Emerging approaches in rehabilitation after brain injury.

This special issue of NeuroRehabilitation reviews the scientific bases of the emerging strategies for motor retraining associated with brain injury. The issue focuses, in particular, on the cutting edge of basic and multidisciplinary translational research from diverse perspectives including contributions from clinicians, physical and occupational therapists as well as engineers. During the last two decades, we have learned that the brain is able to reorganize more after brain injury than thought possible, property known as neuroplasticity. Now, it is believed that these plastic changes play a crucial role in learning and memory processes as well as recovery of function after brain injury. Substantial literature, on the other hand, supports the view that the ability of the mature brain to reorganize decreases with age. As demonstrated by the greater rate of functional motor recovery in younger adults as compared to the elderly. Therefore, a major goal of the research in rehabilitation after brain injury is to harness the capacity of the brain to reorganize after neurologic damage has occurred and thus ultimately leading to successful restoration of function. Remarkable changes in cortical motor system have been demonstrated during the performance of motor activities, in response to pharmacological agents and peripheral or central nervous stimulation. Modification of synaptic strength, axonal sprouting and changes in synaptic firing occur continuously in the adult nervous system and in response to environmental demands. As a result of these recently emerging evidences, rehabilitation after brain injury is experiencing a dramatic paradigm shift and beginning to replace compensatory approaches by strategies to maximize neuroplastic changes. The contributors of this issue critically review and correlate concepts of basic science with interventions to improve motor function in subjects with brain injury. Blanton, Wilsey and Wolf discuss one of the techniques that have been evaluated in large-scale clinical trials known as constraint-induced movement therapy in stroke. This technique involves restraining the unaffected arm with a mitt combined with massive motor training of the affected side. The study is a cornerstone for the development of evidence-based multicenter trials in neurorehabilitation. McCombe Waller and Whitall, on the other hand, focuses on bimanual arm training after stroke, bringing intriguing arguments in favor of bimanual over unimanual training such as constraint-induced movement therapy. Following the same concept of massive training as described above, how about employing state of art equipments such as robotic system to accomplish appropriate degree of motor training? Krebs and colleagues present data regarding robot-assisted therapy to improve arm function in severe and moderate stroke. Hesse assesses the crucial role of gait trainers such as partial body weight supported treadmill training for restoration of gait after brain injury. These two articles are examples of the fascinating and ever growing symbiosis of clinical knowledge and technology. There is no doubt that extraordinary technological advances will be made during the upcoming millennium and words such as robotic exoskeleton