Nudo R J, Friel K M
Center on Aging, University of Kansas Medical Center, Kansas City 66160, USA.
Rev Neurol (Paris). 1999;155(9):713-7.
While adaptive processes in the cerebral cortex have long been thought to contribute to functional recovery after stroke, the precise neuronal structures and mechanisms underlying these processes have been difficult to identify. Over the past 15 years, a large number of studies conducted in human stroke patients and in experimental animal models have contributed to a more coherent picture of the brain's adaptive capacity after injury. These studies suggest that the cerebral cortex undergoes significant and functional structural plasticity for at least several weeks to months following injury. Adaptive changes have been demonstrated in the intact tissue surrounding the lesion, as well as in other cortical motor areas remote from the site of injury. Recent results from non-human primate studies of cortical reorganization after stroke demonstrate marked functional changes in the intact cortical tissue adjacent to the infarct in the weeks following an ischemic lesion. Further, intensive task-specific practice with the impaired limb has a modulatory effect on the inevitable cortical plasticity. Taken together with parallel studies of forced use in human stroke patients, it is likely that use of the impaired limb can influence adaptive reorganizational mechanisms in the intact cerebral cortex, and thus, promote functional recovery.
长期以来，人们一直认为大脑皮层的适应性过程有助于中风后的功能恢复，但这些过程背后精确的神经元结构和机制一直难以确定。在过去15年里，对人类中风患者和实验动物模型进行的大量研究，使人们对大脑损伤后的适应能力有了更连贯的认识。这些研究表明，大脑皮层在损伤后至少几周至几个月内会经历显著的功能结构可塑性变化。在损伤周围的完整组织以及远离损伤部位的其他皮质运动区域都已证实存在适应性变化。非人灵长类动物中风后皮质重组研究的最新结果表明，在缺血性损伤后的几周内，梗死灶附近的完整皮质组织会出现明显的功能变化。此外，对受损肢体进行强化的特定任务练习，对不可避免的皮质可塑性有调节作用。结合对人类中风患者强制使用疗法的平行研究，受损肢体的使用很可能会影响完整大脑皮层中的适应性重组机制，从而促进功能恢复。
