Department of Neurology, Director, Neurologic Rehabilitation and Research Program, Geffen School of Medicine, University of California Los Angeles, Reed Neurologic Research Center, Los Angeles, California 90095-1769, USA
Address for correspondence: Bruce H. Dobkin, MD, Department of Neurology, Director, Neurologic Rehabilitation and Research Program, Geffen School of Medicine, University of California Los Angeles, Reed Neurologic Research Center, 710 Westwood Plaza Los Angeles, California 90095-1769, USA.Voice: 310-206-6500; fax: 310-794-9486. bdobkin{at}mednet.ucla.edu
Rehabilitation aims to lessen the physical and cognitive impairments
and disabilities of patients with stroke, multiple sclerosis,
spinal cord or brain injury, and other neurologic diseases.
Conventional approaches beyond compensatory adjustments to disability
may be augmented by applying some of the myriad experimental
results about mechanisms of intrinsic biological changes after
injury and the effects of extrinsic manipulations on spared
neuronal assemblies. The organization and inherent adaptability
of the anatomical nodes within distributed pathways of the central
nervous system offer a flexible substrate for treatment strategies
that drive activity-dependent plasticity. Opportunities for
a new generation of approaches are manifested by rodent and
non-human primate studies that reveal morphologic and physiologic
adaptations induced by injury, by learning-associated practice,
by the effects of pharmacologic neuromodulators, by the behavioral
and molecular bases for enhancing activity-dependent synaptic
plasticity, and by cell replacement, gene therapy, and regenerative
biologic strategies. Techniques such as functional magnetic
resonance imaging and transcranial magnetic stimulation will
help determine the most optimal physiologic effects of interventions
in patients as the cortical representations for skilled movements
and cognitive processes are modified by the combination of conventional
and biologic therapies. As clinicians digest the finer details
of the neurobiology of rehabilitation, they will translate laboratory
data into controlled clinical trials. By determining how much
they can influence neural reorganization, clinicians will extend
the opportunities for neurorestoration.
