Challenges and opportunities in stroke recovery

Stroke remains a leading cause of death and disability worldwide. Brain injury affects all structural and functional levels, from cellular and molecular to circuit and network organisation, triggering endogenous defence responses that include neuroprotection (immediate) and neurorecovery (long-term).

At the molecular level, endogenous neuromodulation optimises biological processes to prevent degeneration, while at the network level it supports rebalancing of functional connectivity in resting-state networks. Advances in neurotechnologies, including fMRI, PET, DTI, qEEG, TMS, tDCS, deep brain stimulation, and brain-computer interfaces, have provided valuable insights into brain plasticity and network reorganisation after stroke.

Neurorecovery can be enhanced through pharmacological treatments, physical activity, stimulation techniques, and psychological or environmental support. Among pharmacological agents, multimodal biological molecules (e.g., neurotrophic factors) show the most promise by bridging acute neuroprotection and long-term recovery.

Despite major progress in acute therapies such as thrombolysis and thrombectomy, many patients still experience residual deficits, emphasising the need for integrated, multimodal neurorehabilitation.

Learning objectives
By the end of this lecture, students will be able to:

• Explain the concepts of neuroprotection and neurorecovery after stroke.
• Describe mechanisms of endogenous neuromodulation and neuroplasticity.
• Identify key neurotechnologies used in stroke recovery research.
• Discuss multimodal strategies for neurorehabilitation.