周围神经损伤、疼痛与神经可塑性。
Peripheral nerve injuries, pain, and neuroplasticity.
机构信息
Krembil Research Institute, Toronto Western Hospital, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.
Krembil Research Institute, Toronto Western Hospital, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
出版信息
J Hand Ther. 2018 Apr-Jun;31(2):184-194. doi: 10.1016/j.jht.2018.01.011.
INTRODUCTION
Peripheral nerve injuries (PNIs) cause both structural and functional brain changes that may be associated with significant sensorimotor abnormalities and pain.
PURPOSE OF THE STUDY
The aim of this narrative review is to provide hand therapists an overview of PNI-induced neuroplasticity and to explain how the brain changes following PNI, repair, and during rehabilitation.
METHODS
Toward this goal, we review key aspects of neuroplasticity and neuroimaging and discuss sensory testing techniques used to study neuroplasticity in PNI patients.
RESULTS
We describe the specific brain changes that occur during the repair and recovery process of both traumatic (eg, transection) and nontraumatic (eg, compression) nerve injuries. We also explain how these changes contribute to common symptoms including hypoesthesia, hyperalgesia, cold sensitivity, and chronic neurogenic pain. In addition, we describe how maladaptive neuroplasticity as well as psychological and personality characteristics impacts treatment outcome.
DISCUSSION AND CONCLUSION
Greater understanding of the brain's contribution to symptoms in recovering PNI patients could help guide rehabilitation strategies and inform the development of novel techniques to counteract these maladaptive brain changes and ultimately improve outcomes.
简介
周围神经损伤（PNI）会导致结构和功能上的大脑变化，这些变化可能与明显的感觉运动异常和疼痛有关。
目的
本综述旨在为手部治疗师提供 PNI 诱导的神经可塑性概述，并解释 PNI 后、修复过程中和康复期间大脑如何发生变化。
方法
为实现这一目标，我们回顾了神经可塑性和神经影像学的关键方面，并讨论了用于研究 PNI 患者神经可塑性的感觉测试技术。
结果
我们描述了外伤性（例如，切断）和非外伤性（例如，压迫）神经损伤修复和恢复过程中发生的特定大脑变化。我们还解释了这些变化如何导致常见症状，包括感觉迟钝、痛觉过敏、冷敏感和慢性神经性疼痛。此外，我们还描述了适应不良的神经可塑性以及心理和个性特征如何影响治疗结果。
讨论和结论
对恢复中的 PNI 患者大脑对症状的贡献有更深入的了解，可以帮助指导康复策略，并为对抗这些适应不良的大脑变化提供新的技术，最终改善治疗效果。
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