中国神经再生研究(英文版)

中国神经再生研究(英文版) ›› 2015, Vol. 10 ›› Issue (12): 2072-2080.doi: 10.4103/1673-5374.172329

• 综述:脑损伤修复保护与再生 • 上一篇    

脑卒中后步态恢复过程中非侵袭性脑刺激干预与神经可塑性

  

  • 收稿日期:2015-03-28 出版日期:2015-12-30 发布日期:2015-12-30
  • 基金资助:

    国家自然科学基金(Grant No. 30973165, 81372108)，中山大学临床研究5010课题任务( No. 2014001)

Neuroplasticity in post-stroke gait recovery and noninvasive brain stimulation

Yi Xu1, 2, 3, Qing-hua Hou4, Shawn D. Russell3, Bradford C. Bennett5, Andrew J. Sellers6, Qiang Lin1, 2, Dong-feng Huang1, 2, *   

  1. 1 Department of Rehabilitation Medicine, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
    2 Guangdong Provincial Engineering Technology Research Center for Rehabilitation Medicine and Clinical Translation, Guangzhou, Guangdong Province, China
    3 Motion Analysis and Motor Performance Laboratory, Department of Orthopedics and Mechanical Engineering, University of Virginia,
    Charlottesville, VA, USA
    4 Department of Neurology, Guangdong No.2 Provincial People’s Hospital, Guangzhou, Guangdong Province, China
    5 H.C Sweere Center for Clinical Biomechanics and Applied Ergonomics, Northwestern Health Science University, Bloomington, MN, USA
    6 Department of Radiology, Naval Medical Center Portsmouth, Portsmouth, VA, USA
  • Received:2015-03-28 Online:2015-12-30 Published:2015-12-30
  • Contact: Dong-feng Huang, M.D., huangdf_sysu@163.com.
  • Supported by:

    This work was supported by the National Natural Science Foundation of China, No. 30973165, 81372108, and a grant from Clinical Research 5010 Program Mission Statement of Sun Yat-Sen University, China, No. 2014001.

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摘要：

步态异常是严重影响脑卒中后康复的问题。非侵袭性脑刺激可增强神经可塑性，并有改善脑卒中后步态的作用，然而干预效果的个体差异也是不容忽视的。我们首先综述了人类步态的神经生理特征及脑卒中后步态恢复中的神经可塑性特点，继而讨论了非侵袭性脑刺激增强脑卒中后神经可塑性的可行性。非侵袭性脑刺激应该与康复训练，以及其他利于神经可塑性增强的技术方法结合应用，达到促进脑卒中后步态恢复的目的。

关键词: 神经再生, 脑卒中, 脑血管疾病, 神经可塑性, 经颅磁刺激, 经颅直流电刺激, 电刺激疗法, 步态, 行走, 步态异常, 康复

Abstract:

Gait disorders drastically affect the quality of life of stroke survivors, making post-stroke rehabilitation an important research focus. Noninvasive brain stimulation has potential in facilitating neuroplasticity and improving post-stroke gait impairment. However, a large inter-individual variability in the response to noninvasive brain stimulation interventions has been increasingly recognized. We first review the neurophysiology of human gait and post-stroke neuroplasticity for gait recovery, and then discuss how noninvasive brain stimulation techniques could be utilized to enhance gait recovery. While post-stroke neuroplasticity for gait recovery is characterized by use-dependent plasticity, it evolves over time, is idiosyncratic, and may develop maladaptive elements. Furthermore, noninvasive brain stimulation has limited reach capability and is facilitative-only in nature. Therefore, we recommend that noninvasive brain stimulation be used adjunctively with rehabilitation training and other concurrent neuroplasticity facilitation techniques.Additionally, when noninvasive brain stimulation is applied for the rehabilitation of gait impairment in stroke survivors, stimulation montages should be customized according to the specific types of neuroplasticity found in each individual. This could be done using multiple mapping techniques.

Key words: nerve regeneration, stroke, cerebrovascular disorders, transcranial magnetic stimulation, neuroplasticity, transcranial direct current stimulation, electrical stimulation therapy, gait, walking, gait disorders, rehabilitation, neural regeneration