Neural plasticity and bilateral movements: A rehabilitation approach for chronic stroke
Neural plasticity and bilateral movements: A rehabilitation approach for chronic stroke
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DOI：
10.1016/j.pneurobio.2005.04.001
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发表时间：
2005-04-01
影响因子：
6.7
通讯作者：
Summers, JJ
中科院分区：
文献类型：
--
作者：
Cauraugh, JH;Summers, JJ
中风会干扰对运动行为的自主控制。尽管功能可能会自发恢复，但在偏瘫上肢恢复正常运动功能的个体不到15%。然而，越来越多的证据表明，除了与损伤相关的重组外，运动皮层的功能还会因个体的运动经历而改变。这种神经可塑性对中风后进行的康复训练类型具有重要意义。这篇综述提出，基于理论运动控制结构和肢体间协调原理的活动依赖性干预可使上肢在运动恢复方面取得显著进展。基于行为和神经生理机制，双侧运动训练/练习在加速上肢慢性中风恢复方面显示出巨大的潜力。中风后规划和执行双侧运动可能通过三种机制促进皮层神经可塑性：(a)运动皮层去抑制，从而增加对受损半球未受损通路的使用；(b)增加对来自健侧或对侧半球同侧通路的募集，以补充受损的交叉皮质脊髓通路；(c)将下行的前运动神经元指令上调至脊髓固有神经元。（c）2005年爱思唯尔有限公司。保留所有权利。
Stroke interferes with voluntary control of motor actions. Although spontaneous recovery of function can occur, restoration of normal motor function in the hemiplegic upper limb is noted in fewer than 15 % of individuals. However, there is increasing evidence to suggest that in addition to injury-related reorganization, motor cortex functions can be altered by individual motor experiences. Such neural plasticity has major implications for the type of rehabilitative training administered post-stroke. This review proposes that noteworthy upper extremity gains toward motor recovery evolve from activity-dependent intervention based on theoretical motor control constructs and interlimb coordination principles. Founded on behavioral and neurophysiological mechanisms, bilateral movement training/practice has shown great promise in expediting progress toward chronic stroke recovery in the upper extremity. Planning and executing bilateral movements post-stroke may facilitate cortical neural plasticity by three mechanisms: (a) motor cortex disinhibition that allows increased use of the spared pathways of the damaged hemisphere, (b) increased recruitment of the ipsilateral pathways from the contralesional or contralateral hemisphere to supplement the damaged crossed corticospinal pathways, and (c) upregulation of descending premotorneuron commands onto propriospinal neurons. (c) 2005 Elsevier Ltd. All rights reserved.