Abstract：
It is a paradox of neurological rehabilitation that, in an era in which preclinical models have produced significant advances in our mechanistic understanding of neural plasticity, there is inadequate support for many therapies recommended for use in clinical practice. When the goal is to estimate the probability that a specific form of therapy will have a positive clinical effect, the integration of mechanistic knowledge (concerning \'the structure or way of working of the parts in a natural system\') may improve the quality of inference. This is illustrated by analysis of three contemporary approaches to the rehabilitation of lateralized dysfunction affecting people living with stroke: constraint-induced movement therapy; mental practice; and mirror therapy. Damage to \'cross-road\' regions of the structural (white matter) brain connectome generates deficits that span multiple domains (motor, language, attention and verbal/spatial memory). The structural integrity of these regions determines not only the initial functional status, but also the response to therapy. As structural disconnection constrains the recovery of functional capability, \'disconnectome\' modelling provides a basis for personalized prognosis and precision rehabilitation. It is now feasible to refer a lesion delineated using a standard clinical scan to a (dis)connectivity atlas derived from the brains of other stroke survivors. As the individual disconnection pattern thus obtained suggests the functional domains most likely be compromised, a therapeutic regimen can be tailored accordingly. Stroke is a complex disorder that burdens individuals with distinct constellations of brain damage. Mechanistic knowledge is indispensable when seeking to ameliorate the behavioural impairments to which such damage gives rise.
摘要：
这是神经康复的一个悖论，在一个临床前模型在我们对神经可塑性的机械理解方面取得了重大进展的时代，对于许多推荐用于临床实践的疗法,没有足够的支持.当目标是估计特定治疗形式产生积极临床效果的可能性时，机械知识的整合（关于“自然系统中零件的结构或工作方式”）可以提高推理质量。通过对影响中风患者的偏侧功能障碍康复的三种当代方法的分析来说明这一点：约束诱导运动疗法；精神实践；和镜像疗法。对结构（白质）大脑连接体的“交叉道路”区域的损害会产生跨越多个领域的缺陷（运动，语言,注意力和言语/空间记忆)。这些区域的结构完整性不仅决定了初始功能状态，还有对治疗的反应。由于结构断开限制了功能能力的恢复，“分离组”建模为个性化预后和精确康复提供了基础。现在可以将使用标准临床扫描描绘的病变引用到从其他中风幸存者的大脑导出的(dis)连接图谱。由于由此获得的单个断开模式表明功能结构域最有可能受损，治疗方案可以相应地定制。中风是一种复杂的疾病，给个体带来不同类型的脑损伤。在寻求改善这种损害引起的行为损害时，机械知识是必不可少的。
