a Private Inpatient Unit , Santa Lucia foundation IRCCS , Rome , Italy.
b Clinical Laboratory of Experimental Neurorehabilitation , Santa Lucia Foundation IRCCS , Rome , Italy.
Expert Rev Med Devices. 2019 Mar;16(3):187-195. doi: 10.1080/17434440.2019.1574567. Epub 2019 Feb 6.
In recent years, neurorehabilitation has moved from a 'bottom-up' to a 'top down' approach. This change has also involved the technological devices developed for motor and cognitive rehabilitation. It implies that during a task or during therapeutic exercises, new 'top-down' approaches are being used to stimulate the brain in a more direct way to elicit plasticity-mediated motor re-learning. This is opposed to 'Bottom up' approaches, which act at the physical level and attempt to bring about changes at the level of the central neural system.
In the present unsystematic review, we present the most promising innovative technological devices that can effectively support rehabilitation based on a top-down approach, according to the most recent neuroscientific and neurocognitive findings. In particular, we explore if and how the use of new technological devices comprising serious exergames, virtual reality, robots, brain computer interfaces, rhythmic music and biofeedback devices might provide a top-down based approach.
Motor and cognitive systems are strongly harnessed in humans and thus cannot be separated in neurorehabilitation. Recently developed technologies in motor-cognitive rehabilitation might have a greater positive effect than conventional therapies.
近年来，神经康复已经从“自下而上”的方法转变为“自上而下”的方法。这种转变也涉及到为运动和认知康复开发的技术设备。这意味着在任务或治疗性运动期间，正在使用新的“自上而下”方法更直接地刺激大脑，以引发与可塑性相关的运动再学习。这与“自下而上”的方法相反，后者作用于物理层面，并试图在中枢神经系统层面引起变化。
在本非系统性综述中，我们根据最新的神经科学和神经认知发现，介绍了最有前途的创新技术设备，这些设备可以有效地支持基于自上而下方法的康复。特别是，我们探讨了使用包含严肃游戏、虚拟现实、机器人、脑机接口、有节奏的音乐和生物反馈设备等新技术设备是否以及如何提供基于自上而下的方法。
运动和认知系统在人类中被紧密地利用，因此在神经康复中不能被分开。最近在运动认知康复方面开发的技术可能比传统疗法有更大的积极影响。
