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神经康复:应用神经可塑性

Neurorehabilitation: applied neuroplasticity.

作者信息

Khan Fary, Amatya Bhasker, Galea Mary P, Gonzenbach Roman, Kesselring Jürg

机构信息

Department of Rehabilitation Medicine, Royal Melbourne Hospital, 34-54 Poplar Road, Parkville, Victoria, 3052, Australia.

Department of Medicine (Royal Melbourne Hospital), University of Melbourne, Grattan Street, Parkville, Victoria, Australia.

出版信息

J Neurol. 2017 Mar;264(3):603-615. doi: 10.1007/s00415-016-8307-9. Epub 2016 Oct 24.

Abstract

The prevalence of disability due to neurological conditions is escalating worldwide. Neurological disorders have significant disability-burden with long-term functional and psychosocial issues, requiring specialized rehabilitation services for comprehensive management, especially treatments tapping into brain recovery 'neuroplastic' processes. Neurorehabilitation is interdisciplinary and cross-sectorial, requiring coordinated effort of diverse sectors, professions, patients and community to manage complex condition-related disability. This review provides evidence for a range of neurorehabilitation interventions for four common neurological conditions: multiple sclerosis (MS), stroke, traumatic brain injury and Parkinson's disease using the Grade of Recommendation, Assessment, Development and Evaluation tool for quality of evidence. Although, existing best-evidence for many interventions is still sparse, the overall findings suggest 'strong' evidence for physical therapy and psychological intervention for improved patient outcomes; and. 'moderate' evidence for multidisciplinary rehabilitation for longer term gains at the levels of activity (disability) and participation in MS and stroke population. The effect of other rehabilitation interventions is inconclusive, due to a paucity of methodologically robust studies. More research is needed to improve evidence-base for many promising rehabilitation interventions.

摘要

全球范围内,因神经系统疾病导致的残疾患病率正在不断上升。神经系统疾病会带来严重的残疾负担,并引发长期的功能和心理社会问题,需要专门的康复服务进行综合管理,尤其是采用能促进大脑恢复的“神经可塑性”过程的治疗方法。神经康复具有跨学科和跨部门的特点,需要不同部门、专业人员、患者及社区共同协作,以应对与病情相关的复杂残疾问题。本综述使用推荐分级、评估、制定与评价工具来评估证据质量,为四种常见神经系统疾病——多发性硬化症(MS)、中风、创伤性脑损伤和帕金森病——提供了一系列神经康复干预措施的证据。尽管许多干预措施现有的最佳证据仍然不足,但总体研究结果表明,物理治疗和心理干预对改善患者预后具有“有力”证据支持;而多学科康复对MS和中风患者在活动(残疾)和参与水平上取得长期收益具有“中等”证据支持。由于缺乏方法学严谨的研究,其他康复干预措施的效果尚无定论。需要开展更多研究,以完善许多有前景的康复干预措施的证据基础。

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