Consideration of Dose and Timing When Applying Interventions After Stroke and Spinal Cord Injury.
Consideration of Dose and Timing When Applying Interventions After Stroke and Spinal Cord Injury.
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DOI：
10.1097/npt.0000000000000165
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发表时间：
2017-07
期刊：
影响因子：
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通讯作者：
Lang CE
中科院分区：
文献类型：
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作者：
Basso DM;Lang CE
近四十年来对神经系统可塑性的研究表明，时间和剂量都很重要。本文提供了一个概要，我们的讲座在IV STEP会议提出了一个观点，目前的数据问题的时机和剂量的成人中风和脊髓损伤运动康复。对于中风，普遍的证据表明，无论何时，更大的治疗量都不会导致上肢干预的更好结果。更大量的治疗是否会导致下肢和移动干预的更好结果，需要明确测试。对于脊髓损伤，存在损伤后时间、任务特异性和脊髓微环境的复杂相互作用。炎症似乎是一个关键的决定因素是否干预将是有益的或不适应的，和特定的再训练偏心控制在步态可能是必要的。为了超越我们目前干预措施的局限性，并有效地达到无应答者，更精确地对细胞环境进行适时的特定任务干预可能是关键。神经康复可改善持续性缺陷，实现更大程度的恢复并恢复无应答者，这将减少机构化，提高生活质量并预防卒中和SCI后常见的多种继发性并发症。
Nearly four decades of investigation into the plasticity of the nervous system suggest that both timing and dose could matter. This paper provides a synopsis of our lectures at the IV STEP meeting which presented a perspective of current data on the issues of timing and dose for adult stroke and spinal cord injury motor rehabilitation. For stroke, the prevailing evidence suggests that greater amounts of therapy do not result in better outcomes for upper extremity interventions, regardless of timing. Whether or not greater amounts of therapy result in better outcomes for lower extremity and mobility interventions needs to be explicitly tested. For spinal cord injury, there is a complex interaction of timing post injury, task-specificity, and the microenvironment of the spinal cord. Inflammation appears to be a key determinant of whether or not an intervention will be beneficial or maladaptive, and specific re-training of eccentric control during gait may be necessary. To move beyond the limitations of our current interventions and to effectively reach nonresponders, greater precision in task-specific interventions that are well-timed to the cellular environment may hold the key. Neurorehabilitation that ameliorates persistent deficits, attains greater recovery and reclaims non-responders will decrease institutionalization, improve quality of life and prevent multiple secondary complications common after stroke and SCI.