Department of Clinical Neuroscience, Wallenberg Neuroscience Center, Lund University, Sweden.
Acta Neurol Scand. 2011 Mar;123(3):147-59. doi: 10.1111/j.1600-0404.2010.01417.x. Epub 2010 Aug 19.
Current understanding of brain plasticity has lead to new approaches in ischemic stroke rehabilitation. Stroke units that combine good medical and nursing care with task-oriented intense training in an environment that provides confidence, stimulation and motivation significantly improve outcome. Repetitive trans-cranial magnetic stimulation (rTMS), and trans-cranial direct current stimulation (tDCS) are applied in rehabilitation of motor function. The long-term effect, optimal way of stimulation and possibly efficacy in cognitive rehabilitation need evaluation. Methods based on multisensory integration of motor, cognitive, and perceptual processes including action observation, mental training, and virtual reality are being tested. Different approaches of intensive aphasia training are described. Recent data on intensive melodic intonation therapy indicate that even patients with very severe non-fluent aphasia can regain speech through homotopic white matter tract plasticity. Music therapy is applied in motor and cognitive rehabilitation. To avoid the confounding effect of spontaneous improvement, most trials are preformed ≥3 months post stroke. Randomized controlled trials starting earlier after strokes are needed. More attention should be given to stroke heterogeneity, cognitive rehabilitation, and social adjustment and to genetic differences, including the role of BDNF polymorphism in brain plasticity.
目前对大脑可塑性的认识已经为缺血性中风康复带来了新的方法。将良好的医疗和护理与在提供信心、刺激和动力的环境中进行以任务为导向的强化训练相结合的中风单元，可显著改善预后。重复经颅磁刺激（rTMS）和经颅直流电刺激（tDCS）应用于运动功能康复。其长期效果、最佳刺激方式以及在认知康复中的疗效仍需要评估。基于运动、认知和感知过程的多感觉整合的方法，包括动作观察、心理训练和虚拟现实，正在进行测试。密集型失语症训练的不同方法也有所描述。最近关于密集型旋律语调治疗的数据表明，即使是患有非常严重的非流利性失语症的患者，也可以通过同源白质束可塑性恢复言语。音乐疗法应用于运动和认知康复。为了避免自发改善的混杂影响，大多数试验在中风后≥3 个月进行。需要进行更早开始的随机对照试验。应该更加关注中风的异质性、认知康复、社会调整以及遗传差异，包括 BDNF 多态性在大脑可塑性中的作用。
