Wow-- so much that can enhance plasticity. When my husband had a stroke in 1997, I found this old Glass and Maddox article on social support: http://www.ncbi.nlm.nih.gov/pubmed/1641684

Very quickly I realized the key was to encourage him to do as much as he could.  Not providing too much social support/ only as needed likely gives stroke survivors the message that you have confidence in their abilities.  See this article by Molloy-- http://www.ncbi.nlm.nih.gov/pubmed/18377149 Confidence to try activities and adapt them as needed is part of being able to do activities despite ongoing impairments. 

Up to 2010,  the research on plasticity/recovery was mainly about  benefits of  enriched environments and intensive rehab in which the stroke survivor is engaged.  

I personally think that Strategy training,  FES, and gaming systems to make it intensive and engaging are useful:

•  Elizabeth Skidmore's strategy training:  Skidmore ER, Swafford M*, Juengst SB*, Rodakowski J*, Terhorst L. Self-awareness and strategy training:influences on recovery after stroke. American Journal of Occupational Therapy. Under Review.
• Dr. Milos Popovic's Myndmove http://news.utoronto.ca/popovic-brings-hope-paralyzed-patients
• Dr. Arthur Prochazka's ReJoyce http://www.rehabtronics.com/frequently-asked-questions/

Recently,  it looks like direct current stimulation and repetitive transcranial magnetic stimulation are powerful tools to (i) modulate cortical excitability, (ii) induce remote changes within the cortical motor system and (iii) thereby improve upper limb motor function after stroke.http://www.ncbi.nlm.nih.gov/pubmed/20714076

 early and intensive rehabilitation could enhance cerebral plasticity after stroke. There are many studies about stroke rehabilitation.

Moreover, some medicine could enhance plasticity as FLUOXETINE. I have not the reference of studies but it's usually used by doctors.

Emilie Leblong, medical doctor of physical and rehabilitation medicine

Emilie is absolutely right. Depression is associated with significantly less recovery. http://www.ebrsr.com/sites/default/files/chapter18_depression_final_16ed.pdf

If you haven't seen it I highly recommend the Evidence Based Review of Stroke Rehabilitation Site http://www.ebrsr.com.  

Now antidepressants are being tried  to enhance recovery in stroke patients who are not depressed. Our centre participates in FOCUS trial

http://www.focustrial.org.uk/default.html

Mohamed Gouda Gouda Soliman -- This research should answer the question of whether it is the depression or the antidepressants that are the active ingredient. Thanks for the link. 

Hello Shakil,

You could enhance plasticity in stroke patient to use differential training 2 times per week and 3 times per week conventional occupational therapy.

Best regards,

Viktorija

There really is a wealth of literature around this. There seems to open a natural plasticity time window following stroke, which may be open from a couple of days after stroke until several weeks. The window can most likely be kept open longer with intensive training according to rehab principles: i.e. many repetitions, at limit of of capacity, task specific. Drugs may support this, like fluoxetine or other SSRIs (see FLAME trial), or dopaminergic agents, such as levodopa.

Neuromodulation such as non-invasive brain stimulation (NIBS) (eg, tDCS and rTMS) and intensive motor rehabilitation (eg, robot-assisted therapy, RT) can be useful approaches to induce neuroplastic change after stroke.  We have published fMRI and DTI study showing brain plastic changes after RT.

Viktorija's answer raises questions about the intensity of rehab as well as rehab content.  Dr. Nick Ward talks about homeopathic amounts of rehab, in other words, not enough to be effective.  https://www.ucl.ac.uk/ion/departments/sobell/Research/NWard Constraint therapy for arm and hand is offered for full days for 2 or 3 weeks, yet often therapy in chronic stroke is 1x a week for less than an hour.  What is the right intensity?

Cheers.

Sharon

 Hello Shakil

My own answer will be from a physical therapist perspective and it is focused on how we can enhance neuroplastic changes (and not how we can enhance the potential for these changes)

I would prefer initially not to suggest interventions as I think it is more appropriately to discuss about the principles under which the interventions should be provided.

I think that it is agreed that the most important principle for enhancing neural plasticity is the continuous practice/repetition and that the exercises should be actively performed by the patients in a functionally meaningful manner (task or goal-oriented)

Mental practice/preparation is also a strategy usually employed for increasing motor skill acquisition

Other parameters such as the type and frequency of feedback is also important by it is influenced by the patient's stage of learning and its individual presentation.

The same happens with other learning parameters such as blocked vs continuous practice, whole vs sectioned practice, structured vs random practice etc

The book by Shumway-Cook ann Woollaccott is an excellent textbook describing in its initial chapters the basics for these principles.

Therefore, interventions that are provided based on these principles (the principles of motor learning) are the interventions which are suggested by me as the most appropriate for enhancing neural plasticity.

Constraint-induced movement therapy, Motor-relearning approach and functional or task-oriented rehabilitation are in general some interventions that are provided according to these principles.

Hope this helps

Zach

Zach, Sarah Tyson's blog has an excellent discussion of  motor-learning. It canb be found here:  https://sarahtphysioblog.wordpress.com/

Sharon

Sharon thanks, i will visit it.

In terms of motor relearning, task specificity and treatment intensity are active ingredients of effective motor rehabilitation after stroke. Object affordances and functional goals of the task selected for repetitive practice will enrich the practice context and enhance practice outcomes. Feedback is important as well.