Maladaptive plasticity for motor recovery after stroke: mechanisms and approaches.
Maladaptive plasticity for motor recovery after stroke: mechanisms and approaches.
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DOI：
10.1155/2012/359728
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发表时间：
2012
影响因子：
3.1
通讯作者：
Izumi S
中科院分区：
文献类型：
--
作者：
Takeuchi N;Izumi S
在人类和动物模型中的许多研究表明，神经可塑性可弥补中风后运动功能的丧失。然而，中风后与代偿性运动、激活的同侧运动投射以及竞争性相互作用有关的神经可塑性会导致适应不良的可塑性，这对运动恢复产生负面影响。在受影响较小的一侧进行代偿性运动有助于进行自我维持的活动，但也会形成不适当的运动模式，并最终限制正常的运动模式。中风后激活的同侧运动投射无法充分支持皮质脊髓运动投射的中断，并引发与运动能力差相关的异常运动。两个半球之间的竞争性相互作用会导致异常的半球间抑制，从而削弱中风患者的运动功能。此外，广泛的去抑制增加了手和近端手臂之间竞争性相互作用的风险，导致运动恢复不完全。为了尽量减少这种适应不良的可塑性，应根据中风患者的运动障碍选择康复方案。无创性脑刺激可能也有助于纠正中风后的适应不良可塑性。在此，我们综述了中风后适应不良可塑性的潜在机制，并提出了促进适当皮质重组的康复方法。
Many studies in human and animal models have shown that neural plasticity compensates for the loss of motor function after stroke. However, neural plasticity concerning compensatory movement, activated ipsilateral motor projections and competitive interaction after stroke contributes to maladaptive plasticity, which negatively affects motor recovery. Compensatory movement on the less-affected side helps to perform self-sustaining activity but also creates an inappropriate movement pattern and ultimately limits the normal motor pattern. The activated ipsilateral motor projections after stroke are unable to sufficiently support the disruption of the corticospinal motor projections and induce the abnormal movement linked to poor motor ability. The competitive interaction between both hemispheres induces abnormal interhemispheric inhibition that weakens motor function in stroke patients. Moreover, widespread disinhibition increases the risk of competitive interaction between the hand and the proximal arm, which results in an incomplete motor recovery. To minimize this maladaptive plasticity, rehabilitation programs should be selected according to the motor impairment of stroke patients. Noninvasive brain stimulation might also be useful for correcting maladaptive plasticity after stroke. Here, we review the underlying mechanisms of maladaptive plasticity after stroke and propose rehabilitation approaches for appropriate cortical reorganization.
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