Azzollini Valentina, Dalise Stefania, Chisari Carmelo
Department of Translational Research and New Technologies in Medicine and Surgery, DS Neurorehabilitation, University of Pisa, Pisa, Italy.
Department of Neurorehabilitation, Pisa University Hospital - Azienda Ospedaliera Universitaria Pisana (AOUP), Pisa, Italy.
Front Neurol. 2021 Dec 23;12:797559. doi: 10.3389/fneur.2021.797559. eCollection 2021.
Long-term disability caused by stroke is largely due to an impairment of motor function. The functional consequences after stroke are caused by central nervous system adaptations and modifications, but also by the peripheral skeletal muscle changes. The nervous and muscular systems work together and are strictly dependent in their structure and function, through afferent and efferent communication pathways with a reciprocal "modulation." Knowing how altered interaction between these two important systems can modify the intrinsic properties of muscle tissue is essential in finding the best rehabilitative therapeutic approach. Traditionally, the rehabilitation effort has been oriented toward the treatment of the central nervous system damage with a central approach, overlooking the muscle tissue. However, to ensure greater effectiveness of treatments, it should not be forgotten that muscle can also be a target in the rehabilitation process. The purpose of this review is to summarize the current knowledge about the skeletal muscle changes, directly or indirectly induced by stroke, focusing on the changes induced by the treatments most applied in stroke rehabilitation. The results of this review highlight changes in several muscular features, suggesting specific treatments based on biological knowledge; on the other hand, in standard rehabilitative practice, a realist muscle function evaluation is rarely carried out. We provide some recommendations to improve a comprehensive muscle investigation, a specific rehabilitation approach, and to draw research protocol to solve the remaining conflicting data. Even if a complete multilevel muscular evaluation requires a great effort by a multidisciplinary team to optimize motor recovery after stroke.
中风导致的长期残疾很大程度上归因于运动功能受损。中风后的功能后果是由中枢神经系统的适应和改变引起的，但也与外周骨骼肌的变化有关。神经和肌肉系统协同工作，通过传入和传出通信途径以及相互的“调节”，在结构和功能上紧密相关。了解这两个重要系统之间改变的相互作用如何改变肌肉组织的内在特性，对于找到最佳的康复治疗方法至关重要。传统上，康复努力一直以中枢方法治疗中枢神经系统损伤为导向，而忽略了肌肉组织。然而，为确保治疗更有效，不应忘记肌肉也可以是康复过程中的一个靶点。本综述的目的是总结目前关于中风直接或间接引起的骨骼肌变化的知识，重点关注中风康复中最常用治疗方法所引起的变化。本综述的结果突出了几个肌肉特征方面的变化，表明应基于生物学知识进行特定治疗；另一方面，在标准康复实践中，很少对肌肉功能进行实际评估。我们提供了一些建议，以改进全面的肌肉检查、特定的康复方法，并制定研究方案以解决其余相互矛盾的数据。即使完整的多层次肌肉评估需要多学科团队付出巨大努力，以优化中风后的运动恢复。
