Top-Down and Bottom-Up Mechanisms of Motor Recovery Poststroke - 19/03/24

Doi : 10.1016/j.pmr.2023.07.006

Preeti Raghavan, MD ^a,^b,^⁎
^a Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287, USA
^b Department of Neurology, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287, USA

^∗Department of Physical Medicine and Rehabilitation and Neurology, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287, USA.Department of Physical Medicine and Rehabilitation and NeurologyJohns Hopkins University School of Medicine600 North Wolfe StreetBaltimoreMD21287USA

Résumé

Stroke remains a leading cause of disability. Motor recovery requires the interaction of top-down and bottom-up mechanisms, which reinforce each other. Injury to the brain initiates a biphasic neuroimmune process, which opens a window for spontaneous recovery during which the brain is particularly sensitive to activity. Physical activity during this sensitive period can lead to rapid recovery by potentiating anti-inflammatory and neuroplastic processes. On the other hand, lack of physical activity can lead to early closure of the sensitive period and downstream changes in muscles, such as sarcopenia, muscle stiffness, and reduced cardiovascular capacity, and blood flow that impede recovery.

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Keywords : Stroke, Rehabilitation, Muscle, Neuroplasticity, Cardiovascular