Neural Mechanisms Of Spontaneous Recovery - Stroke Care Management
Published: 14 July 2016
Published: 14 July 2016
Spontaneous recovery post ischaemic stroke refers to mechanisms of neural recovery occurring intrinsically within the brain. The amount of recovery seen in the initial few weeks and months post event is reliant upon several neural mechanisms and processes.
“The first 2 to 3 months after stroke are crucial for spontaneous neuroplasticity, which refers to the natural course of neurophysiological repair and cortical reorganisation.”
An acute ischaemic cerebral event is a dynamic process with damage to brain tissue evolving over a short period of time. Initial insult due to lack of blood flow results in two identifiable areas of damage: core and penumbra. The core is the area of ‘direct hit’ resulting in tissue death and is considered non-salvageable. Surrounding the core is brain tissue (of collateral damage) which is at significant risk of being incorporated into the core of dead tissue. Generally, the larger the core the larger the extent of impairment, disability and a poorer outcome.
Neurological recovery is attributed to resolving oedema, the return of blood circulation to the penumbra, and diaschisis reversal. These local central nervous system (CNS) processes occur early on in neural recovery. Cortical reorganisation occurs later in recovery and is particularly influenced by active rehabilitation therapies and treatment.
“Thrombolysis and clot retrieval are medical interventions aimed at penumbra salvage. Currently only 15% of ischaemic strokes receive thrombolysis due to a therapeutically ‘short window of opportunity’. Clot retrieval in Australia is provided in large tertiary hospital settings with relatively few cases being performed at this point.”
“During an ischaemic stroke, a lack of oxygen and glucose leads to a breakdown of the sodium-calcium pumps on brain cell membranes, which in turn results in a massive buildup of sodium and calcium intracellularly. This causes a rapid uptake of water and subsequent swelling of the cells”
From a purely neurobiological level, this may be thought of as the only true level of recovery in the strictest sense of the word, in that the same brain circuits are facilitating function post injury as they were pre injury.
The National Stroke Foundation (NSF) Stroke Guidelines 2010 provide clinicians with recommendations and evidence to support clinical decision making. Efforts in the first few days and weeks post event is aimed at:
Clinicians working with stroke patients must know and understand the evidence and research behind the clinical guidelines and recommendations for stroke management.
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Annette Horton is a Registered Nurse with over 30 years extensive nursing, rehabilitation and management experience. Since 2004 Annette has held a Nurse Unit Manager position of a regional rehabilitation unit in Queensland. Annette is a member of the Australasian Rehabilitation Nurses Association (ARNA) and has presented several papers at ARNA national conferences. Annette has her own nursing blog entitled Nurseconvo, and more recently has become a contributing writer for Ausmed. Interests include stroke, rehabilitation, continence, leadership and management, coaching and case management.