Sánchez Natalia, Winstein Carolee J
Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, United States.
Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States.
Front Hum Neurosci. 2021 Apr 20;15:644335. doi: 10.3389/fnhum.2021.644335. eCollection 2021.
Stroke continues to be a leading cause of disability. Basic neurorehabilitation research is necessary to inform the neuropathophysiology of impaired motor control, and to develop targeted interventions with potential to remediate disability post-stroke. Despite knowledge gained from basic research studies, the effectiveness of research-based interventions for reducing motor impairment has been no greater than standard of practice interventions. In this perspective, we offer suggestions for overcoming translational barriers integral to experimental design, to augment traditional protocols, and re-route the rehabilitation trajectory toward recovery and away from compensation. First, we suggest that researchers consider modifying task practice schedules to focus on key aspects of movement quality, while minimizing the appearance of compensatory behaviors. Second, we suggest that researchers supplement primary outcome measures with secondary measures that capture emerging maladaptive compensations at other segments or joints. Third, we offer suggestions about how to maximize participant engagement, self-direction, and motivation, by embedding the task into a meaningful context, a strategy more likely to enable goal-action coupling, associated with improved neuro-motor control and learning. Finally, we remind the reader that motor impairment post-stroke is a multidimensional problem that involves central and peripheral sensorimotor systems, likely influenced by chronicity of stroke. Thus, stroke chronicity should be given special consideration for both participant recruitment and subsequent data analyses. We hope that future research endeavors will consider these suggestions in the design of the next generation of intervention studies in neurorehabilitation, to improve translation of research advances to improved participation and quality of life for stroke survivors.
中风仍然是导致残疾的主要原因。基础神经康复研究对于了解运动控制受损的神经病理生理学以及开发有潜力改善中风后残疾状况的针对性干预措施至关重要。尽管从基础研究中获得了相关知识，但基于研究的干预措施在减轻运动障碍方面的有效性并不比常规实践干预措施更高。从这个角度出发，我们针对克服实验设计中固有的转化障碍提出建议，以增强传统方案，并将康复轨迹从代偿转向恢复。首先，我们建议研究人员考虑修改任务练习计划，专注于运动质量的关键方面，同时尽量减少代偿行为的出现。其次，我们建议研究人员用辅助测量指标补充主要结局指标，这些辅助指标能够捕捉其他节段或关节出现的不良适应性代偿。第三，我们就如何通过将任务嵌入有意义的情境中来最大限度地提高参与者的参与度、自我导向能力和积极性提供建议，这种策略更有可能实现目标 - 行动耦合，与改善神经运动控制和学习相关。最后，我们提醒读者，中风后的运动障碍是一个多维度问题，涉及中枢和外周感觉运动系统，可能受中风病程的影响。因此，在参与者招募和后续数据分析中都应特别考虑中风病程。我们希望未来的研究工作在设计下一代神经康复干预研究时会考虑这些建议，以促进研究进展转化为中风幸存者更好的参与度和生活质量。
