areas: rehabilitative therapy, surgical interventions, and prevention of future watershed strokes. rehabilitative therapies long-term rehabilitative therapy for watershed stroke patients involves physical, occupational, and speech and language therapies. physical therapy can be used to enhance motor function in the legs and arms that has been impacted by stroke. occupational therapies can be provided to help to alleviate cognitive impairments that result from watershed stroke but its effectiveness remains unclear. occupational therapy can also be used in an effort to improve fine motor function that was damaged as a result of the stroke. stroke can also cause impairments in speech production secondary to neurocognitive and neuromuscular impairments, and therefore speech and language therapies are often a component of long-term care for stroke patients. intensive speech and language therapy has been shown to improve speech deficits associated with aphasia resulting from stroke. surgical interventions endovascular interventions, including surgical revascularization, can increase blood flow in the area of the stroke, thereby decreasing the likelihood that insufficient blood flow to the watershed regions of the brain will result in subsequent strokes. neuroscientists are currently researching stem cell transplantation therapies to improve recovery of cebreral tissue in affected areas of the brain post-stroke. should this intervention be proven effective, it will greatly increase the number of neurons in the brain that can recover from a stroke. prevention of future strokes there are several interventions that are often used to help prevent the recurrence of a watershed stroke; namely, nutritional interventions, as well as antiplatelet, anticoagulant, and statin drug use. nutritional interventions, including increased consumption of certain amino acids, antioxidants, b-group vitamins, and zinc, have been shown to increase the recovery of neurocognitive function after a stroke. antiplatelet drugs, such as aspirin, as well as anticoagulants, are used to help prevent blood clots and therefore embolisms, which can cause watershed strokes. statin drugs are also used to control hyperlipidemia, another risk factor for watershed stroke. research stem cell transplantation ischemic stroke is still a major health concern and studies are being conducted to determine the pathway in which brain damage occurs to identify targets for intervention. stem cell transplantation may help in intervention to improve cell recovery and regeneration. strokes after cardiac surgery although the mechanism is not entirely understood, the likelihood of a watershed stroke increases after cardiac surgery. an experiment conducted in a five-year span studied the diagnosis, etiology, and outcome of these postoperative strokes. it was observed that intraoperative decrease in blood pressure may lead to these strokes and patients who have undergone aortic procedures are more likely to have bilateral watershed infarcts. furthermore, bilateral watershed strokes are associated with poor short-term outcomes and are most reliably observed by diffusion-weighted imaging mri. thus future clinical research and practice should focus on the identification of bilateral stroke characteristics. this identification can help discover affected areas and increase correct diagnosis. deep watershed infarcts hemodynamic impairment is thought to be the cause of deep watershed infarcts, characterized by a rosary-like pattern. however new studies have shown that microembolism might also contribute to the development of deep watershed infarcts. the dual contribution of hemodynamic impairment and microembolism would result in different treatment for patients with these specific infarcts. basilar artery (ba) stenting while intracranial artery stenting is used for same side stroke prevention, basilar artery stenting may help to improve parallel, accessory blood flow. the stent may also lead to termination of recurrent middle cerebral artery (mca) strokes. penumbra imaging the area around the damaged ischemia is known as the penumbra. this viable area has the ability to regenerate with the help of pharmacological treatment however most patients with penumbra are left untreated. new research is being conducted in metabolic suppression, direct energy delivery, and selective drug delivery to help salvage this area of the brain after a stroke. clevsrknc peptide this new drug has been shown to home to ischemic stroke tissue as well as apoptotic neuronal cells of the penumbra region. this discovery may help in creating selective drug delivery for stroke patients. liposomal drug delivery nanoliposomes are currently being researched for specific drug delivery due to their ph-sensitive and high blood–brain barrier diffusion characteristics. many advantages of these drugs include: drugs can be maintained in the active state while encapsulated. being encapsulated provides direct access to target tissue prevention of non-specific binding allows for a high concentration of drug due to the fact that acidic environment and low blood flow are prominent characteristic of the penumbra area, liposomal drugs seem to be well suited. terminology watershed strokes are named because they affect the distal watershed areas of the brain. the original terminology came from the german literature, which used the analogy of an irrigation system. the german scholars compared the blood flow in distal arterial territories of the brain to the last field on a farm, which was the area with the least supply of water and therefore most vulnerable to any reduction in flow. in a medical context, the term "watershed" refers to those areas of the brain that receive dual blood supply from the branching ends of two large arteries.