康复训练对脑梗死大鼠神经功能作用的研究进展

康复训练可以促进脑卒中后神经功能的恢复,康复效果与卒中损伤的严重程度、康复训练介入的时间、康复训练的方式、康复训练的强度等密切相关.康复训练介入时间的早晚可以影响康复效果;各种不同的康复训练方法可以促进神经可塑性及神经恢复;康复训练的强度与康复训练的效果存在相关性.本文对康复训练的介入时间、强度、各种康复训练方法对脑梗死大鼠神经功能恢复的影响作一探讨,以对脑卒中的康复训练提供有价值的建议.     

功能磁共振研究卒中后肢体运动功能重塑机制

脑卒中造成病灶对侧肢体运动功能障碍的恢复与脑可塑性和功能重组有关。在运动功能恢复过程中,大脑皮质有广泛区域参与神经重塑过程。血氧水平依赖功能磁共振成像对于脑卒中后运动功能恢复与脑功能重组之间关系的研究提供了有效平台。     

轴突可塑性在缺血性脑卒中的研究进展

缺血性脑卒中是最常见的脑卒中类型。轴突可塑性是脑缺血后神经功能恢复的基础,这一过程受到各种生长因子、抑制因子及周围内环境调节。目前已有多种手段可通过调节轴突可塑性促进脑缺血后的神经功能恢复。本文将对轴突可塑性在缺血性脑卒中的相关研究予以综述。     

我国脑卒中患者社区康复的进展

脑卒中的康复治疗是一个长期甚至持续终生的过程。长时间、持续性的康复训练能促进大脑可塑性和功能重组的恢复,从而改善患者的整体功能。目前我国的康复资源有限,大量脑卒中患者无法在医院进行长时间和正规化的康复治疗,而社区康复无论从经济,还是防治残疾,有利于脑卒中患者出院后长期康复训练的实施。本文对国内脑卒中患者出院后社区康复开展现状作以分析并提出对策。     

丰富环境与神经可塑性

目的:神经系统的发育是遗传因素和环境因素共同作用的结果,丰富环境对脑发育和脑损伤修复具有显著的促进作用,而脑发育与脑损伤修复的基础是神经可塑性。因此,关于丰富环境与神经可塑性的研究已成为脑损伤修复研究的热点。资料来源:应用计算机检索Medline1994-01/2004-08和ELSEVER1997-07/2004-08期间丰富环境与神经可塑性相关的文章,检索词“Enrichedenvironment,Neuronalplasticity”,并限定语言种类为英文。资料选择:对资料进行初审,选出与丰富环境与神经可塑性关系密切的文摘进行全文查找,浏览全文后,筛除重复研究的文献,将最新研究纳入提取精读范围。资料提炼:共收集到19篇符合要求的文献,其中11篇是关于丰富环境、神经可塑性及二者关系的文献,5篇涉及丰富环境的作用机制,3篇为问题与展望。资料综合:丰富环境可以提供多感官刺激、运动和社交的机会,丰富环境即可刺激和引起神经可塑性的变化,神经系统的生长发育及其损伤修复都具有可塑性。丰富环境刺激可引起神经形态学结构及行为学功能的改变,其作用机制与神经生长因子、离子型谷氨酸受体及早期即刻基因等变化有关。结论:丰富环境刺激具有引起神经形态学结构和行为学功能变化的效果,使其成为一种有效而低风险的脑损伤康复手段。     

被动训练对脑卒中恢复期患者运动功能的影响

摘要:脑卒中后的患者因其中枢神经系统在结构和功能上具有代偿和功能重组能力,功能再训练可使感受器接受的传入性冲动促进大脑皮质功能的可塑性发展,使丧失的功能重新恢复。及时合理的康复训练可以改善患者的功能和预后,提高大部分患者的生活质量,降低脑卒中的病残率。     

