| 姜林鸿,刘晓丹,孙萍萍,赵莉娟,刘 杨,张思聪,史啸龙,齐 瑞.运动想象训练对卒中后患者上肢运动功能恢复的影响及静息态fNIRS脑网络特征研究[J].中国康复医学杂志,2023,(11):1505~1513 |
| 运动想象训练对卒中后患者上肢运动功能恢复的影响及静息态fNIRS脑网络特征研究 点此下载全文 |
| 姜林鸿 刘晓丹 孙萍萍 赵莉娟 刘 杨 张思聪 史啸龙 齐 瑞 |
| 上海中医药大学附属岳阳中西医结合医院，上海，200437 |
| 基金项目：上海市进一步加快中医药事业发展三年行动计划[ZY（2018-2020）-CCCX-2004-05]；基于中国传统功法“以意引气”易筋经对抑郁症认知与躯体运动多模态脑功能研究（20194Y0486） |
| DOI：10.3969/j.issn.1001-1242.2023.11.005 |
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| 摘要
目的：评价运动想象训练（motor imagery training， MIT）对卒中后患者上肢运动功能的干预效果，采用功能性近红外光谱技术（functional near-infrared spectroscopy， fNIRS）初探MIT脑网络功能连接（functional connectivity， FC）特征。
方法：纳入78例脑卒中偏瘫患者随机分为对照组和试验组，每组39例。对照组接受常规康复训练100min/天，6次/周，试验组在对照组基础上接受MIT 30min/天，6次/周，两组均干预3周。干预前以及3周后进行Fugl-Meyer上肢运动功能评定量表（FMA-UE）评定。在两组中各抽取10例左侧偏瘫且病变部位均在基底节区患者，采集10min fNIRS静息态血氧数据。设定感兴趣区（regions of interest， ROI）包括双侧前额叶（prefrontal cortex， PFC）、背外侧前额叶（dorsolateral prefrontal cortex， DLPFC）、前运动区和辅助运动皮层区（pre-motor and supplementary motor cortex， PMC&SMA）、体感联合皮层（somatosensory association cortex， SSAC）及感觉运动区（sensorimotor cortex， SMC），基于氧合血红蛋白（HbO）在时间序列上浓度计算两组患者在所有通道间及ROI间静息态FC强度差异。通过Person相关性检验，计算PMC&SMA、SMC血氧相对增量与FMA-UE评分相对增量之间的相关性。
结果：干预3周后，两组患者FMA-UE评分均较干预前提高（P＜0.05），且试验组提高FMA-UE评分更为显著（P＜0.05）。基于HbO静息态FC分析发现，两组所有通道间FC均增加，与对照组相比，试验组具有显著性差异（P＜0.01）；干预3周后连通性存在显著性差异（0.01＜P＜0.05）的ROI-ROI包括：L_PFC-R_SSAC、L_DLPFC-R_SSAC、L_PFC-R_SMC、R_SSAC-L_DLPFC、R_SSAC-L_SSA、R_SSAC-R_PMC&R_SMA、R_SMC-L_SSAC、R_SMC-L_DLPFC、R_SMC- R_PMC&R_SMA。相关性分析发现，试验组PMC&SMA血氧相对增量与FMA-UE评分相对增量存在正相关性（r=0.658，P=0.039）。
结论：MIT可改善卒中后患者的上肢运动功能，其作用机制可能与改变脑功能网络的失连接异常模式有关，如增加两侧半球运动皮质间固有FC，增加损伤侧半球运动皮质与健侧半球运动皮质、损伤侧额叶皮层间FC强度。 |
| 关键词：运动想象训练 上肢运动功能 功能性近红外光谱技术 静息态 功能连接 |
| Effects of motor imagery training on the recovery of upper extremity motor function in poststroke patients and characteristics of resting-state fNIRS brain network Download Fulltext |
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| Shanghai University of Traditional Chinese Medicine Yueyang Hospital of Integrated Traditional Chinese Medicine and Western Medicine， Shanghai， 200437 |
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| Abstract: |
| Abstract
Objective： To evaluate the effect of motor imagery training （MIT） on upper extremity motor function in poststroke patients and the functional connectivity （FC） characteristics of the MIT brain network using functional near-infrared spectroscopy （fNIRS）.
Method： Seventy-eight post-stroke patients were randomly divided into the control group and treatment group， with 39 patients in each group. The control group received conventional rehabilitation training 100 min/day， 6 times/week， for 3 weeks. The treatment group received MIT 30min/day， 6 times/week based on the control group， for 3 weeks. The Fugl-Meyer Assessment of Upper Extremity （FMA-UE） was performed before and 3 weeks after intervention. Ten patients with left-sided hemiparesis and lesions in the basal ganglia region were selected from each of the two groups. 10 min resting-state fNIRS data were collected from each of the two groups and the brain functional connectivity was calculated. The graph theoretical analysis was further applied to investigate the alterations in regions of interest （ROI）， including the prefrontal cortex （PFC）， dorsolateral prefrontal cortex （DLPFC）， pre-motor and supplementary motor cortex （PMC&SMA）， somatosensory association cortex （SSAC） and sensorimotor cortex （SMC）. The correlation between the Relative ?PMC&SMA， Relative ?SMC blood oxygen and the relative increments of Relative ?FMA-UE scores were calculated by the Person correlation test.
Result： After 3 weeks intervention， the FMA-UE score was improved compared with that before intervention in both groups （P<0.05）. The treatment group had a significant difference in FMA-UE score （P<0.05）. Resting-state FC analysis showed that FC increased in all channels between the two groups， and there was a significant difference between the two groups （P<0.01）. There was significant difference in ROI-ROI after 3 weeks intervention （0.01 |
| Keywords:motor imagery training upper extremity motor function functional near-infrared spectroscopy resting-state functional connectivity |
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