Stroke is the leading cause of complex adult disability in the world. Recovery from stroke is often incomplete, which leaves many people dependent on others for their care. The improvement of long-term outcomes should, therefore, be a clinical and research priority. Most therapeutic strategies to promote recovery involve behavioural interventions, but currently we do not provide enough of the right behavioural interventions to drive recovery. Clear lesion-induced changes occur in brain structure and function early after stroke, which result in a biological brain environment with unique heightened plasticity that can support restoration of function, termed spontaneous biological recovery. It is clear from preclinical models that the underlying biological brain state occurring during spontaneous biological recovery can enhance the effect of this behavioural training. Understanding how to optimize the post-stroke biological brain environment in order to maximize the effect of behavioural interventions remains in its early stages, but does offer the potential for improved clinical outcomes in human stroke patients.
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