Strategies for early stroke recovery: what lies ahead?

OPINION STATEMENT: Most patients experience some degree of recovery after a stroke, but the majority of patients still have persistent impairments months later. Most recovery occurs early after a stroke, in the first few weeks to months, corresponding to a period of enhanced neuroplasticity. We are beginning to understand the mechanisms that underlie this recovery process, and how we can take advantage of this plasticity in designing rehabilitative interventions. In this review, we focus on recent behavioral, pharmacological, and brain stimulation strategies that have shown promise in augmenting stroke recovery. Several studies, both in animals and humans, suggest that early initiation and high doses of therapy are crucial for maximizing the benefits of rehabilitation. The investigation of early and intensive therapy in clinical trials has been limited, likely due to the logistical challenges of conducting such studies. Other strategies for promoting recovery seek to modulate neuroplasticity or to enhance the effects of rehabilitation, including the use of pharmacological agents, stem cell therapy and non-invasive brain stimulation. While there has been recent growth in stroke recovery and rehabilitation research, there is still a great need for more basic science and clinical research to further our understanding of the stroke recovery process and develop optimal rehabilitative strategies for promoting stroke recovery.