《中国康复理论与实践》

《中国康复理论与实践》 ›› 2015, Vol. 21 ›› Issue (08): 913-916.

• 特稿 • 上一篇    下一篇

强制性运动疗法促进脑卒中后功能恢复机制的研究进展

刘培乐，白玉龙   

  1. 复旦大学附属华山医院康复医学科，上海市200040。作者简介：刘培乐(1989-)，女，河南漯河市人，硕士研究生，主要研究方向：脑卒中康复。通讯作者：白玉龙，男，博士，教授。E-mail: dr_baiyl@126.com。
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2015-08-25 发布日期:2015-08-25

Advance in Mechanisms of Constraint Induced Movement Therapy on Motor Function Rehabilitation after Stroke (review)

LIU Pei-le, BAI Yu-long   

  1. Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
  • Received:1900-01-01 Revised:1900-01-01 Published:2015-08-25 Online:2015-08-25

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摘要： 本文主要综述强制性运动疗法(CIMT)对脑卒中后肢体运动能力恢复的起效机制。CIMT可促进侧脑室室管膜下区神经元的新生，并促进缺血半暗带区新生神经元的存活和分化；还可促进来自健侧大脑的皮质脊髓束纤维在脊髓颈段向患肢侧的交叉，进而对神经传导通路产生可塑性影响。生长抑制蛋白勿动蛋白(Nogo-A)可因CIMT训练而下调，从而减弱神经损伤后对纤维生长的抑制。除此之外，CIMT还可通过影响脑源性神经营养因子(BDNF)、Rho激酶等的表达而发挥治疗作用。尽管如此，CIMT所引起的神经系统结构重塑是否在肢体功能支配过程中真正发挥作用还有待进一步证实，分子机制的研究也多缺乏必要的相关分子抑制与促进效应的论证。

关键词: 脑卒中, 强制性运动疗法, 康复, 肢体功能, 综述

Abstract: Constraint induced movement therapy (CIMT) is considered to be effective in restoring the impaired limb motor function in patients after stroke. CIMT enhanced neurogenesis in sub-ventricular zone and promoted the proliferation and long-term survival of the newborn neurons in the ischemic penumbra region. CIMT also enhanced the midline-crossing phenomenon, which means the midline crossing of the contralesional corticospinal tract originated nerve fibers to the denervated side in the cervical spinal cord. CIMT down-regulated the expression of Neurite outgrowth inhibitor-A (Nogo-A) as well as regulated other molecules to promote the growth of nerve fibers. In addition, CIMT ajusted the expression of brain- derived neurotrophic factor and Rho kinsase. Nevertheless, whether the structural plasticity caused by CIMT really participated in limb function remains unknown. And many studies on molecular mechanisms lack the evidence of necessary promotion and inhibition of the related molecule.

Key words: stroke, constraint induced movement therapy, rehabilitation, limb motor function, review