Getting neurorehabilitation right: what can be learned from animal models?
Getting neurorehabilitation right: what can be learned from animal models?
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DOI：
10.1177/1545968312440745
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发表时间：
2012-10
影响因子：
4.2
通讯作者：
Wittenberg GF
中科院分区：
文献类型：
--
作者：
Krakauer JW;Carmichael ST;Corbett D;Wittenberg GF
中风是导致残疾的主要原因，会导致运动和感觉障碍。动物模型表明，中风后早期大脑有大约一个月的可塑性增强，此时大部分人从损伤中恢复过来。这种高度的可塑性发生在兴奋/抑制平衡的背景变化中，在结构上明显表现为轴突重塑，以及皮质MAP的范围和反应性的变化。经验改善预后的最佳时间尚不清楚，但在动物模型中，只有非常早期(发病后5天)和剧烈的活动会导致组织学损伤的增加。相反，晚期康复(>；30天)在结果和形态变化方面的效果都要差得多。在临床实践中，致残中风后的康复需要相对较短的住院康复期，这与动物模型中调查的强度水平相差甚远，还包括训练补偿策略，对损害的影响最小。关于强制诱导和机器人治疗的效果的研究几乎完全是在慢性中风中进行的，但更早的似乎确实更好。目前的康复治疗对中风后早期或晚期的损害影响有限，令人失望。动物模型的转化将需要：(1)大幅增加中风后第一个月提供的治疗强度和剂量，重点是损害；(2)联合治疗方法，例如基于目前对运动学习和脑可塑性的了解，用机器人进行无创脑刺激；(3)研究，强调机械性II期研究，而不是过早的III期临床试验。
Stroke is the leading cause of disability, causing impairments in movement and sensation. Animal models suggest that there is about a month of heightened plasticity in the brain early after stroke when most recovery from impairment occurs. This heightened plasticity occurs against background changes in excitatory/inhibitory balance, is apparent structurally as neurite remodeling, and changes in the extent and responsiveness of cortical maps. The best time for experience to improve outcome is unclear, but in animal models only very early (< 5 days from onset) and intense activities lead to increased histological damage. Conversely, late rehabilitation (>30 days) is much less effective both in terms of outcome and morphological changes. In clinical practice, rehabilitation after disabling strokes involves a relatively brief period of inpatient rehabilitation that does not come close to matching intensity levels investigated in animal models, and it involves training compensatory strategies with minimal impact on impairment. Research on the effect of Constraint-induced and robotic therapy has been conducted almost entirely in chronic stroke but earlier does seem better. Current rehabilitation treatments have a disappointingly modest effect on impairment early or late after stroke. Translation from animal models will require: (1) substantial increases in the intensity and dosage of treatments offered in the first month after stroke with an emphasis on impairment, (2) Treatment combination approaches, for example, non-invasive brain stimulation with robotics, based on current understanding of motor learning and brain plasticity, and (3) Research that emphasizes mechanistic phase II studies over premature phase III clinical trials.