中国神经再生研究(英文版)

中国神经再生研究(英文版) ›› 2024, Vol. 19 ›› Issue (5): 1098-1104.doi: 10.4103/1673-5374.385312

• 原著:脑损伤修复保护与再生 • 上一篇    下一篇

高功能缺血性脑卒中患者双侧协调精细运动任务脑机制：功能性近红外光谱评估

  

  • 出版日期:2024-05-15 发布日期:2023-10-31

Cortical activity in patients with high-functioning ischemic stroke during the Purdue Pegboard Test: insights into bimanual coordinated fine motor skills with functional near-infrared spectroscopy

Siyun Chen1, 2, 3, #, Mengchai Mao1, 2, 3, #, Guangyue Zhu2, Yufeng Chen2, Yuqi Qiu4, Bin Ye5, Dongsheng Xu2, 3, 6, 7, *   

  1. 1The Second Rehabilitation Hospital of Shanghai, Shanghai, China; 2College of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China; 3Engineering Research Center of Traditional Chinese Medicine Intelligent Rehabilitation, Ministry of Education, Shanghai, China; 4School of Statistics, East China Normal University, Shanghai, China; 5The Third Rehabilitation Hospital of Shanghai, Shanghai, China; 6Tongji University, Shanghai, China; 7Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
  • Online:2024-05-15 Published:2023-10-31
  • Contact: Dongsheng Xu, MD, dxu0927@shutcm.edu.cn.
  • Supported by:
    The study was supported by the National Key R&D Program of China, No. 2020YFC2004202 (to DX). 

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摘要：

脑卒中后，即使是功能较好的高功能患者也可能出现双臂协调性和精细动作灵活性受损的情况，导致功能独立性降低。双侧手臂训练被认为是解决这一问题很有前景的干预措施。然而，高功能卒中患者精细运动技能的神经基础仍不清楚。这项横断面观察研究采用了功能性近红外光谱评估20例缺血性脑卒中患者在完成精细运动控制和协调的功能性任务时大脑皮质的反应。患者完成了用于评估手部精细动作协调性的普渡钉板测试。结果发现，在功能较好的脑卒中患者在进行不同精细运动时中存在任务特异性的神经反应模式差异。此外，空间和时间复杂性更高的双侧协调任务更具挑战性。值得注意的是，在双侧协调任务中表现较好的功能较好的脑卒中患者在运动相关区域表现出更高效的皮质激活，强调了有效的神经招募对于成功的运动表现的重要性。这些发现强调了在脑卒中后康复计划中引入双侧手臂训练和进行复杂的双侧协调任务对于功能较好的患者的重要性。总体而言，研究结果扩展了对脑卒中患者双侧协调和精细运动技能神经基础的见解，并展示了功能性近红外光谱与功能性运动范式相结合在评估和理解这些技能方面的实用性。

https://orcid.org/0000-0002-8477-5377 (Dongsheng Xu)

Abstract: After stroke, even high-functioning individuals may experience compromised bimanual coordination and fine motor dexterity, leading to reduced functional independence. Bilateral arm training has been proposed as a promising intervention to address these deficits. However, the neural basis of the impairment of functional fine motor skills and their relationship to bimanual coordination performance in stroke patients remains unclear, limiting the development of more targeted interventions. To address this gap, our study employed functional near-infrared spectroscopy to investigate cortical responses in patients after stroke as they perform functional tasks that engage fine motor control and coordination. Twenty-four high-functioning patients with ischemic stroke (7 women, 17 men; mean age 64.75 ± 10.84 years) participated in this cross-sectional observational study and completed four subtasks from the Purdue Pegboard Test, which measures unimanual and bimanual finger and hand dexterity. We found significant bilateral activation of the sensorimotor cortices during all Purdue Pegboard Test subtasks, with bimanual tasks inducing higher cortical activation than the assembly subtask. Importantly, patients with better bimanual coordination exhibited lower cortical activation during the other three Purdue Pegboard Test subtasks. Notably, the observed neural response patterns varied depending on the specific subtask. In the unaffected hand task, the differences were primarily observed in the ipsilesional hemisphere. In contrast, the bilateral sensorimotor cortices and the contralesional hemisphere played a more prominent role in the bimanual task and assembly task, respectively. While significant correlations were found between cortical activation and unimanual tasks, no significant correlations were observed with bimanual tasks. This study provides insights into the neural basis of bimanual coordination and fine motor skills in high-functioning patients after stroke, highlighting task-dependent neural responses. The findings also suggest that patients who exhibit better bimanual performance demonstrate more efficient cortical activation. Therefore, incorporating bilateral arm training in post-stroke rehabilitation is important for better outcomes. The combination of functional near-infrared spectroscopy with functional motor paradigms is valuable for assessing skills and developing targeted interventions in stroke rehabilitation.

Key words: bilateral arm training, bimanual coordination, cortical activity, fine motor dexterity, functional near-infrared spectroscopy (fNIRS), high-functioning, Purdue Pegboard Test, stroke