功能性核磁共振成像在计算机辅助的上肢功能训练治疗脑梗死上肢偏瘫中的应用研究

Application of functional MRI in upper-limb stroke hemiplegia treated with computer-assisted exercise

目的:探讨计算机辅助训练上肢对脑可塑性的可能作用。方法:脑卒中上肢偏瘫患者10例,均进行计算机辅助训练,治疗前后采用偏瘫上肢功能测试-香港版(FTHUE-HK),Fulg-Meyer上肢评定(FMA)及改良Barthel指数量表(MBI)评定上肢运动功能,及患者屈伸腕关节时进行功能核磁共振扫描(fMRI)。结果:治疗6周后,10例患侧的上肢功能评定FTHUE-HK、FMA及MBI评分均较治疗前后患侧上肢功能评定变化明显提高(P<0.05)。fMRI扫描示:患者健侧手运动脑功能激活区主要位于对侧初级运动皮质区(SMC)及同侧小脑,患者健手在康复训练后脑激活区增多,包括对侧SMC区及同侧小脑、部分边缘系统;患者治疗前患侧手运动激活区分布广泛,而对侧SMC激活减少,同侧SMC激活增多,另主要还见辅助运动区激活增多;治疗后可见双侧SMC及辅助运动区激活,对侧SMC激活较治疗前增多,另主要还见对侧顶上小叶激活增多。结论:计算机训练可以有效改善脑卒中患者上肢运动功能,诱发大脑皮质功能重塑是其机制的重要组成部分。

Objective：To investigate the effects of computer assisted intervention on cortical reorganization and as sociated motor recovery. Methods： Ten stroke patients treated with computer assisted exercise were assessed with Hong Kong Edition of Functional Test for Hemiplegic Upper Extremity Scale （FTHUE-HK）, Fugl-Meyer Motor Assessment （FMA）and Modified Barthel Index （MBI） before and after the treatment. Functional MRI （fMRI） with 1.5T scanner was performed at the time of the subjects attempting sequential wrist flexiowextension before and after treatment. Results： （1） Computer-assisted therapy showed improvements in FTHUE-HK, FMA and MBI at 6th week after treatment （P〈0.05）. （2） Prior to computer assisted exercise, contralateral primary sensorimotor cortex （SMC） and ipsilateral cerebellum were activated during the motor task with unaffected hand of patients; Af ter computer-assisted exercise, the activated areas of uninjured side hand of patients were increased in contralateral primary sensorimotor cortex （SMC） and part of the limbic system. （3） Before the training, the brain maps showed scattered activity in the contralateral primary SMC, and the ipsilateral SMC and SMA were increased during the af- fected wrist movement. After 6-week training, during the paretic wrist movement, activated regions were mainly lo cated in the contralateral and ipsilateral SMC, SMA, contralateral primary SMC and contralateral parietal lobule, and the intensity of contralateral SMC was significantly increased as compared with those before treatment. Conclu- sion： Computer-assisted exercise can improve the upper limb function after stroke, which is mainly contributed to the function remodeling of the brain cortex.