Hirsch Theresa, Barthel Maria, Aarts Pauline, Chen Yi-An, Freivogel Susanna, Johnson Michelle J, Jones Theresa A, Jongsma Marijtje L A, Maier Martina, Punt David, Sterr Annette, Wolf Steven L, Heise Kirstin-Friederike
University of Applied Sciences and Arts Hildesheim/Holzminden/Goettingen, Faculty of Social Work and Health, Hildesheim, Germany.
University of Applied Sciences and Arts Hildesheim/Holzminden/Goettingen, Faculty of Engineering and Health, Goettingen, Germany.
Neurorehabil Neural Repair. 2021 May;35(5):383-392. doi: 10.1177/1545968321999064. Epub 2021 Mar 11.
The negative discrepancy between residual functional capacity and reduced use of the contralesional hand, frequently observed after a brain lesion, has been termed (LNU) and is thought to depend on the interaction of neuronal mechanisms during recovery and learning-dependent mechanisms.
Albeit the LNU phenomenon is generally accepted to exist, currently, no transdisciplinary definition exists. Furthermore, although therapeutic approaches are implemented in clinical practice targeting LNU, no standardized diagnostic routine is described in the available literature. Our objective was to reach consensus regarding a definition as well as synthesize knowledge about the current diagnostic procedures.
We used a structured group communication following the Delphi method among clinical and scientific experts in the field, knowledge from both, the work with patient populations and with animal models.
Consensus was reached regarding a transdisciplinary definition of the LNU phenomenon. Furthermore, the mode and strategy of the diagnostic process, as well as the sources of information and outcome parameters relevant for the clinical decision making, were described with a wide range showing the current lack of a consistent universal diagnostic approach.
The need for the development of a structured diagnostic procedure and its implementation into clinical practice is emphasized. Moreover, it exists a striking gap between the prevailing hypotheses regarding the mechanisms underlying the LNU phenomenon and the actual evidence. Therefore, basic research is needed to bridge between bedside and bench and eventually improve clinical decision making and further development of interventional strategies beyond the field of stroke rehabilitation.
脑损伤后经常观察到的残余功能能力与对侧手使用减少之间的负差异，被称为（LNU），并且被认为取决于恢复过程中神经元机制与学习依赖机制的相互作用。
尽管LNU现象普遍被认为存在，但目前尚无跨学科的定义。此外，虽然临床实践中针对LNU实施了治疗方法，但现有文献中未描述标准化的诊断程序。我们的目的是就定义达成共识，并综合有关当前诊断程序的知识。
我们在该领域的临床和科学专家中采用了遵循德尔菲法的结构化小组交流方式，整合了来自患者群体和动物模型研究工作的知识。
就LNU现象的跨学科定义达成了共识。此外，描述了诊断过程的方式和策略，以及与临床决策相关的信息来源和结果参数，广泛显示出目前缺乏一致的通用诊断方法。
强调了开发结构化诊断程序并将其应用于临床实践的必要性。此外，关于LNU现象潜在机制的主流假设与实际证据之间存在明显差距。因此，需要基础研究来弥合临床与实验台之间的差距，并最终改善临床决策以及中风康复领域之外干预策略的进一步发展。
