Rethinking Stroke Recovery: New Insights into Neuronal Remapping and Rehabilitation Potential
Dan Lewis Foundation

Stroke is a common neurological condition that damages brain cells (neurons) in the affected area, leading to a loss of the functions controlled by that region. A hopeful aspect of stroke recovery is that, over time and with rehabilitation, many individuals regain some abilities. This recovery has been linked to a process called “remapping,” where neurons in unaffected areas of the brain adapt to take over the functions of the damaged areas. Although many studies have explored this remapping phenomenon, most evidence has been indirect, based on changes in brain activation patterns or neuron connections after stroke in animal models. Direct proof that neurons change functionality after stroke has been lacking, partly because measuring neuron activity in the brain over time, especially at the necessary scale and duration, is challenging.

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With advances in neuroscience and microscopy, we set out to test the remapping hypothesis and obtain direct evidence. We induced precise strokes in the part of a mouse’s brain responsible for processing sensory information from whiskers—the somatosensory whisker barrel cortex. While humans don’t have whiskers, the whisker barrel cortex in mice has key features that make it ideal for studying fundamental neuroscience questions. Mice use their whiskers as a primary sensory tool, and the whisker barrel cortex has a precise anatomy where each whisker’s sensory data is processed in distinct columns (or barrels) in the cortex, arranged just as whiskers are on the snout. This setup allows us to pinpoint brain areas activated by specific whisker stimulation.


Using specialized microscopy to observe hundreds of neurons in real-time, we tested remapping by targeting a stroke to a specific barrel of neurons, the “C1” barrel. Before the stroke, only a few neurons in neighboring barrels responded to the C1 whisker. Based on the remapping theory, we anticipated that after the stroke, these nearby neurons would take on the C1 barrel’s function. Surprisingly, we found the opposite: fewer neurons responded to the C1 whisker, and this low response rate persisted for up to two months. When we stimulated other whiskers, these same neurons responded normally, indicating they weren’t damaged but had lost responsiveness specifically to the C1 whisker.


We then applied a rehabilitation technique known as forced use therapy, trimming all whiskers except the C1 whisker, akin to encouraging stroke patients to use a weaker limb during physical therapy. This approach didn’t increase the number of neurons responding to the C1 whisker, but the few neurons that did respond showed more reliable responses with forced use therapy. Our

findings indicate that remapping doesn’t occur naturally after stroke; instead, rehabilitation may work by enhancing the function of existing neurons rather than promoting remapping.


Our study has some limitations. Humans don’t have whiskers, so our results might not translate directly. Additionally, we focused on the sensory system, and other brain areas, like the motor cortex, might recover differently. However, our work adds to evidence suggesting that adaptive plasticity and remapping in brain areas spared by stroke are limited, not enhanced. While this might seem discouraging, it opens new avenues for brain recovery. We may be able to restore function by targeting spared neurons that are dysfunctional but not irreversibly damaged, creating a critical window for post-stroke interventions like optimized physical therapy.


In future work, instead of assuming spontaneous brain remapping, we aim to investigate the specific circuits and molecular mechanisms that limit adaptive plasticity after brain injury. We’re expanding our whisker barrel cortex model and using genetic tools to examine how different types of neurons are affected by stroke. We are studying interactions between neuron populations to understand how these relationships affect remapping potential. Additionally, by analyzing changes in gene expression within neuron populations, we hope to identify new molecular targets that could lead to therapies promoting plasticity, remapping, and recovery for stroke and other brain injuries.

