Constraint-induced movement therapy improves efficacy of task-specific training after severe cortical stroke depending on the ipsilesional corticospinal projections
Constraint-induced movement therapy improves efficacy of task-specific training after severe cortical stroke depending on the ipsilesional corticospinal projections
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DOI：
10.1016/j.expneurol.2018.04.006
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发表时间：
2018-07-01
影响因子：
5.3
通讯作者：
Miyamoto, Osamu
中科院分区：
文献类型：
--
作者：
Okabe, Naohiko;Himi, Naoyuki;Miyamoto, Osamu
下行脊髓通路（皮质脊髓、红核脊髓和网状脊髓）被认为有助于卒中后康复训练导致的功能恢复。然而，每种途径的贡献仍不清楚。在当前的研究中，我们研究了大鼠严重皮质卒中后3周的各种康复[约束诱导运动疗法（CIMT），熟练的前肢伸展，旋转棒和跑步机运动]后康复诱导的功能恢复和下行脊髓通路的重塑。光血栓性中风后，96%的皮质脊髓神经元在同侧运动皮质被破坏。尽管保留了82%的脊髓投射神经元（如红核脊髓和网状脊髓投射神经元），大鼠表现出持续和严重的残疾，特别是在熟练的运动功能。在这个严重的中风模型中，只有CIMT促进功能恢复，与梗死周围运动皮质的皮质脊髓投射增加有关。当恢复的皮质脊髓神经元被第二次中风破坏时，再灌注诱导的恢复被逆转。这些数据表明，训练诱导的功能恢复依赖于同侧皮质脊髓投射，这突出了使用策略来提高存活率、轴突重塑或皮质脊髓神经元再生以有效恢复严重卒中患者的功能的重要性。
Descending spinal pathways (corticospinal, rubrospinal, and reticulospinal) are believed to contribute to functional recovery resulting from rehabilitative training after stroke. However, the contribution of each pathway remains unclear. In the current study, we investigated rehabilitation-induced functional recovery and remodelling of the descending spinal pathways after severe cortical stroke in rats followed by 3 weeks of various rehabilitation [constraint-induced movement therapy (CIMT), skilled forelimb reaching, rotarod, and treadmill exercise]. Following photothrombotic stroke, 96% of corticospinal neurons in the ipsilesional motor cortex were destroyed. Despite the preservation of 82% of total spinal projection neurons (e.g. rubrospinal and reticulospinal projection neurons), rats showed persistent and severe disability, especially in skilled motor function. In this severe stroke model, only CIMT promoted functional recovery, associated with increased corticospinal projections from the peri-infarct motor cortex. Rehabilitation-induced recovery was reversed when the restored corticospinal neurons were destroyed by a second stroke. These data indicate that training-induced functional recovery is dependent on ipsilesional corticospinal projections, which highlights the importance of using strategies to enhance survival, axonal remodelling, or regeneration of corticospinal neurons to effectively restore function in severely affected stroke patients.