Combining dopaminergic facilitation with robot-assisted upper limb therapy in stroke survivors

Duc A. Tran*, Marta Pajaro-Blazquez, Jean Francois Daneault, Jaime G. Gallegos, Jose L Pons, Felipe Fregni, Paolo Bonato, Ross Zafonte

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

13 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)459-474
Number of pages16
JournalAmerican Journal of Physical Medicine and Rehabilitation
Volume95
Issue number6
DOIs
StatePublished - Jun 1 2016

Keywords

  • Dopamine
  • Levodopa
  • Neuroplasticity
  • Robot-assisted Therapy
  • Stroke

ASJC Scopus subject areas

  • Physical Therapy, Sports Therapy and Rehabilitation
  • Rehabilitation

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