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Title: Combining Dopaminergic Facilitation with Robot-Assisted Upper Limb Therapy in Stroke Survivors: A Focused Review.
Authors: Tran, Duc A
Pajaro-Blazquez, Marta
Daneault, Jean-Francois
Gallegos, Jaime G
Pons, Jose
Fregni, Felipe
Bonato, Paolo
Zafonte, Ross
metadata.dc.subject.mesh: Combined Modality Therapy
Dopamine Agents
Exercise Therapy
Neuronal Plasticity
Stroke Rehabilitation
Upper Extremity
Issue Date: 2016
Abstract: 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.
metadata.dc.identifier.doi: 10.1097/PHM.0000000000000438
Appears in Collections:Producción 2020

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