Early intervention neurophysiotherapy can be vital in maximising outcomes for patients after stroke, new research has found.
Following ischaemic stroke, researchers found that the capacity of the human brain to recover and rewire itself peaks after around two weeks.
And it is during those crucial early stages, when the brain has a greater capacity to modify its neural connections and its plasticity is increased, when neurophysiotherapy can deliver optimum impact.
“It is during this early period after stroke that any physiotherapy is going to be most effective because the brain is more responsive to treatment,” says Dr Brenton Hordacre, lead author of a study conducted in London and Australia.
“Earlier experiments with rats showed that within five days of an ischaemic stroke, they were able to repair damaged limbs and neural connections more easily than if therapy was delayed until 30 days post stroke.”
In the new study, published in Neurorehabilitation and Neural Repair, the recovery of 60 stroke patients was charted up to one year after post-stroke. Brain scans were carried out as they recovered during the 12 month period.
The research team report that they found, in the initial days following an ischaemic stroke, the brain has a greater capacity to modify its neural connections and its plasticity is increased.
Dr Hordacre, of the University of Southern Australia in Adelaide, says that the two week peak post-stroke for the brain to recover was demonstrated in their findings.
“Earlier animal studies suggested this was the case, but this is the first time we have conclusively demonstrated this phenomenon exists in humans,” he says.
The researchers used continuous transcranial magnetic stimulation (cTBS) repetitively, to activate different hemispheres of the motor cortex.
According to researchers: “This initiates early stages of synaptic plasticity that temporarily reduces cortical excitability and motor-evoked potential amplitude. Thus, the greater the effect of cTBS on the motor-evoked potential, the greater the inferred level of synaptic plasticity.”
Separate measurements were taken from each cohort. The Adelaide laboratory tested the stroke damaged motor cortex, while the London laboratory tested the non-stroke damaged hemisphere.
Dr Hordacre says: “Our assessments showed that plasticity was strongest around two weeks after stroke in the non-damaged motor cortex. Contrary to what we expected, there was no change in the damaged hemisphere in response to cTBS.
“The next step is to identify techniques which prolong or even re-open a period of increased brain plasticity, so we can maximise recovery.”
