The concept of permanent neurological injury is so 20th century.

Instead, there has been gradual recognition of the brain's potential for long-term regeneration and reorganization and so rehabilitations strategies are undergoing radical changes. The potential for five new translational interventions was examined in an recent Neurology Clinical Practice article.

Medical resources are limited, so it is important to focus on areas of greatest potential, according to Dr. A.M. Barrett and co-authors, and strive for advances that translate to effective treatments in the shortest possible timeframes. An emphasis on experience-dependent learning is advised, as well as biological techniques that induce a permissive state for the development of new, optimal, functional brain activation patterns. 

"The five treatments we identified are based on behavioral (1, 2, 3), or non-invasive physiological stimulation (4, 5)," said Barrett. "While these have been explored primarily in stroke rehabilitation, they are potentially applicable to other neurological conditions such as brain injury, spinal cord injury and multiple sclerosis."

Barrett is director of Stroke Rehabilitation Research at Kessler Foundation. Credit: Kessler Foundation

1. Constraint-induced movement therapy, and other intensive, experience-dependent learning, may improve rehabilitation outcomes in people with hemiparesis from stroke and other brain disorders.

2. Constraint-induced language therapy, and other methods to stimulate speech and motor output, may improve rehabilitation outcomes in aphasia.
3. Prism adaptation therapy, and therapies using virtual feedback and implicitly integrating 3-D motor and perceptual function, may improve function in spatial neglect.
4. Transcranial magnetic stimulation may induce a permissive brain state therapeutic for depression and promoting better motor and cognitive recovery.
5. Transcranial direct current stimulation might promote better mood, motor and cognitive rehabilitation outcomes, and has an appealing risk/cost profile for feasible future implementation.