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Stroke is the commonest cause of physical disability in the world and yet we are still struggling for consensus on how best to treat stroke survivors in order to maximise recovery after the acute event.
When it comes to treating motor impairment there are two complementary therapeutic approaches to consider. First, physical therapies which are based on massed practice followed by incorporation of improvements into functional tasks through the instruction and knowledge provided by skilled physiotherapists and occupational therapists.1 Second, there are a number of experimental approaches under investigation which aim to increase the effects of training by enhancing the potential for use-dependent plasticity. These ‘primers’ of the motor system might include drugs (eg, fluoxetine2), specific forms of activity (active–passive bilateral arm training,3 aerobic exercise4) and non-invasive brain stimulation (eg, transcranial direct current stimulation, tDCS5 ,6). None of these interventions should be thought of as treatments, but rather as tools for enhancing the effects of conventional practice-based treatment, which in the case of post-stroke motor impairment is currently physical therapy.
It is worth stating at …