Post-Stroke Exercise and Rehabilitation: Internal and External Drivers of Neuroplasticity

Nearly 800,000 Americans suffer a stroke each year. While stroke mortality rates have been decreasing, the increased survivorship leaves many individuals with permanent disabilities. Chief among them are upper and lower extremity motor impairments. Physical and occupational therapies are typically performed to reduce these impairments. These therapies seek to harness neuroplasticity, which is defined as the nervous system's ability to adapt and/or change behavior in response to learning and experience. The purpose of this symposium is to introduce the concept of neuroplasticity and how exercise and rehabilitation can beneficially affect the neuroplastic environment leading to improved motor function. Motor rehabilitation typically involves the use of repetitive task-based movements. Under such parameters, long-term potentiation (LTP) (i.e., strengthening of neural connections) like mechanisms are thought to enhance the neuroplastic environment. Additionally, aerobic exercise is thought to increase local and peripheral metabolites/neurotrophic factors (e.g., Brain-derived Neurotropic Factor) that increase the effectiveness of LTP-like mechanisms thereby enhancing the neuroplastic environment. However, improvements in laboratory measurements may not always transfer to real-world situations as the transfer may be dependent on the intervention itself, the timing of the intervention, and how (e.g., verbal cues, attentional focus) they are performed. In this symposium, we will discuss the basics of neuroplasticity. We will discuss our recent and ongoing work that utilizes exercise as a priming method to enrich the neuroplastic environment and subsequently enhance the rehabilitation response. We will also discuss how altering exercise and rehabilitation modalities may better retrain stroke survivors to be independently mobile while reducing the risk of secondary stroke. Lastly, we will introduce several external methods/technologies that can assist in creating a more beneficial neuroplastic environment. These adjuvant therapies may help improve motor outcomes post-rehabilitation.