Stroke is the considered to be the second most common cause of death worldwide. 85% of strokes are due to Ischemia (reduction of blood flow) by various causes and the rest are haemorrhagic strokes. Currently the therapy approaches are both pharmacological and via rehab (physical and occupational).
Nesin explored studies in rodents (reach-grasp test), squirrel monkeys(intracortical microstimulation) and humans (constraint induced movement therapy) that looked at cortical plasticity effects both ipsilateral (at the penumbra) and contralateral to the lesions. There is evidence that there could be unmasking of ipsilateral pathways (via the thalamus) post rehab activity. Pre-lesion exposure to enriched environments (EE) also seem to have a neuroprotective effect.
This last point sparked some debate - whether the hypermetabolic states post EE may cause more damage during lesioning. The discussion centred around the point that post anaesthesia induced hypometabolism may be neuroprotective if lesioning takes place. The overall evidence seems to point towards exposure to enriched environment pre-lesion is beneficial.
The critical period of rehab seems to be 5-14 days for rats and the first three months for humans.