Experience, cortical remapping, and recovery in brain disease

Recovery of motor function in brain and spinal cord disorders is an area of active research that seeks to maximize improvement after an episode of neuronal death or dysfunction. Recovery likely results from changes in structure and function of undamaged neurons, and this plasticity is a target for rehabilitative strategies. Sensory and motor function are mapped onto brain regions somatotopically, and these maps have been demonstrated to change in response to experience, particularly in development, but also in adults after injury. The map concept, while appealing, is limited, as the fine structure of the motor representation is not well-ordered somatotopically. But after stroke, the spared areas of the main cortical map for movement appear to participate in representing affected body parts, expanding representation in an experience-dependent manner. This occurs in both animal models and human clinical trials, although one must be cautious in comparing the results of invasive electrophysiological techniques with non-invasive ones such as transcranial magnetic stimulation. Developmental brain disorders, such as cerebral palsy, and embryonic abnormalities, such as dysmelia, demonstrate the potential of the human brain to remap the motor system. Future therapies may be able to use that potential to maximize recovery.