Stroke is one of the most common causes of long-term disability in the elderly but also in younger subpopulations with predisposing factors. Recovery of function after stroke is often a lifelong endeavor. Poor nighttime sleep quality and daytime somnolence are commonly reported by stroke patients in the rehabilitation setting and may influence responses to rehabilitative interventions after stroke. Given that memory consolidation relies on precise sequencing of sleep events, it is conceivable that impaired sleep architecture after stroke may negatively influence motor skill learning after stroke. However, there is paucity of knowledge about sleep patterns after stroke. In this scoping review, mechanisms of sleep modulation on learning after stroke are reviewed. Stroke units and rehabilitation centers should make efforts to screen for sleep disorders and facilitate therapeutic environments that may incorporate sleep breaks into therapy regimens. Further study is needed to increase our knowledge on sleep patterns after stroke which may then pave the way for therapeutic interventions targeting sleep to enhance motor recovery after stroke. Every year, 15 million people worldwide suffer a stroke. To date, tissue plasminogen activator remains the only FDA-approved treatment for ischemic stroke; to get this treatment, one must present inside an hour and a half of onset of side effects. Past this point, interventions are limited to prevention of future recurrence and reducing deficit. Factors underlying recovery of stroke are still not precisely understood and rehabilitation interventions, for the most part, are empiric. Sleep-wake disturbances are among the foremost indicators that are predictive of poor prognosis of functional recovery. Furthermore, the mechanisms of neural re-organization may be susceptible to modulation by behavioral states during sleep and wakefulness which may, in part, account for inter-individual difference in stroke recovery. In this review, the link between recovery and sleep is explored with a concept report of current literature.

We are constantly faced with opportunities to learn and perform motor skills, the ability of which is influenced by neural plasticity and cortical reorganization. Use and repetition through motor practice is the conventional method utilized to develop a functional motor skill. This method is associated with increased corticomotor excitability within the primary motor cortex in conjunction with disinhibition through downregulation of extrasynaptic GABA-A mediated receptor activation, a mechanism initially suggested by animal models and strengthened by magnetic resonance spectroscopy studies. Task-related movement representations in the primary motor cortex precede development of a stable functional motor skill

With Regards,
Sara Giselle
Associate Managing Editor
 Journal of Stroke Research & Therapy