Translating the science into practice: shaping rehabilitation practice to enhance recovery after brain damage

The revolution in neuroscience provided strong evidence for learning-dependent neuroplasticity and presaged the role of motor learning as essential for restorative therapies after stroke and other disabling neurological conditions. The scientific basis of motor learning has continued to evolve from a dominance of cognitive or information processing perspectives to a blend with neural science and contemporary social-cognitive-psychological science, which includes the neural and psychological underpinnings of motivation. This transformation and integration across traditionally separate domains is timely now that clinician scientists are developing novel, evidence-based therapies to maximize motor recovery in the place of suboptimal solutions. We will review recent evidence pertaining to therapeutic approaches that spring from an integrated framework of learning-dependent neuroplasticity along with the growing awareness of protocols that directly address the patient's fundamental psychological needs. Of importance, there is mounting evidence that when the individual's needs are considered in the context of instructions or expectations, the learning/rehabilitation process is accelerated.