Dobkin Bruce H, Carmichael S Thomas
David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
Neurorehabil Neural Repair. 2016 Jun;30(5):470-8. doi: 10.1177/1545968315604400. Epub 2015 Sep 10.
Novel molecular, cellular, and pharmacological therapies to stimulate repair of sensorimotor circuits after stroke are entering clinical trials. Compared with acute neuroprotection and thrombolysis studies, clinical trials for repair in subacute and chronic hemiplegic participants have a different time course for delivery of an intervention, different mechanisms of action within the milieu of the injury, distinct relationships to the amount of physical activity and skills practice of participants, and need to include more refined outcome measures. This review examines the biological interaction of targeted rehabilitation with neural repair strategies to optimize outcomes. We suggest practical guidelines for the incorporation of inexpensive skills training and exercise at home. In addition, we describe some novel outcome measurement tools, including wearable sensors, to obtain the more detailed outcomes that may identify at least some minimal level of success from cellular and regeneration interventions. Thus, proceeding in the shadow of acute stroke trial designs may unnecessarily limit the mechanisms of action of new repair strategies, reduce their impact on participants, and risk missing important behavioral outcomes.
用于促进中风后感觉运动回路修复的新型分子、细胞和药物疗法正在进入临床试验阶段。与急性神经保护和溶栓研究相比，针对亚急性和慢性偏瘫患者进行修复的临床试验在干预措施的实施时间进程、损伤环境中的不同作用机制、与患者身体活动量和技能练习的不同关系方面存在差异，并且需要纳入更精细的结局指标。本综述探讨了针对性康复与神经修复策略之间的生物学相互作用，以优化治疗效果。我们提出了在家中开展低成本技能训练和锻炼的实用指南。此外，我们还描述了一些新型结局测量工具，包括可穿戴传感器，以获取更详细的结局，这些结局可能会确定细胞和再生干预措施至少取得了一些最低限度的成功。因此，照搬急性中风试验设计可能会不必要地限制新修复策略的作用机制，降低其对患者的影响，并有可能遗漏重要的行为学结局。
