decision-making around the selection and timing of interventions after stroke.