Neurological Rehabilitation Unit, Department of Physiotherapy, Bayero University Kano, Nigeria.
Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Movant, Wilrijk, Belgium.
Neural Plast. 2020 Jun 15;2020:9484298. doi: 10.1155/2020/9484298. eCollection 2020.
Recovery of motor function after stroke involves many biomarkers. This review attempts to identify the biomarker effects responsible for recovery of motor function following the use of Constraint-Induced Movement Therapy (CIMT) and discuss their implications for research and practice. From the studies reviewed, the biomarker effects identified include improved perfusion of motor areas and brain glucose metabolism; increased expression of proteins, namely, Brain-Derived Neurotrophic Factor (BDNF), Vascular Endothelial Growth Factor (VEGF), and Growth-Associated Protein 43 (GAP-43); and decreased level of Gamma-Aminobutyric Acid (GABA). Others include increased cortical activation, increased motor map size, and decreased interhemispheric inhibition of the ipsilesional hemisphere by the contralesional hemisphere. Interestingly, the biomarker effects correlated well with improved motor function. However, some of the biomarker effects have not yet been investigated in humans, and they require that CIMT starts early on poststroke. In addition, one study seems to suggest the combined use of CIMT with other rehabilitation techniques such as Transcortical Direct Stimulation (tDCs) in patients with chronic stroke to achieve the biomarker effects. Unfortunately, there are few studies in humans that implemented CIMT during early poststroke. Thus, it is important that more studies in humans are carried out to determine the biomarker effects of CIMT especially early on poststroke, when there is a greater opportunity for recovery. Furthermore, it should be noted that these effects are mainly in ischaemic stroke.
脑卒中后运动功能的恢复涉及多种生物标志物。本综述旨在确定与使用强制性运动疗法（CIMT）后运动功能恢复相关的生物标志物效应，并讨论其对研究和实践的意义。从回顾的研究中发现，生物标志物效应包括运动区灌注和脑葡萄糖代谢的改善；蛋白质表达的增加，即脑源性神经营养因子（BDNF）、血管内皮生长因子（VEGF）和生长相关蛋白 43（GAP-43）；以及γ-氨基丁酸（GABA）水平的降低。其他包括皮质激活增加、运动图大小增加以及对侧半球对同侧半球的抑制作用降低。有趣的是，生物标志物效应与运动功能的改善密切相关。然而，一些生物标志物效应尚未在人类中进行研究，而且它们需要 CIMT 在脑卒中后早期开始。此外，一项研究似乎表明，将 CIMT 与经颅直流电刺激（tDCS）等其他康复技术结合使用，可在慢性脑卒中患者中实现生物标志物效应。遗憾的是，在人类中实施早期 CIMT 的研究较少。因此，有必要在人类中进行更多的研究，以确定 CIMT 的生物标志物效应，特别是在脑卒中后早期，此时恢复的机会更大。此外，值得注意的是，这些效应主要在缺血性脑卒中中。
