The applicability of motor learning to neurorehabilitation

Rehabilitation is a form of directed training and is therefore predicated on the idea that patients respond to such training by learning. Current concepts in motor learning are reviewed. Recovery is not synonymous with re-learning and that it is important to be specific about what learning mechanism is being targeted by any given therapy. There is a unique milieu of heightened plasticity post-stroke that is responsible for reduction in impairment both through spontaneous biological recovery and increased responsiveness to training. In the chronic phase of stroke, plasticity returns to normal levels and learning for the most part only leads to task-specific compensation. Thus, new forms of intervention may have quite distinct effects depending on whether they are initiated in the sensitive period after stroke or in the chronic phase. It is to be hoped that new pharmacological and non-invasive brain stimulation approaches will allow the post-stroke sensitive period to be augmented, extended, and re-opened.