使用非侵入性脑刺激增强运动训练诱导的可塑性。

Using non-invasive brain stimulation to augment motor training-induced plasticity.

作者信息

Bolognini Nadia, Pascual-Leone Alvaro, Fregni Felipe

机构信息

Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA.

出版信息

J Neuroeng Rehabil. 2009 Mar 17;6:8. doi: 10.1186/1743-0003-6-8.

Abstract

Therapies for motor recovery after stroke or traumatic brain injury are still not satisfactory. To date the best approach seems to be the intensive physical therapy. However the results are limited and functional gains are often minimal. The goal of motor training is to minimize functional disability and optimize functional motor recovery. This is thought to be achieved by modulation of plastic changes in the brain. Therefore, adjunct interventions that can augment the response of the motor system to the behavioural training might be useful to enhance the therapy-induced recovery in neurological populations. In this context, noninvasive brain stimulation appears to be an interesting option as an add-on intervention to standard physical therapies. Two non-invasive methods of inducing electrical currents into the brain have proved to be promising for inducing long-lasting plastic changes in motor systems: transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS). These techniques represent powerful methods for priming cortical excitability for a subsequent motor task, demand, or stimulation. Thus, their mutual use can optimize the plastic changes induced by motor practice, leading to more remarkable and outlasting clinical gains in rehabilitation. In this review we discuss how these techniques can enhance the effects of a behavioural intervention and the clinical evidence to date.

摘要

中风或创伤性脑损伤后运动功能恢复的治疗方法仍不尽人意。迄今为止,最佳方法似乎是强化物理治疗。然而,其结果有限,功能改善往往微乎其微。运动训练的目标是尽量减少功能残疾并优化功能性运动恢复。人们认为这可通过调节大脑中的可塑性变化来实现。因此,能够增强运动系统对行为训练反应的辅助干预措施,可能有助于提高神经疾病患者的治疗性恢复。在这种情况下,无创脑刺激作为标准物理治疗的附加干预措施似乎是一个有趣的选择。已证明两种将电流导入大脑的无创方法有望在运动系统中诱导持久的可塑性变化:经颅磁刺激(TMS)和经颅直流电刺激(tDCS)。这些技术是激发皮层兴奋性以应对后续运动任务、需求或刺激的有力方法。因此,它们的联合使用可以优化运动练习所诱导的可塑性变化,从而在康复中带来更显著和持久的临床改善。在本综述中,我们讨论了这些技术如何增强行为干预的效果以及迄今为止的临床证据。

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