Rehabilitation for Parkinson's disease: Current outlook and future challenges
Rehabilitation for Parkinson's disease: Current outlook and future challenges
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DOI：
10.1016/j.parkreldis.2015.09.005
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发表时间：
2016-01-01
影响因子：
4.1
通讯作者：
Pelosin, Elisa
中科院分区：
文献类型：
--
作者：
Abbruzzese, Giovanni;Marchese, Roberta;Pelosin, Elisa
康复被认为是药物和手术治疗帕金森病（PD）的辅助手段，以最大限度地提高功能能力，减少继发性并发症。最初，方法是基于经验的经验，但越来越多的证据表明，运动依赖的可塑性构成了物理治疗效果的主要机制。运动增加突触强度并影响神经传递，从而增强PD的功能回路。此外，运动是运动学习的关键要素。PD患者保留了足够的运动学习能力，尽管与正常对照组相比，学习率和表现有所降低。最近的荟萃分析表明，康复可以诱导短暂的，但临床上重要的好处，特别是步态和平衡。然而，干预措施在很大程度上是异质的（拉伸，肌肉强化，平衡，姿势练习，职业治疗，提示，跑步机训练），仍然没有关于最佳方法的共识。最近提出了创新技术：虚拟现实和运动游戏，运动图像和动作观察，机器人辅助物理治疗和非传统疗法（例如：舞蹈、武术）。PD的康复计划应该是“基于目标的”（针对核心区域的练习和学习特定活动），但需要确定一些练习变量（强度，特异性，复杂性），并且该计划应该针对个体患者的特征。(C)2015爱思唯尔有限公司版权所有。
Rehabilitation is considered as an adjuvant to pharmacological and surgical treatments for Parkinson's disease (PD) to maximize functional ability and minimize secondary complications. Originally, approaches were based on empirical experience, but growing evidence suggests that exercise-dependent plasticity constitutes the main mechanism underlying the effects of physiotherapy. Exercise increases synaptic strength and influences neurotransmission, thus potentiating functional circuitry in PD. In addition, exercise is a pivotal element of motor learning. PD patients retain a sufficient capacity of motor learning, though learning rates and performance are reduced in comparison to normal controls. Recent meta-analyses demonstrated that rehabilitation could induce short-lasting, but clinically important benefits, particularly for gait and balance. However, the interventions are largely heterogeneous (stretching, muscle strengthening, balance, postural exercises, occupational therapy, cueing, treadmill training), and there is still no consensus about the optimal approach. Innovative techniques have been recently proposed: virtual reality and exergaming, motor imagery and action observation, robot-assisted physiotherapy and non-conventional therapies (e.g.: dance, martial arts). The rehabilitative program for PD should be "goal-based" (targeted to practicing and learning specific activities in the core areas), but a number of practice variables (intensity, specificity, complexity) need to be identified and the program should tailored to the individual patients' characteristics. (C) 2015 Elsevier Ltd. All rights reserved.