Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Departments of Neurology, Neuroscience, and Physical Medicine & Rehabilitation, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Neurorehabil Neural Repair. 2023 Jun;37(6):356-366. doi: 10.1177/15459683221137341. Epub 2022 Nov 16.
Here we report and comment on the magnitudes of post-stroke impairment reduction currently observed using new neurotechnologies. We argue that neurotechnology's best use case is impairment reduction as this is neither the primary strength nor main goal of conventional rehabilitation, which is better at targeting the activity and participation levels of the ICF. The neurotechnologies discussed here can be divided into those that seek to be adjuncts for enhancing conventional rehabilitation, and those that seek to introduce a novel behavioral intervention altogether. Examples of the former include invasive and non-invasive brain stimulation. Examples of the latter include robotics and some forms of serious gaming. We argue that motor learning and training-related recovery are conceptually and mechanistically distinct. Based on our survey of recent results, we conclude that large reductions in impairment will need to begin with novel forms of high dose and high intensity behavioral intervention that are qualitatively different to conventional rehabilitation. Adjunct forms of neurotechnology, if they are going to be effective, will need to piggyback on these new behavioral interventions.
在这里，我们报告并评论了目前使用新神经技术观察到的卒中后功能障碍减轻的程度。我们认为，神经技术的最佳应用案例是功能障碍的减轻，因为这既不是传统康复的主要优势，也不是其主要目标，传统康复更侧重于国际功能、残疾和健康分类（ICF）的活动和参与水平。这里讨论的神经技术可以分为旨在增强传统康复的辅助技术，以及旨在引入全新行为干预的技术。前者的例子包括有创和无创脑刺激。后者的例子包括机器人和一些形式的严肃游戏。我们认为，运动学习和训练相关的恢复在概念上和机制上是不同的。基于我们对最近结果的调查，我们得出结论，需要从新型的高剂量和高强度行为干预开始，才能实现功能障碍的大幅减轻，而这种干预在性质上与传统康复不同。如果辅助形式的神经技术要有效，就需要依赖这些新的行为干预。
