中国神经再生研究(英文版)

中国神经再生研究(英文版) ›› 2019, Vol. 14 ›› Issue (6): 1004-1012.doi: 10.4103/1673-5374.250580

• 原著:脑损伤修复保护与再生 • 上一篇    下一篇

基于镜像神经元理论治疗失语症：神经心理学和功能磁共振的随机区组临床试验

  

  • 出版日期:2019-06-15 发布日期:2019-06-15
  • 基金资助:

    中国国家自然科学基金项目（81472163，81874035），2016年度高校哲学社会科学研究一般项目（2016SJB740015），张家港市科技计划项目（ZKS1615），2018年度苏州市“科教兴卫”青年科技项目（KJXW2018059）

Aphasia rehabilitation based on mirror neuron theory: a randomized-block-design study of neuropsychology and functional magnetic resonance imaging

Wen-Li Chen 1, 2, Qian Ye 3 , Si-Cong Zhang 4 , Yang Xia 5 , Xi Yang 5 , Ti-Fei Yuan 6 , Chun-Lei Shan 4, 7, 8 , Jian-An Li 1   

  1. 1 Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
    2 Department of Rehabilitation Medicine, Zhangjiagang Hospital Affiliated to Nanjing University of Chinese Medicine, Zhangjiagang, Jiangsu Province, China
    3 School of Rehabilitation Sciences, Nanjing Normal University of Special Education, Nanjing, Jiangsu Province, China
    4 Yueyang Hospital of Integrated Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
    5 Department of Rehabilitation Medicine, Zhongda Hospital, Southeast University, Nanjing, Jiangsu Province, China
    6 Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
    7 School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
    8 Institute of Rehabilitation Medicine, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
  • Online:2019-06-15 Published:2019-06-15
  • Contact: Jian-An Li, MD, lijianan@carm.org.cn; Chun-Lei Shan, MD, shanclhappy@163.com.
  • Supported by:

    This work was supported by the National Natural Science Foundation of China, No. 81472163, 81874035 (to CLS); the General Project of University Philosophy and Social Science Research of China, No. 2016SJB740015 (to QY); the Science and Technology Plan Project of Zhangji¬agang city of China in 2016, No. ZKS1615 (to WLC); the Youth Science and Technology Project of Suzhou Health Development through Scientific Research and Education in 2018, No.KJXW2018059 (to WLC) .

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摘要：

当看到他人执行某种动作时，镜像神经元发生的激活现象与自己亲自执行该动作时所引起的激活极为类似。作者在既往的单样本病例研究的基础上提出，手动作观察训练可能会引起镜像神经元系统包括重要语言中枢的激活和重塑，可能改善失语症患者的语言功能。此次随机区组临床试验首先在中国东南大学中大医院招募的24例失语症患者，随机等分为3组，分别进行手动作观察结合复述的训练、动态物体观察结合复述的训练以及常规失语症训练，所有训练均为每周训练5d，每天训练35min，共训练2周。以西部失语症成套测验、物体图片命名测试和行动图片命名测试评价患者的语言功能。然后取其中1例患者及患者妻子和其他4名健康大学生志愿者进行功能磁共振分析手动作观察以及动态物体观察时的脑区变化。结果显示，手动作观察较动态物体观察更能改善命名和西部失语症成套测验中失语商及其各分项的成绩，且总体疗效与常规失语症训练的效果相当，同时在词汇提取、自发言语的信息量方面较常规训练更有优势；手动作观察较动态物体观察更多地激活镜像神经元系统，激活区域包括Broca区，Wernicke区和缘上回等重要语言中枢。表明手动作观察结合复述的训练较动态物体观察结合复述的训练更能改善失语症患者的语言功能。这种干预方法的疗效机制可能与手动作观察激活更多的镜像神经元系统以及可能修复与重塑受损的神经网络有关。试验已于2011年3月11日经南京医科大学伦理委员会批准，批准号为2011-SRFA-086。试验已在ISRCTN注册，注册号ISRCTN84827527。

orcid: 0000-0002-6674-581X (Wen-Li Chen)

关键词: 镜像神经元, 手动作观察, 失语症, 神经康复, 卒中, 功能性磁共振, 神经心理学, 神经再生

Abstract:

When watching someone performs an action, mirror neurons are activated in a way that is very similar to the activation that occurs when actually performing that action. Previous single-sample case studies indicate that hand-action observation training may lead to activation and re¬modeling of mirror neuron systems, which include important language centers, and may improve language function in aphasia patients. In this randomized-block-design experiment, we recruited 24 aphasia patients from, Zhongda Hospital, Southeast University, China. The patients were divided into three groups where they underwent hand-action observation and repetition, dynamic-object observation and repetition, or conven¬tional speech therapy. Training took place 5 days per week, 35 minutes per day, for 2 weeks. We assessed language function via picture naming tests for objects and actions and the Western Aphasia Battery. Among the participants, one patient, his wife and four healthy student volunteers underwent functional magnetic resonance imaging to analyze changes in brain activation during hand-action observation and dynamic-object observation. Results demonstrated that, compared with dynamic-object observation, hand-action observation led to greater performance with respect to the aphasia quotient and affiliated naming sub-tests and a greater Western Aphasia Battery test score. The overall effect was similar to that of conventional aphasia training, yet hand-action observation had advantages compared with conventional training in terms of vocabulary extraction and spontaneous speech. Thus, hand-action observation appears to more strongly activate the mirror neuron system compared with dynamic-object observation. The activated areas included Broca’s area, Wernicke’s area, and the supramarginal gyrus. These results suggest that hand-action observation combined with repetition might better improve language function in aphasia patients compared with dynamic-object observation combined with repetition. The therapeutic mechanism of this intervention may be associated with activation of additional mirror neuron systems, and may have implications for the possible repair and remodeling of damaged nerve networks. The study protocol was ap¬proved by the Ethical Committee of Nanjing Medical University, China (approval number: 2011-SRFA-086) on March 11, 2011. This trial has been registered in the ISRCTN Registry (ISRCTN84827527).

Key words: nerve regeneration, mirror neuron, hand-action observation, aphasia, rehabilitation, stroke, functional magnetic resonance imaging, neuropsychology, neural regeneration