Functional restoration for the stroke survivor: informing the efforts of engineers.

As bioengineers begin to notice the importance of therapy in the recovery from stroke and other brain injuries, new technologies will be increasingly conceived, adapted, and designed to improve the patient's road to recovery. What is clear from engineering history, however, is that the best engineering efforts are often built on strong scientific foundations. In an effort to inform engineers with the necessary background on cutting edge research in the field of stroke and motor recovery, this article summarizes the views of several experts in the field as a result of a workshop held in 2006 on the topic. Here we elaborate on several areas relevant to this goal, including the pathophysiology of stroke and stroke recovery, the biomechanics, the secondary peripheral changes in muscle and other tissue, and the results of neuroimaging studies. One conclusion is that the current state of knowledge is now ripe for research using machines but that highly sophisticated robotic devices may not yet be needed. Instead, what may be needed is basic evidence that shows a difference in one therapeutic strategy over another.