丰富环境与神经可塑性

目的：神经系统的发育是遗传因素和环境因素共同作用的结果，丰富环境对脑发育和脑损伤修复具有显的促进作用，而脑发育与脑损伤修复的基础是神经可塑性。因此，关于丰富环境与神经可塑性的研究已成为脑损伤修复研究的热点。资料来源：应用计算机检索Medline 1994-01／2004-08和ELSEVER 1997-07／2004-08期间丰富环境与神经可塑性相关的章，检索词“Enriched environment，Neuronal plasticity”，并限定语言种类为英。资料选择：对资料进行初审，选出与丰富环境与神经可塑性关系密切的进行全查找，浏览全后，筛除重复研究的献，将最新研究纳入提取精读范围。资料提炼：共收集到19篇符合要求的献，其中11篇是关于丰富环境、神经可塑性及二关系的献，5篇涉及丰富环境的作用机制，3篇为问题与展望。资料综合：丰富环境可以提供多感官刺激、运动和社交的机会，丰富环境即可刺激和引起神经可塑性的变化，神经系统的生长发育及其损伤修复都具有可塑性。丰富环境刺激可引起神经形态学结构及行为学功能的改变，其作用机制与神经生长因子、离子型谷氨酸受体及早期即刻基因等变化有关。结论：丰富环境刺激具有引起神经形态学结构和行为学功能变化的效果，使其成为一种有效而低风险的脑损伤康复手段。     

康复训练对脑梗死大鼠脑组织结构和功能的影响

目的:康复训练促进脑梗死后神经功能恢复已成共识,而其确切机制目前尚不明了,综述康复训练对脑梗死大鼠脑组织结构与功能恢复的影响,归纳其可能的作用途径。资料来源:应用计算机检索Medline2000-01/2005-10期间与脑梗死或脑缺血、康复训练和大鼠相关文献,检索词:“cerebralischemiaorcere-bralinfarction,rehabilitationtrainingorphysicaltraining,rat”,并限定语言种类为English,以及中国期刊全文数据库、中文科技期刊数据库2000-01/2005-10期间的文章,限定文章语言种类为中文,检索词“脑梗死,康复训练,大鼠”。资料选择:纳入标准:对资料进行初审,选择包含康复训练对脑梗死大鼠脑组织结构与功能恢复影响的基础研究文章,排除标准:筛除综述类及与临床研究的文章。资料提炼:选出以康复训练对脑梗死或脑缺血大鼠为研究对象的文章65篇,通过阅读摘要或全文对文章内容进行分类整理,其中17篇与综述内容关系密切,17篇论著中包含:关于康复训练对脑梗死大鼠脑组织结构可塑性的影响8篇;关于神经功能的重组和提高3篇;相关蛋白质和基因组学的作用及其机制6篇。因论述侧重点及内容相似等原因排除48篇。资料综合:①脑梗死后的康复训练可使与梗死脑组织毗邻的脑区发生适应性可塑性改变,齿状回神经前体细胞增殖,星形胶质细胞增多,突触数目增加,传导功能增强,结构更精细。②康复训练有利于脑梗死体积的缩小,改善对侧大脑和梗死区周围的血液供应。③康复训练可明显促进脑梗死鼠肢体运动功能和学习记忆能力的恢复。④康复训练促进脑梗死后多种神经保护性因子的表达,使组织修复、神经细胞及其突触再生的标志性因子表达上调。这些蛋白质因子表达上调,从不同角度反映了康复训练可促进大鼠脑梗死后神经功能的恢复,同时也揭示了康复训练促进脑梗死后神经功能恢复的机制。结论:康复训练可促进脑梗死后大鼠肢体运动功能及学习记忆能力恢复,使梗死灶体积缩小,增强健存脑组织的突触可塑性,提高脑组织内保护性蛋白因子的基因表达。     

康复训练对脑梗死大鼠脑组织结构和功能的影响

目的：康复训练促进脑梗死后神经功能恢复已成共识，而其确切机制目前尚不明了，综述康复训练对脑梗死大鼠脑组织结构与功能恢复的影响，归纳其可能的作用途径。资料来源：应用计算机检索Medline2000—01／2005—10期间与脑梗死或脑缺血、康复训练和大鼠相关文献，检索词：“cerebral ischemia or cere．bral infarction，rehabilitation training or physical training，rat”，并限定语言种类为English，以及中国期刊全文数据库、中文科技期刊数据库2000—01／2005—10期间的文章，限定文章语言种类为中文，检索词“脑梗死，康复训练，大鼠”。资料选择：纳入标准：对资料进行初审，选择包含康复训练对脑梗死大鼠脑组织结构与功能恢复影响的基础研究文章，排除标准：筛除综述类及与临床研究的文章。资料提炼：选出以康复训练对脑梗死或脑缺血大鼠为研究对象的文章65篇，通过阅读摘要或全文对文章内容进行分类整理，其中17篇与综述内容关系密切，17篇论著中包含：关于康复训练对脑梗死大鼠脑组织结构可塑性的影响8篇；关于神经功能的重组和提高3篇；相关蛋白质和基因组学的作用及其机制6篇。因论述侧重点及内容相似等原因排除48篇。资料综合：①脑梗死后的康复训练可使与梗死脑组织毗邻的脑区发生适应性可塑性改变，齿状回神经前体细胞增殖，星形胶质细胞增多，突触数目增加，传导功能增强，结构更精细。②康复训练有利于脑梗死体积的缩小，改善对侧大脑和梗死区周围的血液供应。③康复训练可明显促进脑梗死鼠肢体运动功能和学习记忆能力的恢复。④康复训练促进脑梗死后多种神经保护性因子的表达，使组织修复、神经细胞及其突触再生的标志性因子表达上调。这些蛋白质因子表达上调，从不同角度反映了康复训练可促进大鼠脑梗死后神经功能的恢复，同时也揭示了康复训练促进脑梗死后神经功能恢复的机制。结论：康复训练可促进脑梗死后大鼠肢体运动功能及学习记忆能力恢复，使梗死灶体积缩小，增强健存脑组织的突触可塑性，提高脑组织内保护性蛋白因子的基因表达。     

