Neurorehabilitation in stroke

Question 1

what do you need to think of in predicting the outcome

Answer 1

think of cortex and other descending WM pathways

Question 2

what can post-stoke plasticity show in terms of improvement

Answer 2

rapid generalised improvement in impairment and enhanced effect of behavioural training

Question 3

what can DTI measure

Answer 3

large wm tracts but not axonal terminal fields

Question 4

what is the role of GABA and glutamate in plasticity

Answer 4

in the cortex, GABA in inhibitory, glutamate is excitatory.
Reduced activity at GABAergic interneurons allows plasticity in adult brain
Enhanced glutamatergic signalling leads to LTP.
Altering inhibition/excitation can reopen plasticity

Question 5

what does alpha5IA do?

Answer 5

targets alpha5 subunit of extrasynaptic GABA receptor to reverse early post-stroke tonic inhibition

Question 6

what does Fluoxetine do and what were the trials?

Answer 6

Reopens critical period plasticity in adult brain through - reducing GABAergic inhibition
-increased BDNF expression

trials - FLAME/FOCUS

Question 7

summarise plasticity

Answer 7

stroke induces critical period plasticity
window does not shut
structural and functional plasticity play a role
drugs available to manipulate
stratify patients in rehab trial s based on targeting mechanisms

Question 8

what approach is taken to rehab

Answer 8

behaviour
prediction
plasticity