J.M. Cassidy, PT, DPT, PhD Candidate, Graduate Program in Rehabilitation Science, University of Minnesota, 420 Delaware St SE, MMC 388, Minneapolis, MN 55455 (USA).
Phys Ther. 2014 Jan;94(1):139-50. doi: 10.2522/ptj.20130027. Epub 2013 Aug 15.
Repetitive transcranial magnetic stimulation (rTMS) is emerging as a potentially valuable intervention to augment the effects of behavioral therapy for stroke. When used in conjunction with other therapies, rTMS embraces the concept of metaplasticity. Due to homeostatic mechanisms inherent to metaplasticity, interventions known to be in isolation to enhance excitability can interact when applied successively under certain timing conditions and produce enhanced or opposite effects. Similar to "muscular wisdom," with its self-protective mechanisms, there also appears to be "synaptic wisdom" in neural networks with homeostatic processes that prevent over- and under-excitability. These processes have implications for both enhancing and suppressing the excitability effects from behavioral therapy. The purpose of this article is to relate the concept of metaplasticity, as derived from studies in humans who are healthy, to stroke rehabilitation and consider how it can be leveraged to maximize stroke outcomes.
重复经颅磁刺激（rTMS）作为一种有潜力的干预手段，可以增强行为疗法对中风的疗效。当与其他疗法结合使用时，rTMS 包含了易化现象的概念。由于易化现象固有的自身平衡机制，已知的单独用于增强兴奋性的干预措施在特定的时间条件下连续应用时会相互作用，从而产生增强或相反的效果。类似于“肌肉智慧”及其自我保护机制，在具有自身平衡过程的神经网络中似乎也存在“突触智慧”，它可以防止过度和不足的兴奋性。这些过程对增强和抑制行为疗法的兴奋性效应都有影响。本文的目的是将源自健康人群的易化现象概念与中风康复联系起来，并考虑如何利用它来最大限度地提高中风的治疗效果。