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By Dan Lewis Foundation November 6, 2024
After a life-altering accident in October 2022, Devon Guffey’s story is about resilience and determination. His journey has been profiled in the summer 2023 issue of the Making Headway Newsletter: https://www.danlewisfoundation.org/devons-story . Hit by a drunk driver, Devon sustained severe brain and physical injuries, including axonal shearing, a traumatic frontal lobe injury, and facial fractures. Even after contracting meningitis while in a coma, Devon fought hard to survive – and today, his recovery continues to inspire us all. In late 2023, Devon worked as an assistant basketball coach at Blue River Valley, where he had once been a student. His love for sports and dedication to regaining his physical strength returned him to the gym, where his hard work paid off. Devon’s persistence earned him another job at the YMCA, guiding gym members and supporting facility upkeep. Through all the challenges—deafness in one ear, blindness in one eye, and a permanent loss of taste and smell—Devon perseveres. He recently regained his driving license, a significant milestone that symbolizes his increasing independence and cognitive and physical recovery. While each day may not show significant changes, Devon now sees his progress over time. Today, Devon speaks to groups about his journey, the dangers of drunk driving, and finding strength in adversity. His message is clear: recovery is a process, and sometimes, "can't" simply means "can't do it yet ." Every TBI is unique, and Devon’s story powerfully reminds us of the strength that comes from resilience and community. We are grateful to Devon for continuing to share his story and for his role in uplifting others facing difficult paths. His journey is a testament to the fact that we are stronger together. #BrainInjuryAwareness #DevonsJourney #Resilience #EndDrunkDriving #MakingHeadway
A close up of a brain with a lot of cells and a purple background.
By Dan Lewis Foundation | Summer 2024 July 10, 2024
Scientists worldwide are working to find ways to stimulate healing and functional recovery after severe brain injuries. This work is driven by the desperate needs of persons who have suffered brain damage. It is inspired by the knowledge that the information required to create new brain cells, cause these cells to interconnect, and stimulate new learning is contained in our genome. Now that we can readily generate stem cells from adult tissue, we have access to the genomic program that can control all of the intricate details of brain tissue formation. A number of different research themes are being pursued productively. These include: (1) enabling injured neurons to self-repair (“axonal repair”) 1,2 ; (2) replacing damaged tissue by increasing the growth of new neurons (“neurogenesis”) 3-5 ; (3) transplanting new brain cells that are derived from a person’s own stem cells (“autologous cellular repletion”) 6-8 ; (4) stimulating the re-wiring of new or surviving tissue by encouraging the formation of new connections (“synaptogenesis”) 9,10 ; and (5) augmenting the function of a damaged brain by the use of bio-computational prostheses (“brain-computer interfaces”) 11,12 ; We’ve explored these themes in previous newsletters. The goal of stimulating meaningful brain regeneration is now sufficiently plausible that a large-scale, well-funded campaign needs to be funded to bring meaningful new therapies to patients within the foreseeable future. Here, we suggest a high-level outline of the research themes for such a campaign. A ‘moon shot’ program towards brain regeneration would leverage cutting-edge technologies in stem cell research, gene therapy, synaptic plasticity, neuronal repair, and brain-computer interfaces (BCIs) to develop innovative treatments for brain injuries and neurodegenerative diseases. These treatments would target the restoration of lost brain functions and improvement in the quality of life for individuals affected by severe brain injuries. This research agenda aims to catalyze serious discussion about creating a federal program with funding, organizational resources, and expert governance to enable brain regeneration in our lifetimes. Major Themes For a Brain Regeneration “Moon Shot” Program 1: Promote the formation of new neurons 1.1 Stimulate the brain to create new neurons 1.2 Create new neurons from patient-derived induced pluripotent stem cells to be transplanted back into the patient. Create new glial cells to support neurogenesis. 2: Stimulate new synaptic formation 2.1 Develop drugs that enhance synaptic plasticity and promote the formation of new synaptic connections 3: Stimulate self-repair of damaged neurons 3.1 Develop drugs that de-repress neurons and, thereby, enable axonal regrowth 4: Develop brain-computer interfaces (BCIs) for brain-injured patients 4.1: Develop and test BCIs that enable the brain to control behaviors or external devices and, thereby, augment or replace impaired functions. 4.2: Develop and test BCIs that can accelerate the training of remapped brain tissue in persons with brain injuries to optimize functional recovery. 4.3: Combine BCIs with other strategies (e.g., cell repletion, synaptogenesis, and enhanced plasticity) to accelerate adaptation and functional improvement. The proposed research themes can underpin targeted research to stimulate meaningful brain regeneration, offering new hope for patients with brain injuries and neurodegenerative diseases. While the scientific challenges are profound, there has been sufficient progress to justify substantial investment in brain regeneration research. Any such large-scale program will require coordinated collaborations among academic and commercial partners, skillful governance and management, and a shared sense of profound commitment to the goal. The recent pace of advances in cell biology, stem cell technology, bio-computational interfaces, and genomically targeting medicines suggests that large-scale investment will yield meaningful clinical advances toward brain regeneration after injury. With robust funding and skilled leadership, this comprehensive research agenda has a realistic potential to transform scientific breakthroughs into tangible medical therapies, offering hope to millions affected by brain damage.
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