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年人长期残疾的主要原因。没有普遍接受的治疗方法可用于治疗这种疾病，这种残疾的经济，个人，家庭和社会成本不可低估。来自不同实验室的初步数据表明，有可能通过药理学、脑刺激和体感刺激技术来调节受损大脑中的可塑性过程。本Z01的目的是表征最有前途的技术，以改善这些患者的皮质可塑性，以提高功能恢复。 今年的发现：今年，我们研究了与中风后癫痫相关的运动皮层功能，这是一个以前没有详细探索过的领域，发现运动皮层兴奋性变化与这种情况之间存在重要的相关性。我们扩展了体感刺激对中风后运动功能的有用性的工作，并特别研究了这种干预后对侧病变初级运动皮质的功能。 我们的一位研究员在《神经病学》杂志上描述了神经康复作为一个子专业的发展。 我们继续努力，以更好地了解中风和其他疾病继发性瘫痪患者的脑机接口的生理学。 我们的特点是中风后的身体训练的行动观察的影响，注意到它的好处。我们还描述了中风后麻痹手的体感刺激和半球间相互作用变化之间的一组重要的相互作用。 我们进一步了解脑卒中后运动准备过程中大脑半球间的相互作用和皮质内抑制性GABA能回路之间的相互作用。与校外研究者合作，我们进一步研究了在中风后几周内给予体感刺激对运动功能的影响。 我们未来的计划包括推进我们对这些不同刺激技术（包括体感刺激、皮层刺激和脑计算机接口）中的每一种有助于脑损伤后运动功能恢复的机制的理解。 其中一些工作将集中在即将到来的一年创伤性脑损伤，主要是轻度至中度。此外，我们将尝试确定刺激和技术的最佳参数，以增强这种干预对神经康复治疗的有益影响。 含义：该项目的意义在于，它可以更好地理解康复过程的机制，并开发更有效的干预措施，以改善中风和创伤性脑损伤后使用脑刺激技术的神经结果。

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.