Session Chairs: Julie Bernhardt, Australia and Friedhelm Hummel, Switzerland

Report by Prof. Dr. Zdravka Poljaković, Croatia

Maybe the best way to describe this session in few words would be: challenging topic itself, with excellent presentation of controverse opinions decorated with highly interesting discussion, lot of questions and respectable number of listeners (more than 500).

Brain Repair Is the Right Target to Improve Outcome or Brain Repair Does Not Work, Reorganisation Is Key?

The session started with the lecture of professor Krakauer from The Johns Hopkins University who presented his view of recovery model, based on training-induced recovery without reorganization of cortex. According to this opinion, recovery of function is a result of  recovery of preexisting cortico-subcortical connections. The CON part was presented by  dr Ballester, a post-doctoral researcher from IBEC, Spain, with the main message: „early behaviour training drives the recovery“, explaining also the importance of critical time-window for rehabilitation (which is much more than preassumed 6 months, probably even much more than 1 year).

The More the Better – More Therapy Can Improve Recovery or It’s Just Spontaneous Recovery – Therapy Only Drives Behavioral Compensation?

Further PRO and CON part of the session continued with the lecture of prof Ward from UCL Queen Square, whose  respectable work in the field of brain recovery and rehabilitation is widely recognized for long time. Prof Ward spoke about the importance of precise evaluation of duration of the specific therapy and measurement of recovery. In his lecture he managed to convince the audience that more therapy improves recovery, but only if we really understand the words „more“, the complexity of specific „therapies“ as well as the meaning of „recovery“ considering possibility of participation in certain activities and behavioral repairment (especially if we believe that behavioral repair requires neural repairment). Professor Kwakkel, from Amsterdam University Medical Center, presented on the other hand his opinion about recovery potentials, which is based on the model of spontaneous recovery potentials during time. Using the well known „Time is brain“ model, he explained the importance of time impact in the process of recovery and clinical improvement after stroke in acute, subacute and chronic phase. According to his work, significant changes (improvement) occur in the first weeks after stroke (up to ten weeks), meaning that spontaneous recovery is the clue, and that time changes explain up to 90% of variations in the outcome. Therapy is than not so much interaction and neural repairment but learning of new ways of coping, it is actually a way of compensation of the lost abilities.

Non-Invasive Brain Stimulation Is Getting Close to Clinical Application for Stroke or Non-Invasive Brain Stimulation for Stroke Recovery Has Failed?

Finally, the last two speakers talked about non-invasive brain stimulation in stroke, showing the possibilities of this  therapy, as well as limitations. The first talk from prof Thiel from McGill University in Montreal, a stroke neurologist, concentrated mainly on repetitive transcranial magnetic stimulation (rTMS) and influence of this method to recovery of motor functions and speech disturbances in subacute and chronic phase after stroke. In his talk he presented good results of the method, still with the conclusion that further studies are necessary to prove those results, as well as define the exact time of starting and ending this sort of rehabilitation. The last speaker, dr Branscheit from University Hospital Zurich, presented a critical review of the most important studies in the field of non-invasive brain stimulation in stroke, whose main concerns are apparently small samples, „one-size fits all“ approach and short time of follow-up. In her conclusion slide she emphasized that the rational of the studies should be stated very clearly, that also technical facts must be systematically assessed and that trials must be designed to fit one or two features (and not more) as well as be long-lasting.

After the lectures, the session chairs opened the Q&A session and discussion. As already said, it was a lot to ask, and a lot to discuss. The whole session lasted nearly two hours. And there was more left to say…