Combining Dopaminergic Facilitation with Robot-Assisted Upper Limb Therapy in Stroke Survivors: A Focused Review.
Combining Dopaminergic Facilitation with Robot-Assisted Upper Limb Therapy in Stroke Survivors: A Focused Review.
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DOI：
10.1097/phm.0000000000000438
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发表时间：
2016-06
影响因子：
3
通讯作者：
Zafonte R
中科院分区：
文献类型：
--
作者：
Tran DA;Pajaro-Blazquez M;Daneault JF;Gallegos JG;Pons J;Fregni F;Bonato P;Zafonte R
尽管有积极的常规治疗，但大部分中风幸存者仍持续存在持续性偏瘫。本文的目的是批判性地回顾通过将机器人治疗与药物治疗和基于虚拟现实的奖励学习相结合来缓解中风幸存者上肢损伤的运动学习网络沿着多个部位的原理。个性化的药理学促进每个人的独特的生物学方法也进行了审查。在分子水平上，左旋多巴治疗可诱导长时程增强样和实践依赖性可塑性。临床上，在中风幸存者中结合常规治疗与左旋多巴的试验产生了统计学显著但临床上不令人信服的结果，因为有限的个性化，标准化和可重复性。机器人治疗可以通过提供密集的、可重复的和功能上有意义的干预来诱导神经可塑性，这些干预对于严格的研究来说是足够客观的。机器人疗法还为虚拟现实提供了一个合适的平台，通过参与奖励回路来促进学习。中风康复的未来应该通过个性化的多模式治疗针对不同的分子，突触和皮质部位，以最大限度地提高运动恢复。
Despite aggressive conventional therapy, lasting hemiplegia persists in a large percentage of stroke survivors. The aim of this article is to critically review the rationale behind targeting multiple sites along the motor learning network by combining robotic therapy with pharmacotherapy and virtual reality–based reward learning to alleviate upper extremity impairment in stroke survivors. Methods for personalizing pharmacologic facilitation to each individual’s unique biology are also reviewed. At the molecular level, treatment with levodopa was shown to induce long-term potentiation-like and practice-dependent plasticity. Clinically, trials combining conventional therapy with levodopa in stroke survivors yielded statistically significant but clinically unconvincing outcomes because of limited personalization, standardization, and reproducibility. Robotic therapy can induce neuroplasticity by delivering intensive, reproducible, and functionally meaningful interventions that are objective enough for the rigors of research. Robotic therapy also provides an apt platform for virtual reality, which boosts learning by engaging reward circuits. The future of stroke rehabilitation should target distinct molecular, synaptic, and cortical sites through personalized multimodal treatments to maximize motor recovery.