强迫运动疗法的研究进展

脑卒中偏瘫经康复训练后，大多数患者的肢体功能可在不同程度上得到恢复。目前我们对恢复的机制尚未完全明了，但是对中枢神经系统功能重组的作用愈加关注。功能核磁（fMRI）、经颅磁刺激（transcranic Mmagnetic stimulation，TMS）和正电子发射扫描（positron emission tomography．PET）使得对工作中的大脑进行无创性研究成为可能，对人脑的研究表明脑卒中后的大脑网络中发生了功能相关性的变化。正确认识这些脑功能的变化能为康复训练的恢复机制提供依据，并可使根据神经生理学原理，创立新的、有效的康复疗法成为可能。[第一段]     

卒中后运动皮层功能重组的BOLD-fMRI研究进展

卒中后患者运动功能的自行恢复与神经可塑性及运动皮层功能重组有关。以BOLD-fMRI为主的功能磁共振技术在卒中后运动皮层功能重组研究中的作用日益显著。本文就卒中后神经可塑性和运动皮层功能重组机制、BOLD-fM-RI在卒中后运动皮层功能重组研究中的进展予以综述。     

基于运动想象的脑机交互康复训练新技术对脑卒中大脑可塑性影响

目的:验证脑机接口结合功能性电刺激(BCI-FES)在中枢神经康复中的可行性及其机制.方法:对1例40岁男性脑卒中后左侧上肢重度瘫痪患者进行4周的基于运动想象的BCI-FES训练,训练前后各进行一次系统上肢功能评价及包含“运动”及“想象”组块的fMRI检测,进行功能激活图的绘制.结果:经过为期1个月的训练后左手最快抓握速度提高24.7％,左手抓握运动时功能性磁共振成像(fMRI)激活表现为出现病灶同侧主要运动区(M1)及辅助运动区(SMA)的激活,病灶对侧M1区及运动前区(PMC)激活较训练前减弱.左手运动想象任务时出现了双侧SMA及病灶同侧右后顶叶的激活.结论:脑机交互技术可促进脑卒中患者的中枢神经重塑.BCI-FES应用于存在脑损伤的脑卒中患者的康复训练是可行的.     

早期康复治疗对脑卒中神经功能重建的影响

目的:探讨对脑卒中患者进行早期康复治疗的方法及其对患者神经功能重建的影响。方法:将180例具有中度以上神经功能缺损的脑卒中患者随机分为康复组和对照组各90例,2组均接受神经内科常规药物治疗,康复组同时接受早期康复治疗。于治疗前、治疗后1个月评定2组神经功能缺损程度、肢体运动功能(FMA评分)及日常生活活动能力(Barthel指数)。结果:康复组神经功能缺损程度评分、FMA评分及Barthel指数的改善均明显优于对照组(P<0.05)。结论:脑卒中患者的早期康复治疗,能帮助患者改善运动功能,促进神经功能恢复,提高患者ADL能力。     

Movement therapy induced neural reorganization and motor recovery in stroke: a review

This paper is a review conducted to provide an overview of accumulated evidence on contemporary rehabilitation methods for stroke survivors. Loss of functional movement is a common consequence of stroke for which a wide range of interventions has been developed. Traditional therapeutic approaches have shown limited results for motor deficits as well as lack evidence for their effectiveness. Stroke rehabilitation is now based on the evidence of neuroplasticity, which is responsible for recovery following stroke. The neuroplastic changes in the structure and function of relevant brain areas are induced primarily by specific rehabilitation methods. The therapeutic method which induces neuroplastic changes, leads to greater motor and functional recovery than traditional methods. Further, the recovery is permanent in nature. During the last decade various novel stroke rehabilitative methods for motor recovery have been developed. This review focuses on the methods that have evidence of associated cortical level reorganization, namely task-specific training, constraint-induced movement therapy, robotic training, mental imaging, and virtual training. All of these methods utilize principles of motor learning. The findings from this review demonstrated convincing evidence both at the neural and functional level in response to such therapies. The main aim of the review was to determine the evidence for these methods and their application into clinical practice.     

