Five new avenues for stroke rehabilitation research explored

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Treatments based on behavioral or non-invasive physiological stimulation show greatest potential

Because the concept of permanent neurological injury has given way to recognition of the brain's potential for long-term regeneration and reorganization, rehabilitation strategies are undergoing radical changes. The potential for five new translational interventions was examined in an article published ahead of print by Neurology Clinical Practice.

Medical resources are limited, so it is important to focus on areas of greatest potential, according to Dr. Barrett, and strive for advances that translate to effective treatments in the shortest possible timeframes. An emphasis on experience-dependent learning is advised, as well as biological techniques that induce a permissive state for the development of new, optimal, functional brain activation patterns. "The five treatments we identified are based on behavioral (1, 2, 3), or non-invasive physiological stimulation (4, 5)," said Dr. Barrett. "While these have been explored primarily in stroke rehabilitation, they are potentially applicable to other neurological conditions such as brain injury, spinal cord injury and multiple sclerosis."

1. Constraint-induced movement therapy, and other intensive, experience-dependent learning, may improve rehabilitation outcomes in people with hemiparesis from stroke and other brain disorders.
2. Constraint-induced language therapy, and other methods to stimulate speech and motor output, may improve rehabilitation outcomes in aphasia.
3. Prism adaptation therapy, and therapies using virtual feedback and implicitly integrating 3-D motor and perceptual function, may improve function in spatial neglect.
4. Transcranial magnetic stimulation may induce a permissive brain state therapeutic for depression and promoting better motor and cognitive recovery.
5. Transcranial direct current stimulation might promote better mood, motor and cognitive rehabilitation outcomes, and has an appealing risk/cost profile for feasible future implementation.

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Funding: Supported by Kessler Foundation (AMB, MO-P, PC), the National Institutes of Health (R01NS 055808 and K24HD062647: PI Barrett) and the Department of Education (NIDRR grant H133G120203).
Barrett AM, Oh-Park M, Chen P, Ifejika NL: Five New Things in Neurorehabilitation. doi: 10.1212/01.CPJ.0000437088.98407.fa. Drs. Barrett, Oh-Park and Chen are affiliated with Kessler Foundation. Dr. Ifejika is with the University of Texas Medical School at Houston.
About Stroke Rehabilitation Research at Kessler Foundation: Research studies span all domains of post-stroke cognitive dysfunction, but emphasize hidden disabilities after stroke, including hidden disabilities of functional vision (spatial bias and spatial neglect). Students, resident physicians, and post-doctoral trainees are mentored in translational neuroscience of rehabilitation. Dr. Barrett and her colleagues work closely with the clinical staff at Kessler Institute for Rehabilitation. Among their collaborative efforts are the founding of the Network for Spatial Neglect and development of the Kessler Foundation Neglect Assessment Process (KF-NAPTM). Stroke Research receives funding from the Department of Education/NIDRR; the National Institutes of Health/NICHD/NCMRR; Kessler Foundation; the Healthcare Foundation of New Jersey; and the Wallerstein Foundation for Geriatric Improvement. Scientists have faculty appointments at Rutgers New Jersey Medical School.
About A.M. Barrett, MD: A.M. Barrett, MD, a cognitive neurologist and clinical researcher, is director of Stroke Rehabilitation Research at Kessler Foundation, as well as chief of Neurorehabilitation Program Innovation at Kessler Institute for Rehabilitation. Her focus is brain-behavior relationships from the perspectives of cognitive neurology, cognitive neuroscience, and cognitive neurorehabilitation. Dr. Barrett is an expert in hidden cognitive disabilities after stroke, which contribute to safety problems & rehospitalization, increased caregiver burden, & poor hospital-to-home transition. She is a founder of the Network for Spatial Neglect, which promotes multidisciplinary research for this underdiagnosed hidden disability. Dr. Barrett is also professor of physical medicine & rehabilitation at Rutgers New Jersey Medical School and adjunct professor of neurology at Columbia University School of Medicine. She is a former president of the American Society for Neurorehabilitation. Dr. Barrett is author of the reference article Spatial Neglect on emedicine.com. A recent publication is Barrett AM. Picturing the body in spatial neglect: descending a staircase. Neurology. 2013 Oct 8;81(15):1280-1.
http://www.kesslerfoundation.org/
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Five new avenues for stroke rehabilitation research explored

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