Lamola Giuseppe, Fanciullacci Chiara, Rossi Bruno, Chisari Carmelo
Unit of Neurorehabilitation, University Hospital of Pisa, Via Paradisa 2 - 56124 Pisa, Italy. Email:
Arch Ital Biol. 2014 Dec;152(4):259-71. doi: 10.12871/00039829201446.
Emerging findings deriving from neuromodulation and neuroradiology are providing us new insights about plas- ticity and functional reorganization of the brain after stroke, but the direct clinical assessment of motor function should still be considered an indispensable tool for the evaluation of the effects of plasticity in stroke patients. Recovery of motor function can be spontaneous or guided by training. Substantial functional recovery can occur spontaneously especially in the first month post-stroke. Instead, the guided recovery may take more time and may rely on a number of rehabilitation techniques which proved to be capable of stimulating cerebral plasticity. Even the time course of these processes is a decisive element. First, it is important to correlate the trends of plasticity after stroke, from the enhancement of earlier periods to the later stages, to the behavioral changes observed. Furthermore, it is crucial to distinguish recovery of function occurring through improvement of motor deficit from compensatory mechanisms, distinction that has also an effect on timing of recovery. Another relevant question is the maintenance over time of the improvements reached with the treatment, feature on which various clinical studies have been conducted in acute and chronic stroke patients. Further studies are needed to allow us to get a more precise definition of the potentiality of functional recovery and of the mechanisms underlying the recovery depending on its levels and timing. Understanding the mechanisms, the effects and the limits of neural plasticity may eventually help enhancing the recovery process in stroke patients, significantly improving the quality of life of these patients. Then, a greater attention towards the clinical implica- tions of the changes related to plasticity can be a crucial element to further improve the therapeutic options used in neurorehabilitation.
神经调节和神经放射学的新发现为我们提供了有关中风后大脑可塑性和功能重组的新见解，但运动功能的直接临床评估仍应被视为评估中风患者可塑性影响的不可或缺的工具。运动功能的恢复可以是自发的，也可以是由训练引导的。显著的功能恢复尤其可能在中风后的第一个月自发出现。相反，引导性恢复可能需要更多时间，并且可能依赖于一些已被证明能够刺激大脑可塑性的康复技术。甚至这些过程的时间进程也是一个决定性因素。首先，将中风后可塑性的趋势，从早期的增强到后期阶段，与观察到的行为变化联系起来很重要。此外，区分通过运动功能缺陷改善而发生的功能恢复与代偿机制至关重要，这种区分也对恢复时间有影响。另一个相关问题是治疗所达到的改善随时间的维持情况，针对这一特征已经在急性和慢性中风患者中进行了各种临床研究。需要进一步的研究，以便我们能够更精确地定义功能恢复的潜力以及取决于其水平和时间的恢复潜在机制。了解神经可塑性的机制、影响和局限性最终可能有助于增强中风患者的恢复过程，显著提高这些患者的生活质量。然后，更加关注与可塑性相关变化的临床意义可能是进一步改善神经康复中所用治疗选择的关键因素。
