Breathing Research and Therapeutics Center, Department of Physical Therapy and McKnight Brain Institute, University of Florida, Gainesville, FL, United States.
Department of Comparative Biosciences, School of Veterinary Medicine, University of Wisconsin, Madison, WI, United States.
Handb Clin Neurol. 2022;188:409-432. doi: 10.1016/B978-0-323-91534-2.00016-3.
Widespread appreciation that neuroplasticity is an essential feature of the neural system controlling breathing has emerged only in recent years. In this chapter, we focus on respiratory motor plasticity, with emphasis on the phrenic motor system. First, we define related but distinct concepts: neuromodulation and neuroplasticity. We then focus on mechanisms underlying two well-studied models of phrenic motor plasticity: (1) phrenic long-term facilitation following brief exposure to acute intermittent hypoxia; and (2) phrenic motor facilitation after prolonged or recurrent bouts of diminished respiratory neural activity. Advances in our understanding of these novel and important forms of plasticity have been rapid and have already inspired translation in multiple respects: (1) development of novel therapeutic strategies to preserve/restore breathing function in humans with severe neurological disorders, such as spinal cord injury and amyotrophic lateral sclerosis; and (2) the discovery that similar plasticity also occurs in nonrespiratory motor systems. Indeed, the realization that similar plasticity occurs in respiratory and nonrespiratory motor neurons inspired clinical trials to restore leg/walking and hand/arm function in people living with chronic, incomplete spinal cord injury. Similar application may be possible to other clinical disorders that compromise respiratory and non-respiratory movements.
近年来，人们普遍认识到，神经可塑性是控制呼吸的神经系统的一个重要特征。在本章中，我们重点介绍呼吸运动的可塑性，重点是膈神经运动系统。首先，我们定义了相关但不同的概念：神经调制和神经可塑性。然后，我们专注于两种研究得很好的膈神经运动可塑性模型的机制：（1）短暂暴露于急性间歇性低氧后膈神经长期易化；（2）呼吸神经活动长时间或反复减少后膈神经运动易化。我们对这些新的和重要的可塑性形式的理解进展迅速，已经在多个方面得到了启发：（1）开发新的治疗策略，以在患有严重神经疾病（如脊髓损伤和肌萎缩侧索硬化症）的人群中保留/恢复呼吸功能；（2）发现类似的可塑性也发生在非呼吸运动系统中。事实上，类似的可塑性也发生在呼吸和非呼吸运动神经元中的这一发现，激发了临床试验，以恢复患有慢性、不完全性脊髓损伤的人的腿部/行走和手部/手臂功能。类似的应用也可能适用于其他影响呼吸和非呼吸运动的临床疾病。
