Abstract
Over the past 8 years that I have served as the editor of Neurorehabilitation and Neural Repair, many well-designed, conceptually driven, randomized clinical trials have been published in this journal, as well as in others. This positive turn reveals a growing interest in the scientific bases of neurorehabilitation that was barely apparent as recently as 15 years ago.
Consider this. In 1999, Gert Kwakkel and colleagues published a randomized clinical trial in the New England Journal of Medicine, a journal not prone to publishing rehab studies at the time. They reported that therapy focused on the upper extremity improved dexterity but not walking and that therapy focused on the leg improved walking outcomes, but not arm functioning; both strategies were better than no therapy in patients who started treatment within 14 days of stroke. That focused, intensive enough therapy can improve outcomes at almost any time after stroke has been shown many times since then. Indeed, it is now unlikely that an experimental intervention would be tested against a control group that did not receive an equally intensive training paradigm.
Energy abounds around the world in neurologic rehabilitation, evidenced by a citation factor of 4.8 for Neuro-rehabilitation and Neural Repair over the past 5 years. What has changed since 1999?? It is the rising tide of scientific insights and promising strategies. Treatments being tested include action-observation and imagery, virtual reality applications, transcranial magnetic stimulation and direct current neurostimulation to modulate learning, electromechanical assists for arm and leg practice, brain-computer interfaces to control the environment, and exoskeletons to assist movement. Mobile health and tele-rehabilitation strategies to monitor practice, give feedback, and for more clinically meaningful outcome measurements may compliment these. A new era of pharmacologic interventions to enhance learning, neural repair by cellular and axon/dendrite growth promoters and neuromodulators, genetic insights, imbedded electrodes to activate brain or spinal networks, and adaptive robotic training are among those that will come into testing over the next 5 to 10 years.
It is my pleasure to congratulate Randolf Nudo, PhD, Professor of Molecular and Integrative Physiology at the University of Kansas, as the new editor of Neurorehabiliation and Neural Repair. He has been a major contributor to modeling physiologic and structural neural adaptations in relation to rehabilitation interventions. He and his editorial staff will have the opportunity to influence the clinical and basic science innovations, through their interaction with researchers, that will make the next 10 years exciting for clinicians and hopeful for our patients.
Left to right: Gert Kwakkel, Tom Carmichael, Mickey Selzer (editor, 2000-2005), Bruce Dobkin (editor, 2006-13), Randy Nudo (incoming editor).
Thanks to Gert Kwakkel, my European managing editor, Tom Carmichael, my managing editor for the neurobiology of repair, the associate editors and editorial board, the indefatigable authors and peer reviewers, the American Society of NeuroRehabiliation, the World Federation of NeuroRehabilitation, and the staff at SAGE Publications for all their help. All of us will be there to help Randy Nudo nurture the journal into the future of neurologic rehabilitation.