Nuclear medicine in the rehabilitative treatment evaluation in stroke recovery. Role of diaschisis resolution and cerebral reorganization

There has recently been a tremendous increase in imaging technology and imaging methodology enabling noninvasive exploration of brain function to such an intricate degree as to enable measurements of very small spatial and short temporal cerebral operations responsible for neurological and functional recovery after stroke. This has allowed conceptualization of rehabilitation strategies designed to maximally enhance rehabilitation protocols tailored to the individual patient's deficits. Rehabilitation strategies may now be designed and optimized by employing methods to synchronize functional training of brain regions ascribed to those areas innately undergoing neuronal plasticity change responsible for stroke recovery. In order to effectively apply these noninvasive imaging methods, one must have a clear understanding of the physics and technique of the imaging methodologies and how these are best applied to understand brain physiology during the stroke recovery process to provide a solid rationale for development of rehabilitation protocols. Nuclear medicine imaging is first presented as a diagnostic method to assess the stroke process. The initial brain damage and resulting neurological disability can be primarily assessed in terms of changes in the vascular and hemodynamic status of the cerebral circulation in addition to alterations in the metabolic status around the infarction region. Techniques for assessing perfusion and metabolism include regional cerebral blood flow (rCBF), single photon emission computed tomography (SPECT), and F-18 2-Fluoro-2-deoxy-D-glucose (F-18 FDG) positron emission tomography (PET). In addition, hemodynamic vascular insufficiency can be assessed using O-15 O2 oxygen extraction PET and rest and Diamox rCBF SPECT. The status of the peri-infarction region can be characterized in terms of components of diaschisis and ischemia using proton magnetic resonance spectroscopy imaging ((1)H MRSI) and rest/stress rCBF assessment of cerebral vascular reserve. As the brain recovers from cerebral infarction, areas of reorganization and energy utilization by the brain can be measured using oxygen extraction methods with PET, F-18 FDG glucose utilization by PET, and functional magnetic resonance imaging (fMRI) measures using the blood oxygenation level dependent (BOLD) technique. In addition, high field MRI imaging of the brain is now able to provide detailed fractional anisotropy (FA) maps to characterize changes in white matter by fiber tracking mapping using diffusion tensor imaging. Imaging of the stroke recovery process focuses on the physiologic model of stroke characterized by rCBF, metabolism, 1H spectroscopic measures of N-acetyl aspartate (NAA), choline (Ch) and creatine (Cr) in the peri-infarction zone as well as in the extended stroke penumbra including areas of distant 'pure' diaschisis unencumbered with the confound of cerebral ischemia. Data is presented describing the results of application of imaging methodologies as the patient undergoes rehabilitation that demonstrates the importance of blood flow and metabolic changes in the contralesional frontal lobe both during the resting state and during motor and speech activation paradigms. The results of advanced imaging technologies on cerebral damage and cerebral reorganization during rehabilitation are presented in the context of furthering designs of rehabilitation strategies. Success can be monitored to assess the optimization of rehabilitation strategy design to maximize neurological recovery from stroke by employing facilitatory methods to maximally synchronize rehabilitation techniques with recovery of functionally counterpart areas of viable brain.     

