McDonald John W, Sadowsky Cristina L, Stampas Argyrios
Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Handb Clin Neurol. 2012;109:317-36. doi: 10.1016/B978-0-444-52137-8.00020-6.
For neurorehabilitation of patients with spinal cord injury (SCI), the traditional emphasis on social adaptation is being expanded to include strategies that promote plasticity and regeneration in the central nervous system. Such strategies are needed to optimize recovery of neurological function. For example, the known dependence of most cellular processes on physical activity has led to the novel concept that activity is important in neural repair. This hypothesis has given rise to activity-based restoration therapies (ABRT), which aim to optimize neural activity in the damaged spinal cord, particularly below the injury level. Here, we review the basic science and clinical evidence supporting the lifelong use of ABRT for recovery from spinal cord injury. We define and describe ABRT, and discuss its components, its clinical applications, its relationship to medical management of spinal cord injury, and the potential influences of medications on recovery. We also discuss the health benefits of ABRT under physiological and pathological conditions. We stress that lifelong ABRT is required to optimize return of function and to allow patients to benefit from any "cures" that will be discovered.
对于脊髓损伤（SCI）患者的神经康复，传统上对社会适应的强调正在扩展，以纳入促进中枢神经系统可塑性和再生的策略。需要这些策略来优化神经功能的恢复。例如，大多数细胞过程对体力活动的已知依赖性导致了一个新的概念，即活动在神经修复中很重要。这一假设催生了基于活动的恢复疗法（ABRT），其旨在优化受损脊髓中的神经活动，尤其是损伤水平以下的神经活动。在此，我们综述支持终身使用ABRT促进脊髓损伤恢复的基础科学和临床证据。我们定义并描述ABRT，并讨论其组成部分、临床应用、与脊髓损伤医疗管理的关系以及药物对恢复的潜在影响。我们还讨论了生理和病理条件下ABRT对健康的益处。我们强调，需要终身进行ABRT以优化功能恢复，并使患者能够从未来发现的任何“治愈方法”中受益。
