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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

Lookup NU author(s): Professor Gary Ford, Professor David Howard, Richard Rothwell

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Abstract

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.


Publication metadata

Author(s): Cheeran B, Cohen L, Dobkin B, Ford G, Greenwood R, Howard D, Husain M, Macleod M, Nudo R, Rothwell J, Rudd A, Teo J, Ward N, Wolf S

Publication type: Article

Publication status: Published

Journal: Neurorehabilitation and Neural Repair

Year: 2009

Volume: 23

Issue: 2

Pages: 97-107

ISSN (print): 1545-9683

ISSN (electronic): 1552-6844

Publisher: Sage Publications, Inc.

URL: http://dx.doi.org/10.1177/1545968308326636

DOI: 10.1177/1545968308326636

Notes: Cumberland Consensus Working Group Cheeran, Binith Cohen, Leonardo Dobkin, Bruce Ford, Gary Greenwood, Richard Howard, David Husain, Masud Macleod, Malcolm Nudo, Randolph Rothwell, John Rudd, Anthony Teo, James Ward, Nicholas Wolf, Steven Wellcome Trust/United Kingdom Research Support, Non-U.S. Gov't United States Neurorehabilitation and neural repair Neurorehabil Neural Repair. 2009 Feb;23(2):97-107.


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