中国神经再生研究(英文版)

中国神经再生研究(英文版) ›› 2018, Vol. 13 ›› Issue (10): 1771-1781.doi: 10.4103/1673-5374.238616

• 原著:脑损伤修复保护与再生 • 上一篇    下一篇

运动想象训练可诱发脑卒中患者脑神经网络的变化

  

  • 收稿日期:2018-07-20 出版日期:2018-10-15 发布日期:2018-10-15
  • 基金资助:

    中国国家自然科学基金项目（U1613228），国家十二五计划子课题（2011BAI08B11），北京市科委基金项目（Z161100002616018），中央级公益性科研院所基本业务费专项基金项目（2014CZ-5, 2015CZ-30）

Motor imagery training induces changes in brain neural networks in stroke patients

Fang Li1, 2, Tong Zhang1, 2, Bing-Jie Li1, 2, Wei Zhang1, 2, Jun Zhao1, 2, Lu-Ping Song1, 2   

  1. 1 Capital Medical University School of Rehabilitation Medicine, Beijing, China
    2 Neurorehabilitation Center, Beijing Boai Hospital, China Rehabilitation Research Center, Beijing, China
  • Received:2018-07-20 Online:2018-10-15 Published:2018-10-15
  • Contact: Tong Zhang, MD,sunshine0691@163.com.
  • Supported by:

    This study was supported by the National Natural Science Foundation of China, No. U1613228; a grant from the Sub-Project under National “Twelfth Five-Year” Plan for Science & Technology Support Project in China, No. 2011BAI08B11; a grant from the Beijing Municipal Science & Technology Commission in China, No. Z161100002616018; the Special Fund for Basic Scientific Research Business of Central Public Scientific Research Institutes in China, No. 2014CZ-5, 2015CZ-30.

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摘要：

运动想象是动作的心理表征，并没有发生任何明显的运动或肌肉的激活。但运动想象对脑卒中引起的手部功能障碍和脑神经网络变化有哪些影响目前尚不清楚。作者在中国康复研究中心进行了随机对照试验，招募20例卒中患者（13男7女，年龄32-51岁），随机分为运动想象训练联合常规康复训练组和常规康复训练组，各10例。2组患者每天接受1次康复训练，45min/次，5次/周，共进行4周。运动想象训练联合常规康复训练组在每天的康复训练后进行1次45min运动想象训练。在治疗前后使用手臂动作调查测试及上肢运动功能测试评价手功能，以经颅磁刺激分析患肢的运动诱发电位，以扩散张量成像测试脑神经网络的变化。试验结果显示，与单纯常规康复训练患者相比，经运动想象训练联合常规康复训练患者的手功能恢复更为明显，外展肌运动诱发电位波幅较高，右侧背侧通路各向异性分数较高，且双侧背侧通路各向异性分数改善程度较高。表明4周的运动想象训练联合常规康复训练可通过整合背侧通路改善卒中患者的手部功能。试验已在中国临床试验注册中心注册（注册号：ChiCTR-OCH-12002238）。

orcid:0000-0002-8169-6331(Tong Zhang)

关键词: 卒中, 手功能, 运动想象疗法, 脑神经网络, 运动诱发电位, 背侧通路, 腹侧通路, 扩散张量成像, 神经再生

Abstract:

Motor imagery is the mental representation of an action without overt movement or muscle activation. However, the effects of motor imagery on stroke-induced hand dysfunction and brain neural networks are still unknown. We conducted a randomized controlled trial in the China Rehabilitation Research Center. Twenty stroke patients, including 13 males and 7 females, 32–51 years old, were recruited and randomly assigned to the traditional rehabilitation treatment group (PP group, n = 10) or the motor imagery training combined with traditional rehabilitation treatment group (MP group, n = 10). All patients received rehabilitation training once a day, 45 minutes per session, five times per week, for 4 consecutive weeks. In the MP group, motor imagery training was performed for 45 minutes after traditional rehabilitation training, daily. Action Research Arm Test and the Fugl-Meyer Assessment of the upper extremity were used to evaluate hand functions before and after treatment. Transcranial magnetic stimulation was used to analyze motor evoked potentials in the affected extremity. Diffusion tensor imaging was used to assess changes in brain neural networks. Compared with the PP group, the MP group showed better recovery of hand function, higher amplitude of the motor evoked potential in the abductor pollicis brevis, greater fractional anisotropy of the right dorsal pathway, and an increase in the fractional anisotropy of the bilateral dorsal pathway. Our findings indicate that 4 weeks of motor imagery training combined with traditional rehabilitation treatment improves hand function in stroke patients by enhancing the dorsal pathway. This trial has been registered with the Chinese Clinical Trial Registry (registration number:ChiCTR-OCH-12002238).

Key words: nerve regeneration, stroke, hand function, motor imagery, brain neural network, motion evoked potential, dorsal pathway, ventral pathway, diffusion tensor imaging, neural regeneration