臨床神経学

<シンポジウム(2)―12―1>リハビリテーションからみた神経回路の可塑性とBMI

脳機能解析と神経リハビリテーション

宮井 一郎1), 三原 雅史1)2), 服部 憲明1), 畠中 めぐみ1), 河野 悌司1), 矢倉 一1)

1)社会医療法人森之宮病院神経リハビリテーション研究部〔〒536―0025 大阪市城東区森之宮2―1―88〕
2)現 大阪大学神経内科

Recent studies of functional neuroimaging and clinical neurophysiology have implied that functional recovery after stroke is associated with use-dependent plasticity of the damaged brain. However the property of the reorganized neural network depends on site and size of the lesion, which makes it difficult to assess what the adaptive plasticity is. From clinical point of view there is accumulating randomized controlled trials for the benefit of taskoriented rehabilitative intervention including constraint-induced movement therapy, robotics, and body-weight supported treadmill training. However dose-matched control intervention is usually as effective as a specific intervention. This raises a question regarding the specificity of a task-oriented intervention. Second question is whether such intervention goes beyond the biological destiny of human. Specifically there is no known strategy enhancing recovery of severely impaired hand. To augment functional gain, several methods of neuro-modulation may bring break-through on the assumption that they induce greater adaptive plasticity. Such neuro-modulative methods include neuropharmacological modulation, brain stimulation using transcranial magnetic stimulation and direct current stimulation, peripheral nerve stimulation, neurofeedback using real-time fMRI and real-time fNIRS, and brain-machine interface. A preliminary randomized controlled trial regarding real-time feedback of premotor activities revealed promising results for recovery of paretic hand in patients with stroke.
Full Text of this Article in Japanese PDF (315K)

(臨床神経, 52:1174−1177, 2012)
key words:脳卒中,神経リハビリテーション,脳機能画像,脳の可塑性,運動学習

(受付日:2012年5月24日)