Modulating brain plasticity in rehabilitation of stroke and other brain lesions

背景：中风和创伤性脑损伤导致的残疾是成人长期残疾的主要原因。目前还没有普遍接受的治疗方法来治疗这种疾病，这种残疾在经济、个人、熟悉和社会方面的代价也不能低估。来自不同实验室的初步数据表明，通过药理学、脑刺激和体感刺激技术来调节受损大脑的可塑性过程是可能的。Z01的目的是描述最有希望改善这些患者皮质可塑性以促进功能恢复的技术。 今年的研究结果：今年我们研究了与中风后癫痫相关的运动皮质功能，这是一个以前从未详细探索过的领域，发现运动皮质兴奋性的变化与这种情况之间存在重要的相关性。我们扩大了我们关于躯体感觉刺激对中风后运动功能的有用性的研究，并在干预后特别研究了对侧初级运动皮质的功能。我们的一位研究员很荣幸地在《神经学》杂志上将神经康复的发展描述为一个子专业。我们继续工作，以更好地了解中风和其他疾病继发瘫痪患者的脑机接口的生理学。我们描述了动作观察对中风后体育训练的影响，指出了它的好处。我们还描述了中风后瘫痪手的躯体感觉刺激和大脑半球间相互作用的变化之间的一组重要的相互作用。在卒中后的运动准备过程中，我们加深了对大脑半球间相互作用和皮质内抑制性GABA能回路之间相互作用的理解。在与校外研究人员的合作下，我们进一步研究了在中风后的几周内实施躯体感觉刺激对运动功能的影响。 我们未来的计划包括促进我们对这些不同刺激技术的机制的理解，这些不同的刺激技术包括体感刺激、皮质刺激和脑计算机接口，它们都有助于脑损伤后运动功能的恢复。其中一些工作将在即将到来的一年集中在创伤性脑损伤上，主要是轻微到中度。此外，我们将尝试确定最佳的刺激参数和技术，以增强这种干预在神经康复治疗中的有益效果。 这个项目的意义在于，它可以更好地了解康复过程的潜在机制，并开发更有效的干预措施，利用脑刺激技术改善中风和创伤性脑损伤后的神经预后。

Background: Disability resulting from stroke and traumatic brain injury represent the main cause of long term disability among adults. There are no universally accepted treatments available for the treatment of this condition and the financial, personal, familiar and social cost of this disability cannot be underestimated. Preliminary data from different laboratories has shown that it is possible to modulate plastic processes in the lesioned brain by pharmacological, brain stimulation and somatosensory stimulation techniques. The purpose of this Z01 is to characterize the most promising techniques to improve cortical plasticity in these patients in order to enhance functional recovery. Findings this year: This year we studied motor cortical function associated with post stroke epilepsy, an area that has not been explored before in detail, finding important correlates between changes in motor cortical excitability and this condition. We expanded our work on the usefulness of somatosensory stimulation on motor function after stroke and studied in particular function in the contralesional primary motor cortex after this intervention. One of our fellows was honored by describing the development of neurorehabilitation as a subspecialty in the journal Neurology. We continued work to better understand the physiology of brain-computer interfaces in patients with paralysis secondary to stroke and other disorders. We characterized the effects of action observation on physical training after stroke, noting its benefits. We also characterized an important set of interactions between somatosensory stimulation of the paretic hand after stroke and changes in interhemispheric interactions. We advanced our understanding of the interactions between interhemispheric interactions and intracortical inhibitory gabaergic circuits during movement preparation after stroke. In collaboration with extramural investigators, we proceeded to study further the influence of somatosensory stimulation on motor function when administered in the weeks following stroke. Our future plans include advancing our understanding of the mechanisms by which each of these different stimulation techniques including somatosensory stimulation, cortical stimulation and brain computer interfaces contribute to recovery of motor functions after brain lesions. Some of this work will be focused in the upcoming year on traumatic brain injury, predominantly mild to moderate. Additionally, we will try to determine the optimal parameters of stimulation and techniques to enhance the beneficial effects of this intervention on neurorehabilitative treatments. Implications: The significance of this project is that it can lead to a better understanding of the mechanisms underlying rehabilitative processes and to the development of more effective interventions to improve neurological outcome after stroke and traumatic brain injury using brain stimulation techniques.