Poststroke arm and hand paresis: should we target the cervical spinal cord?
尽管对皮质脊髓运动控制和中风病理生理学的理解取得了进展，但目前针对中风后上肢麻痹的康复疗法在损伤水平上的疗效有限。为了解决这个问题，作者提出了一种新的治疗方法的概念案例。该文首先总结了目前对中风后手臂和手部运动控制缺陷的理解，以及它们与脊髓损伤(SCI) 的共同生理机制。然后，作者回顾了脊髓刺激(SCS) 用于恢复 SCI 后运动的研究，这些研究为增强残余皮质脊髓功能提供了令人信服的证据。通过推断，作者主张使用颈椎 SCS 来恢复中风后的上肢运动控制。
Despite advances in understanding of corticospinal motor control and stroke pathophysiology, current rehabilitation therapies for poststroke upper limb paresis have limited effificacy at the level of impairment. To address this problem, we make the conceptual case for a new treatment approach. We fifirst summarize current understanding of motor control defificits in the arm and hand after stroke and their shared physiological mechanisms with spinal cord injury (SCI). We then review studies of spinal cord stimulation (SCS) for recovery of locomotion after SCI, which provide convincing evidence for enhancement of residual corticospinal function. By extrapolation, we argue for using cervical SCS to restore upper limb motor control after stroke.
Highlights：
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中风后的永久性运动缺陷，例如丧失灵活性、丧失力量和异常的肌肉协同作用，是皮质脊髓束 (CST) 损伤的结果。
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在脊髓损伤患者中，腰骶部脊髓电刺激具有辅助作用（即，它能够自主控制先前瘫痪的肢体）。这些辅助效果在打开刺激后立即出现，并在关闭后立即消失。
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最近的数据表明，脊髓刺激 (SCS) 与广泛的训练相结合也可以产生治疗效果（即在没有刺激的情况下恢复自主运动控制）。
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来自动物和人类的数据表明，SCS 增加了残留 CST 的功效。因此，SCS 与针对损伤的强化训练相结合，可能是中风后手臂和手部的有效恢复方法。
Permanent motor defificits after stroke, such as loss of dexterity, loss of strength, and aberrant muscle synergies, are the result of damage to the corticospinal tract (CST).
In patients with spinal cord injury, electrical stimulation of the lumbosacral spinal cord has an assistive effect (i.e., it enables voluntary control over previously paralyzed limbs). These assistive effects
appear immediately upon turning on the stimulation and disappear as soon as it is turned off.
Recent data show that spinal cord stimulation (SCS) combined with extensive training can also have a therapeutic effect (i.e., recovery of voluntary motor control in the absence of stimulation).
Data from animals and humans show that SCS increases the effificacy of the residual CST. Thus, SCS combined with intense training focused on impairment may be an effective restorative approach
for the poststroke arm and hand.
原文链接：https://www.sciencedirect.com/science/article/pii/S0166223622000960
