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The Future of Restorative Neurosciences in Stroke: Driving the Translational Research Pipeline From Basic Science to Rehabilitation of People After Stroke

Binith Cheeran

Sobell Department of Motor Neuroscience, Institute of Neurology, London, United Kingdom

Leonardo Cohen, PhD

National Institute of Neurological Disorders & Stroke, National Institutes of Health Bethesda, Maryland

Bruce Dobkin, MD

University of California at Los Angeles

Gary Ford

University of Newcastle

Richard Greenwood, MD

National Hospital for Neurology & Neurosurgery, Institute of Neurology, London, United Kingdom, Sobell Department of Motor Neuroscience, Institute of Neurology, London, United Kingdom, richard.greenwood{at}uclh.nhs.uk

David Howard, PhD

University of Newcastle

Masud Husain, MD

National Hospital for Neurology & Neurosurgery, Institute of Neurology, London, United Kingdom, Institute of Cognitive Neuroscience, University College London United Kingdom

Malcolm Macleod, PhD

University of Edinburgh

Randolph Nudo, PhD

Kansas University Medical Center Kansas City

John Rothwell, PhD

Sobell Department of Motor Neuroscience, Institute of Neurology, London, United Kingdom

Anthony Rudd

Kings College London

James Teo

Sobell Department of Motor Neuroscience, Institute of Neurology, London, United Kingdom

Nicholas Ward, MD

Sobell Department of Motor Neuroscience, Institute of Neurology, London, United Kingdom, Wellcome Trust Centre for Neuroimaging, Institute of Neurology, London, United Kingdom

Steven Wolf, PhD

Emory University Atlanta, Georgia

Background. Major advances during the past 50 years highlight the immense potential for restoration of function after neural injury, even in the damaged adult human brain. Yet, the translation of these advances into clinically useful treatments is painstakingly slow. Objective. Here, we consider why the traditional model of a "translational research pipeline" that transforms basic science into novel clinical practice has failed to improve rehabilitation practice for people after stroke. Results. We find that (1) most treatments trialed in vitro and in animal models have not yet resulted in obviously useful functional gains in patients; (2) most clinical trials of restorative treatments after stroke have been limited to small-scale studies; (3) patient recruitment for larger clinical trials is difficult; (4) the determinants of patient outcomes and what patients want remain complex and ill-defined, so that basic scientists have no clear view of the clinical importance of the problems that they are addressing; (5) research in academic neuroscience centers is poorly integrated with practice in front-line hospitals and the community, where the majority of patients are treated; and (6) partnership with both industry stakeholders and patient pressure groups is poorly developed, at least in the United Kingdom where research in the translational restorative neurosciences in stroke depends on public sector research funds and private charities. Conclusions. We argue that interaction between patients, front-line clinicians, and clinical and basic scientists is essential so that they can explore their different priorities, skills, and concerns. These interactions can be facilitated by funding research consortia that include basic and clinical scientists, clinicians and patient/carer representatives with funds targeted at those impairments that are major determinants of patient and carer outcomes. Consortia would be instrumental in developing a lexicon of common methods, standardized outcome measures, data sharing and long-term goals. Interactions of this sort would create a research-friendly, rather than only target-led, culture in front-line stroke rehabilitation services.

Key Words: Rehabilitation • Research pipeline • Translation

Neurorehabilitation and Neural Repair, Vol. 23, No. 2, 97-107 (2009)
DOI: 10.1177/1545968308326636


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