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Brain repair after stroke—a novel neurological model

Nature Reviews Neurology volume 9, pages 698–707 (2013)Cite this article

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Abstract

Following stroke, patients are commonly left with debilitating motor and speech impairments. This article reviews the state of the art in neurological repair for stroke and proposes a new model for the future. We suggest that stroke treatment—from the time of the ictus itself to living with the consequences—must be fundamentally neurological, from limiting the extent of injury at the outset, to repairing the consequent damage. Our model links brain and behaviour by targeting brain circuits, and we illustrate the model though action observation treatment, which aims to enhance brain network connectivity. The model is based on the assumptions that the mechanisms of neural repair inherently involve cellular and circuit plasticity, that brain plasticity is a synaptic phenomenon that is largely stimulus-dependent, and that brain repair required both physical and behavioural interventions that are tailored to reorganize specific brain circuits. We review current approaches to brain repair after stroke and present our new model, and discuss the biological foundations, rationales, and data to support our novel approach to upper-extremity and language rehabilitation. We believe that by enhancing plasticity at the level of brain network interactions, this neurological model for brain repair could ultimately lead to a cure for stroke.

Key Points

  • The ultimate goal of stroke treatment—after the initial insult has been appropriately limited in extent and severity—should be to repair the injured brain to effect a cure

  • Current practice focuses on compensation, which is cheaper and quicker than brain repair and remediation, but involves low outcome expectations

  • Rebuilding brain circuits to recover motor functions and speech depends on endogenous biological factors and exogenous input, as brain plasticity is inherently stimulus-dependent

  • Several stroke treatment programmes based on physiological rationales aimed at repairing brain circuits are currently undergoing testing

  • Action observation treatment for hand motor dysfunction is based on macaque research in action understanding, and has shown some preliminary success for treatment of stroke and other neurological injuries

  • Action observation treatment for speech and language dysfunction seems to affect brain plasticity and have some benefit

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Figure 1: Possible mirror neuron network for syllable observation and imitation.
Figure 2: Visual stimuli for action observation treatment.

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Acknowledgements

This research was supported by the National Institute of Deafness and other Communication Disorders (NIDCD) under grants R01-DC003378 and R01-DC007488 (to S. L. Small), and by the National Institute of Neurological Disorders and Stroke under grant R01-NS054942 (to A. Solodkin). Additional support was provided by the James S. McDonnell Foundation under the Brain Network Recovery Group and Virtual Brain Project grants to the Rotman Research Institute. This support is gratefully acknowledged.

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Authors and Affiliations

  1. Department of Neurology, University of California, Irvine, 200 Manchester Avenue, Suite 206, Orange, 92697, CA, USA

    Steven L. Small

  2. Dipartimento di Scienze Mediche e Chirurgiche, Università Magna Graecia di Catanzaro, Campus Universitario “Salvatore Venuta”, Viale Europa—Localitá Germaneto, Catanzaro, 88100, Italy

    Giovanni Buccino

  3. Department of Neurobiology and Anatomy, University of California, Irvine, Hewitt Hall, Room 1505, Irvine, 92697, CA, USA

    Ana Solodkin

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Small, S., Buccino, G. & Solodkin, A. Brain repair after stroke—a novel neurological model. Nat Rev Neurol 9, 698–707 (2013). https://doi.org/10.1038/nrneurol.2013.222

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