title: The future of restorative neurosciences in stroke: driving the translational research pipeline from basic science to rehabilitation of people after stroke.
abstract: BACKGROUND
  Major advances during the past 50 years highlight the immense potential for restoration of function after neural injury, even in the damaged adult human brain. Yet, the translation of these advances into clinically useful treatments is painstakingly slow.
  
  
  OBJECTIVE
  Here, we consider why the traditional model of a "translational research pipeline" that transforms basic science into novel clinical practice has failed to improve rehabilitation practice for people after stroke.
  
  
  RESULTS
  We find that (1) most treatments trialed in vitro and in animal models have not yet resulted in obviously useful functional gains in patients; (2) most clinical trials of restorative treatments after stroke have been limited to small-scale studies; (3) patient recruitment for larger clinical trials is difficult; (4) the determinants of patient outcomes and what patients want remain complex and ill-defined, so that basic scientists have no clear view of the clinical importance of the problems that they are addressing; (5) research in academic neuroscience centers is poorly integrated with practice in front-line hospitals and the community, where the majority of patients are treated; and (6) partnership with both industry stakeholders and patient pressure groups is poorly developed, at least in the United Kingdom where research in the translational restorative neurosciences in stroke depends on public sector research funds and private charities.
  
  
  CONCLUSIONS
  We argue that interaction between patients, front-line clinicians, and clinical and basic scientists is essential so that they can explore their different priorities, skills, and concerns. These interactions can be facilitated by funding research consortia that include basic and clinical scientists, clinicians and patient/carer representatives with funds targeted at those impairments that are major determinants of patient and carer outcomes. Consortia would be instrumental in developing a lexicon of common methods, standardized outcome measures, data sharing and long-term goals. Interactions of this sort would create a research-friendly, rather than only target-led, culture in front-line stroke rehabilitation services.
authors.affiliation: Sobell Department of Motor Neuroscience, Institute of Neurology, London, United Kingdom.
authors.forename: Binith
authors.initials: B
authors.lastname: Cheeran
authors.forename: Leonardo
authors.initials: L
authors.lastname: Cohen
authors.forename: Bruce
authors.initials: B
authors.lastname: Dobkin
authors.forename: Gary
authors.initials: G
authors.lastname: Ford
authors.forename: Richard
authors.initials: R
authors.lastname: Greenwood
authors.forename: David
authors.initials: D
authors.lastname: Howard
authors.forename: Masud
authors.initials: M
authors.lastname: Husain
authors.forename: Malcolm
authors.initials: M
authors.lastname: Macleod
authors.forename: Randolph
authors.initials: R
authors.lastname: Nudo
authors.forename: John
authors.initials: J
authors.lastname: Rothwell
authors.forename: Anthony
authors.initials: A
authors.lastname: Rudd
authors.forename: James
authors.initials: J
authors.lastname: Teo
authors.forename: Nicholas
authors.initials: N
authors.lastname: Ward
authors.forename: Steven
authors.initials: S
authors.lastname: Wolf
mesh_terms: D035843:Biomedical Research / Q000592:standards* / Q000639:trends; D002986:Clinical Trials as Topic / Q000592:standards / Q000639:trends; D005544:Forecasting; D006291:Health Policy; D006801:Humans; D033183:Interdisciplinary Communication; D015201:Meta-Analysis as Topic; D009462:Neurology / Q000592:standards* / Q000639:trends; D009488:Neurosciences / Q000592:standards* / Q000639:trends; D010348:Patient Care Team / Q000592:standards / Q000639:trends; D026761:Physical Therapy Specialty / Q000592:standards / Q000639:trends; D020521:Stroke / Q000503:physiopathology; D000071939:Stroke Rehabilitation; D006113:United Kingdom