[Neuroscience based strategies for neurorehabilitation].

摘要

Recent advances in basic neuroscience revealed that functional recovery after brain damages is attributed to vicarious function of neural networks. From clinical point of view, functional neuroimaging and neurophysiological testing also have shown functional reorganization of the damaged neural networks after stroke. Understanding of such neural mechanisms has induced an evolutional progress in strategies for neurorehabilitation. Use-dependent plasticity of the central nervous system is attributed to both dose-dependent and context dependent effects of rehabilitative intervention referred as enriched environment and enriched rehabilitation. For instance constraint-induced movement therapy emphasizes not only forced use of the paretic hand but also "shaping" by which patients are always rewarded in structural and progressive approaches. Principals of motor learning such as task-oriented repetitive and rhythmical approaches, feedback of knowledge of results and mental practice using motor imagery has been also applied to rehabilitative strategies. Robot-assisted rehabilitation also provides useful information about the context of neurorehabilitation. There is accumulative evidence that plasticity of the damaged brain is modified by neuropharmacological intervention and noninvasive and invasive brain stimulation coupled with rehabilitation. Furthermore development of brain-machine interfaces might enable to produce new connections among brain regions, muscles, computer and prosthesis bypassing the damaged area. Efficacy of these strategies is based on the assumption that the damaged areas are stable. However if these strategies results in dramatic enhancement and acceleration of functional recovery, patients with neurological diseases of recurrent or degenerative nature might also have real-world benefit, which is trade-off between gains and progression, from neurorehabilitation.