Motor learning: its relevance to stroke recovery and neurorehabilitation
Motor learning: its relevance to stroke recovery and neurorehabilitation
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DOI：
10.1097/01.wco.0000200544.29915.cc
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发表时间：
2006-02-01
影响因子：
4.8
通讯作者：
Krakauer, JW
中科院分区：
文献类型：
--
作者：
Krakauer, JW
回顾目的大部分神经康复都基于这样的假设：患者可以通过实践得到改善。本综述将集中于手臂运动，并解决以下问题：（一）什么是运动学习？(ii)轻偏瘫患者有学习障碍吗？(iii)受伤后的恢复是运动学习的一种形式吗？(iv)基于运动学习原理的方法对康复有用吗？最近的研究结果运动学习可以分为运动学和动力学组件。对健康受试者的研究表明，运动学习的保持最好通过可变的训练计划来完成。动物模型和人类的功能成像表明，成熟的大脑在学习和恢复过程中会发生可塑性变化。定量运动控制方法允许区分补偿和真正的恢复，尽管两者都随着实践而改进。一些有前途的新康复方法是基于运动学习理论。这些包括损伤定向训练（IOT），约束诱导运动疗法（CIMT），肌电图（EMG）触发的神经肌肉刺激，机器人互动疗法和虚拟现实（VR）。为了获得最佳效果，康复技术应针对患者的特定运动缺陷，并可能结合，例如，CIMT与VR。对于康复技术，有两个关键问题应该始终被问到：训练后的收益是否能持续很长一段时间，以及它们是否能推广到未经训练的任务。
Purpose of review Much of neurorehabilitation rests on the assumption that patients can improve with practice. This review will focus on arm movements and address the following questions: (i) What is motor learning? (ii) Do patients with hemiparesis have a learning deficit? (iii) Is recovery after injury a form of motor learning? (iv) Are approaches based on motor learning principles useful for rehabilitation?Recent findings Motor learning can be broken into kinematic and dynamic components. Studies in healthy subjects suggest that retention of motor learning is best accomplished with variable training schedules. Animal models and functional imaging in humans show that the mature brain can undergo plastic changes during both learning and recovery. Quantitative motor control approaches allow differentiation between compensation and true recovery, although both improve with practice. Several promising new rehabilitation approaches are based on theories of motor learning. These include impairment oriented-training (IOT), constraint-induced movement therapy (CIMT), electromyogram (EMG)-triggered neuromuscular stimulation, robotic interactive therapy and virtual reality (VR).Summary Motor learning mechanisms are operative during spontaneous stroke recovery and interact with rehabilitative training. For optimal results, rehabilitation techniques should be geared towards patients' specific motor deficits and possibly combined, for example, CIMT with VR. Two critical questions that should always be asked of a rehabilitation technique are whether gains persist for a significant period after training and whether they generalize to untrained tasks.