Rehabilitation pharmacology: bridging laboratory work to clinical application.

Background: Converging lines of evidence indicate the utility of medications for enhancing functional recovery after brain injury. Methods: Laboratory studies using rats and cats suggest that drugs augmenting noradrenergic function may facilitate recovery after cortical injury, when combined with appropriate environmental experience. This short-term noradrenergic strategy can be initiated months after injury and enhance recovery to a higher ultimate outcome level. Additional support for a central role of noradrenaline on recovery of function is that administration of drugs reducing noradrenergic function has the opposite effect, slowing functional recovery. Importantly these include several commonly prescribed medications such as alpha 2-adrenergic agonists, alpha 1-adrcncrgic blockers, and GABAergic agents that can retard recovery. The role for other medication such as those that affect acetylcholine requires further investigation. Conclusions: There is a need for controlled clinical trials investigating effects on functional recovery after brain injury addressing basic pharmacological issues of efficacy safety, and interaction with the rehabilitation environment. Rehabilitation research centers capable of integrating laboratory and clinical research efforts need to be established. This will be a slow and costly endeavor, but certainly less expensive than not developing a scientific basis for rehabilitation medicine.