Centre de recherche sur le vieillissement, faculté de médecine et des sciences de la santé de l'université de Sherbrooke, Sherbrooke, Québec (QC), Canada.
Centre de recherche sur le vieillissement, faculté de médecine et des sciences de la santé de l'université de Sherbrooke, Sherbrooke, Québec (QC), Canada.
Ann Phys Rehabil Med. 2018 Jul;61(4):224-234. doi: 10.1016/j.rehab.2017.04.003. Epub 2017 Jun 7.
Physical training is known to be an effective intervention to improve sensorimotor impairments after stroke. However, the link between brain plastic changes, assessed by transcranial magnetic stimulation (TMS), and sensorimotor recovery in response to physical training is still misunderstood. We systematically reviewed reports of randomized controlled trials (RCTs) involving the use of TMS over the primary motor cortex (M1) to probe brain plasticity after upper-limb physical training interventions in people with stroke.
We searched 5 databases for articles published up to October 2016, with additional studies identified by hand-searching. RCTs had to investigate pre/post-intervention changes in at least one TMS outcome measure. Two independent raters assessed the eligibility of potential studies and reviewed the selected articles' quality by using 2 critical appraisal scales.
In total, 14 reports of RCTs (pooled participants=358; mean 26±12 per study) met the selection criteria. Overall, 11 studies detected plastic changes with TMS in the presence of clinical improvements after training, and these changes were more often detected in the affected hemisphere by using map area and motor evoked potential (MEP) latency outcome measures. Plastic changes mostly pointed to increased M1/corticospinal excitability and potential interhemispheric rebalancing of M1 excitability, despite sometimes controversial results among studies. Also, the strength of the review observations was affected by heterogeneous TMS methods and upper-limb interventions across studies as well as several sources of bias within the selected studies.
The current evidence encourages the use of TMS outcome measures, especially MEP latency and map area to investigate plastic changes in the brain after upper-limb physical training post-stroke. However, more studies involving rigorous and standardized TMS procedures are needed to validate these observations.
运动训练已被证实是改善脑卒中后感觉运动功能障碍的有效干预手段。然而，经颅磁刺激（TMS）评估的大脑可塑性变化与运动训练后感觉运动功能恢复之间的联系仍不清楚。我们系统地检索了涉及使用 TMS 刺激初级运动皮层（M1）来探测脑卒中患者上肢运动训练干预后大脑可塑性变化的随机对照试验（RCT）的报告。
我们检索了截至 2016 年 10 月的 5 个数据库中的文章，并通过手工检索确定了额外的研究。RCT 必须调查 TMS 结果测量至少有一项干预前后的变化。两名独立的评估员评估潜在研究的资格，并使用 2 个关键评估量表审查所选文章的质量。
共有 14 项 RCT 的报告（汇总参与者=358；每项研究平均 26±12）符合选择标准。总的来说，11 项研究在训练后临床改善的情况下检测到 TMS 中的可塑性变化，并且这些变化更经常在患病侧通过使用地图面积和运动诱发电位（MEP）潜伏期的结果测量来检测到。尽管在研究中有时会出现争议结果，但这些变化主要指向 M1/皮质脊髓兴奋性增加和 M1 兴奋性的潜在大脑半球间平衡。此外，综述观察的强度受到跨研究的 TMS 方法和上肢干预以及所选研究中几个偏倚来源的影响。
目前的证据鼓励使用 TMS 结果测量，尤其是 MEP 潜伏期和地图面积来研究脑卒中后上肢运动训练后大脑的可塑性变化。然而，需要更多涉及严格和标准化 TMS 程序的研究来验证这些观察结果。
