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AbstractManipulating neural plasticity to enhance functional recovery after damage to the motor systemJohn Rothwell, University College London, UKA large number of brain imaging studies have shown that the pattern of activity associated with a given movement may change after partial damage to the motor system (e.g. after stroke). It is thought that there are changes in the pattern of connectivity between motor areas as the system attempts to make optimal use of remaining anatomical pathways. However, there is also evidence that even in the chronic stage of recovery, optimality has not been achieved: for example, constraint induced movement therapy can improve movement in patients in chronic stroke and this is accompanied by further changes in connectivity in a system that must clearly have been suboptimal prior to therapy. The challenge of therapy is to achieve as near an optimal use of a damaged system as possible. It is also the therapist’s task to define optimality in the context of each individual patient’s needs and aspirations. However, I will argue that even if these objectives are achieved, the best they amount to is letting the brain repair itself. New lines of research using brain stimulation, pharmacological interventions, and even stem cell implants seek to increase the ability of the brain to reorganise, by influencing processes involved in synaptic plasticity and learning. To be maximally effective, these new methods need to operate in conjunction with targeted therapy to avoid maladaptive changes and improve recovery.” |
