中国神经再生研究(英文版) ›› 2014, Vol. 9 ›› Issue (15): 1474-1484.doi: 10.4103/1673-5374.139465

• 原著:脑损伤修复保护与再生 • 上一篇    下一篇

运动想象联合常规康复训练后脑卒中患者脑内激活区域的变化:一项功能磁共振研究

  

  • 收稿日期:2014-06-23 出版日期:2014-08-12 发布日期:2014-08-12

Changes in brain activation in stroke patients after mental practice and physical exercise: a functional MRI study

  • Received:2014-06-23 Online:2014-08-12 Published:2014-08-12
  • Contact: Tong Zhang, M.D., Ph.D., Capital Medical University School of Rehabilitation Medicine, China Rehabilitation Research Center, Beijing 100068, China, zhangtong61611@hotmail.com. Luping Song, Capital Medical University School of Rehabilitation Medicine, China Rehabilitation Research Center, Beijing 100068, China, songluping_1@126.com.

摘要:

运动想象训练是指用于提高运动功能的运动想象任务在心理的预演过程,是一种新的康复训练方法,但运动想象训练后脑内激活区域的变化和运动恢复之间的关系仍未阐明。我们采用功能功能磁共振研究了脑卒中患者在运动想象联合常规康复训练后脑内激活区域的变化,并且检测了这些变化是否与患手运动功能恢复有关。结果发现,运动想象联合常规康复训练4周后,患者患手Fugl-Meyer得分显著提高。功能核磁共振检测显示,患者患侧右手想象运动任务可观察到左侧初级感觉皮质激活增强、右侧初级运动皮质激活减弱和右侧小脑激活增强,这些大脑皮质活动的变化与手运动功能恢复相关。结果提示运动想象训练后脑卒中患者大脑皮质和小脑功能重组促进了手运动功能的恢复。

关键词: 神经再生, 脑激活, 脑皮质激活, 大脑皮质, 皮质重组, 脑卒中, 功能磁共振, 心理训练, 功能恢复, 运动想象

Abstract:

Mental practice is a new rehabilitation method that refers to the mental rehearsal of motor imagery content with the goal of improving motor performance. However, the relationship between activated regions and motor recovery after mental practice training is not well understood. In this study, 15 patients who suffered a first-ever subcortical stroke with neurological deficits affecting the right hand, but no significant cognitive impairment were recruited. 10 patients underwent mental practice combined with physical practice training, and 5 patients only underwent physical practice training. We observed brain activation regions after 4 weeks of training, and explored the correlation of activation changes with functional recovery of the affected hands. The results showed that, after 4 weeks of mental practice combined with physical training, the Fugl-Meyer assessment score for the affected right hand was significantly increased than that after 4 weeks of practice training alone. Functional MRI showed enhanced activation in the left primary somatosensory cortex, attenuated activation intensity in the right primary motor cortex, and enhanced right cerebellar activation observed during the motor imagery task using the affected right hand after mental practice training. The changes in brain cortical activity were related to functional recovery of the hand. Experimental findings indicate that cortical and cerebellar functional reorganization following mental practice contributed to the improvement of hand function.

Key words: nerve regeneration, brain activation, cortical activation, somatosensory cortex, cortical reorganization, stroke, mental practice, functional recovery, motor imagery, neural regeneration

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