Cheng Ivy, Hamdy Shaheen
Centre for Gastrointestinal Sciences, Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
Neurol Sci. 2022 Jan;43(1):199-209. doi: 10.1007/s10072-021-05654-9. Epub 2021 Oct 16.
Dysphagia is a common and devastating complication following brain damage. Over the last 2 decades, dysphagia treatments have shifted from compensatory to rehabilitative strategies that facilitate neuroplasticity, which is the reorganization of neural networks that is essential for functional recovery. Moreover, there is growing interest in the application of cortical and peripheral neurostimulation to promote such neuroplasticity. Despite some preliminary positive findings, the variability in responsiveness toward these treatments remains substantial. The purpose of this review is to summarize findings on the effects of neurostimulation in promoting neuroplasticity for dysphagia rehabilitation and highlight the need to develop more effective treatment strategies. We then discuss the role of metaplasticity, a homeostatic mechanism of the brain to regulate plasticity changes, in helping to drive neurorehabilitation. Finally, a hypothesis on how metaplasticity could be applied in dysphagia rehabilitation to enhance treatment outcomes is proposed.
吞咽困难是脑损伤后常见且严重的并发症。在过去20年中，吞咽困难的治疗已从代偿性策略转向促进神经可塑性的康复策略，神经可塑性是神经网络的重组，对功能恢复至关重要。此外，人们越来越关注应用皮层和外周神经刺激来促进这种神经可塑性。尽管有一些初步的阳性结果，但对这些治疗的反应变异性仍然很大。本综述的目的是总结神经刺激在促进吞咽困难康复的神经可塑性方面的作用，并强调需要制定更有效的治疗策略。然后，我们讨论了元可塑性（一种调节可塑性变化的大脑稳态机制）在推动神经康复中的作用。最后，提出了一个关于如何将元可塑性应用于吞咽困难康复以提高治疗效果的假设。
