Hummel F C
Defitech Chair of Clinical Neuroengineering, BrainMind Institute (BMI) and Center for Neuroprosthetics (CNP), Swiss Federal Institute of Technology (EPFL), Campus Biotech, Rm H4.3.132.084 9, Chemin des Mines, 1202, Genf, Schweiz.
Defitech Chair of Clinical Neuroengineering, BrainMind Institute (BMI) and Center for Neuroprosthetics (CNP), Swiss Federal Institute of Technology (EPFL Valais), Clinique Romande de Réadaptation, 1951, Sitten, Schweiz.
Nervenarzt. 2017 Aug;88(8):850-857. doi: 10.1007/s00115-017-0369-0.
Every year in Europe 1.5 million patients suffer a new stroke. Despite the further developments in acute therapy with nationwide stroke units, thrombolysis, thrombectomy and post-acute neurorehabilitation, only a small proportion of patients recover to a satisfactory degree allowing them to return to their normal social and professional life. This makes stroke the main cause of long-term disability with a corresponding impact on patient lives, socioeconomics and the healthcare system. Thus, the concepts of neurorehabilitation have to be extended to enhance the effects of rehabilitative treatment strategies. To achieve this, an understanding of the prediction of the course of recovery, the mechanisms underlying functional recovery and factors influencing recovery have to be enhanced for the development towards patient-tailored precision medicine approaches. A central point towards this is the understanding of stroke as a disease, which not only influences the damaged area but also the associated network. This is crucial for the understanding of the stroke-induced deficits, for prediction of recovery and options for interventional treatment strategies, which can target different areas in this network (e.g. primary motor cortex and secondary motor regions) based on individual factors of the patient. The present article discusses the importance of network alterations for motor neurorehabilitation after a stroke and which novel options, concepts and consequences could arise from this for neurorehabilitation.
在欧洲，每年有150万患者首次发生中风。尽管在急性治疗方面有了进一步发展，建立了全国性的中风单元，开展了溶栓、取栓及急性后期神经康复治疗，但只有一小部分患者能恢复到令人满意的程度，从而能够回归正常的社会和职业生活。这使得中风成为长期残疾的主要原因，对患者生活、社会经济和医疗保健系统产生相应影响。因此，神经康复的理念必须加以扩展，以增强康复治疗策略的效果。要做到这一点，就必须加强对恢复过程预测、功能恢复潜在机制以及影响恢复因素的理解，从而朝着针对患者的精准医疗方法发展。实现这一目标的一个关键点是将中风理解为一种不仅影响受损区域而且影响相关网络的疾病。这对于理解中风导致的功能障碍、预测恢复情况以及介入治疗策略的选择至关重要，这些治疗策略可以根据患者的个体因素针对该网络中的不同区域（如初级运动皮层和次级运动区域）。本文讨论了网络改变对中风后运动神经康复的重要性，以及由此可能为神经康复带来的新选择、新理念和新结果。
