Article

Despite aggressive conventional therapy, lasting hemiplegia persists in a large
percentage of stroke survivors. The aim of this article is to critically review
the rationale behind targeting multiple sites along the motor learning network by
combining robotic therapy with pharmacotherapy and virtual reality-based reward
learning to alleviate upper extremity impairment in stroke survivors. Methods for
personalizing pharmacologic facilitation to each individual's unique biology are
also reviewed. At the molecular level, treatment with levodopa was shown to
induce long-term potentiation-like and practice-dependent plasticity. Clinically,
trials combining conventional therapy with levodopa in stroke survivors yielded
statistically significant but clinically unconvincing outcomes because of limited
personalization, standardization, and reproducibility. Robotic therapy can induce
neuroplasticity by delivering intensive, reproducible, and functionally
meaningful interventions that are objective enough for the rigors of research.
Robotic therapy also provides an apt platform for virtual reality, which boosts
learning by engaging reward circuits. The future of stroke rehabilitation should
target distinct molecular, synaptic, and cortical sites through personalized
multimodal treatments to maximize motor recovery.

Langue : ANGLAIS