Non-invasive brain stimulation (NIBS) and motor recovery after stroke

Recovery of motor function after stroke occurs largely on the basis of a sustained capacity of the adult brain for plastic changes. This brain plasticity has been validated by functional imaging and electrophysiological studies. Various concepts of how to enhance beneficial plasticity and in turn improve functional recovery are emerging based on the concept of functional interhemispheric balance between the two motor cortices. Besides conventional rehabilitation interventions and the most recent neuropharmacological approaches, non-invasive brain stimulation (NIBS) has recently been proposed as an add-on method to promote motor function recovery after stroke. Several methods can be used based either on transcranial magnetic stimulation (repetitive mode: rTMS, TBS) via a coil, or small electric current via larges electrodes placed on the scalp, (transcranial direct current stimulation tDCS). Depending on the different electrophysiological parameters of stimulation used, NIBS can induce a transient modulation of the excitability of the stimulated motor cortex (facilitation or inhibition) via a probable LTP-LTD-like mechanism. Several small studies have shown feasible and positive treatment effects for most of these strategies and their potential clinical relevance to help restoring the disruption of interhemispheric imbalance after stroke. Results of these studies are encouraging but many questions remain unsolved: what are the optimal stimulation parameters? What is the best NIBS intervention? Which cortex, injured or intact, should be stimulated? What is the best window of intervention? Is there a special subgroup of stroke patients who could strongly benefit from these interventions? Finally is it possible to boost NIBS treatment effect by motor training of the paretic hand or by additional neuropharmacological interventions? There is clearly a need for large-scale, controlled, multicenter trials to answer these questions before proposing their routine use in the management of stroke patients.     

丰富环境及康复训练对创伤性脑损伤大鼠神经功能恢复的影响

目的:研究丰富环境及康复训练对创伤性脑损伤大鼠神经功能恢复的影响.方法:成年SD大鼠制作创伤性脑损伤大鼠模型,随机分为单纯脑损伤组、丰富环境组、行为训练组、运动训练组及综合康复训练组,每组10只,另设正常对照组10只.单纯脑损伤组不予任何处理,置于标准笼饲养;丰富环境组给予丰富环境笼饲养,不予训练;行为训练组给予水迷宫训练,置于标准笼饲养;运动训练组给予行走、平衡、抓握训练,置于标准笼饲养;综合康复训练组给予丰富环境笼饲养,并给予水迷宫及行走、平衡、抓握训练.各组大鼠于损伤后第3天、7天、14天、21天分别给予运动及学习记忆功能评定.结果:脑损伤后第3天,各组大鼠的运动及学习记忆能力无显著性差异,均低于空白对照组(P＜0.05).综合康复训练组大鼠的运动及学习记忆能力在训练第7天时明显改善,与空白对照组大鼠比较无显著性差异;而行为训练组大鼠的学习记忆能力也在第7天—第14天有显著改善,与对照组无明显差异;运动训练组与丰富环境组大鼠的学习记忆能力第21天开始也有明显好转,但均低于对照组(P＜ 0.05).运动训练组大鼠的运动能力在第7天—第14天有显著改善,与对照组无明显差异;行为训练组与丰富环境组大鼠的运动能力第21天开始也有明显好转,但均低于对照组(P＜0.05);单纯脑损伤组大鼠的运动及学习记忆能力未见有显著改善,低于对照组(P＜0.05).结论:丰富环境及康复训练可促进创伤性脑损伤大鼠运动及学习记忆功能的恢复.     

Functional electrical stimulation-induced neural changes and recovery after stroke

Rehabilitation as a treatment approach to affect neural remodeling or 'plasticity' of the injured brain is gaining increasing attention and appreciation. While rehabilitation continues to emphasize re-establishment of functional abilities, the approach of neurorehabilitation attempts to improve recovery by impacting on changes within the central nervous system rather than reliance on compensatory techniques. Functional electrical stimulation is one of the prominent modalities being used for neurorehabilitation. This report provides an overview of the relevance of brain plasticity to rehabilitation, and of the physiological and clinical studies that indicate the effects of functional electrical stimulation as a potential tool in neural remodeling.     

Central nervous system lesions: sprouting and unmasking in rehabilitation

Recovery of function following a central nervous system lesion can continue for months or years following the injury. Considerable experimental evidence supports the conclusion that the plasticity of the brain is of importance to the functional recovery. A number of neural mechanisms may be involved in the functional recovery. Two of the mechanisms of neuroplasticity considered particularly likely to play a role, are the following: 1) Collateral sprouting from intact cells to a denervated region after some or all of its normal input has been destroyed, and 2) The unmasking of neural pathways and synapses which are not normally used for the particular function under study but which can be called upon when the ordinarily of dominant system fails. The process of unmasking is extensively discussed in the context of the role of rehabilitation in obtaining maximum recovery of function.     

Rehabilitation treatment of dysphagia in 81 cases of stroke

Dysphagia is the common common complication in stroke,often leads to nutrition deficiency,asparition pneumonia,suffocation and at the same time the pessimism,despair,complicated reduce patients‘ living confidence that will influence entire therapeutic course.OBJECTIVE:To investigate the treating Methods of dysphagia in stroke.