Rethinking stimulation of the brain in stroke rehabilitation: why higher motor areas might be better alternatives for patients with greater impairments.
Rethinking stimulation of the brain in stroke rehabilitation: why higher motor areas might be better alternatives for patients with greater impairments.
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DOI：
10.1177/1073858414537381
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发表时间：
2015-06
期刊：
影响因子：
--
通讯作者：
Machado A
中科院分区：
文献类型：
--
作者：
Plow EB;Cunningham DA;Varnerin N;Machado A
刺激大脑以驱动其适应的可塑性潜力有望加速中风的康复结果。Ipsilesional初级运动皮质(M1)总是被促进。然而，支持其有效性的证据存在分歧，表明我们可能过度概括了它的潜力。由于M1及其皮质脊髓输出经常受到损害，在有严重损害和损害的患者中，单独的运动前区(PMA)可能是有用的替代。我们的前提是他们更高的生存概率，更大的下降预测，以及适应能力，这是严重受损患者康复的原因。使用概念模型，我们描述了慢性刺激PMA将如何强烈影响卒中运动恢复的关键机制，如促进交替下行输出的可塑性，恢复大脑半球间的平衡，以及建立广泛的连接。尽管目前很难预测PMA是否会“更好”，但重要的是至少要调查它们是否是M1的合理替代品。即使对M1的刺激可能使那些具有最大恢复潜力的人受益，而PMA的刺激可能只帮助更弱势的人，但在大多数人中实现一些恢复可能仍然是合理的，而不是刺激注定对所有人都不一致有效的单一基因座。
Stimulating the brain to drive its adaptive plastic potential is promising to accelerate rehabilitative outcomes in stroke. Ipsilesional Primary Motor Cortex (M1) is invariably facilitated. However, evidence supporting its efficacy is divided, indicating we may have over-generalized its potential. Since M1 and its corticospinal output are frequently damaged, in patients with serious lesions and impairments, ipsilesional premotor areas (PMA) could be useful alternates instead. We base our premise on their higher probability of survival, greater descending projections, and an adaptive potential, which is causal for recovery across the seriously impaired. Using a conceptual model, we describe how chronically stimulating PMA would strongly affect key mechanisms of stroke motor recovery, such as facilitating plasticity of alternate descending output, restoring inter-hemispheric balance, and establishing widespread connectivity. Although at this time it is difficult to predict whether PMA would be ‘better’, it is important to at least investigate whether they are reasonable substitutes for M1. Even if stimulation of M1 may benefit those with maximum recovery potential, while that of PMA may only help the more disadvantaged, it may still be reasonable to achieve some recovery across the majority rather than stimulate a single locus fated to be inconsistently effective across all.
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