分级运动想象训练对脑梗死上肢偏瘫患者 脑功能局部一致性影响的研究

Regional homogeneity in patients with cerebral infarction and upper extremity hemiparesis before and af⁃ter graded motor imagery training:a resting-state fMRI study

目的:利用静息态功能磁共振技术探讨分级运动想象(GMI)训练对脑梗死上肢偏瘫患者脑功能的影响。方法:脑梗死患者16例随机分为常规作业治疗组和分级运动想象组,每组各8例。常规作业治疗组(OT组)患者进行常规作业治疗,予以常规药物、物理治疗、常规作业治疗(1h/d)。分级运动想象组(GMI组)以相同的常规药物和物理治疗,并予以常规作业治疗(0.5h/d)和分级运动想象训练(0.5h/d)。于治疗前和治疗4周后对两组患者进行上肢Fugl-Meyer运动功能量表(FMA)和组块测试(BBT)的评估,及磁共振扫描,包括结构像和功能像。观察两组脑梗死患者治疗前后大脑局部一致性(ReHo)的差异性,提取和比较两组患者治疗前后角回、额下回、顶上小叶、顶下小叶、辅助运动区、缘上回、中央前回和中央后回等8个感兴趣区(ROI)的ReHo值变化。结果:治疗前,两组患者上肢和手Fugl-Meyer评分、BBT评分组间差异均无显著性意义(P>0.05);除常规OT组上肢Fugl-Meyer评分外,两组患者治疗后上述疗效指标显著改善(P<0.05);4周治疗后,除BBT评分外,两组患者上述疗效指标的组间差异均具有显著性意义(P<0.05)。GMI组治疗后ReHo值高于治疗前的患侧脑区主要包括辅助运动区、中央旁小叶、扣带回、中央前回、额中回、额下回三角部/岛盖部、楔前叶、顶上小叶等(P<0.05)。常规OT组治疗后ReHo值高于治疗前的患侧脑区主要包括中央旁小叶、楔前叶等(P<0.05)。ROI分析发现GMI组额下回、缘上回的ReHo值增加,常规OT组额下回、缘上回的ReHo值降低,且两组该脑区ReHo值组间差异具有显著性意义(P<0.05)。结论:与单纯常规作业疗法相比,GMI训练结合常规作业疗法可能更有助于增强患侧半球镜像神经系统的神经活动以及促进大脑运动相关皮层的重组和修复,进而改善脑梗死患者患侧上肢运动功能。

Objective:To investigate the effect of graded motor imagery therapy on brain function of patients with cerebral infarction and upper extremity hemiparesis by resting-state functional magnetic resonance imaging(fMRI).Method:Sixteen patients with cerebral infarction and upper extremities hemiparesis were randomly assigned into a routine occupational therapy(OT)group(N=8)or a graded motor imagery(GMI)group(N=8).The routine OT group received routine medication,conventional physical therapy and occupational therapy(1h/d).The GMI group received routine occupational therapy(0.5h/d)and the graded motor imagery training(0.5h/d).Before and after 4 weeks treatment,the patients in both groups were evaluated with Fugl-Meyer assessment for the upper extremities(FMA-UE)and box and block test(BBT)and MRI scanning,including anatomy and functional images.Then,we examined the values of regional homogeneity(ReHo)of brain cortex before and after treatment.We extracted the ReHo values from eight regions of interest(ROIs)including angular gyrus,inferior frontal gyrus(IFG),inferior parietal lobule(IPL),superior parietal lobule(SPL),supplementary motor area(SMA),supramarginal gyrus,precentral gyrus,postcentral gyrus.Meanwhile,we analyzed the changes of the ReHo before and after treatment and compare it between two groups.Result:The FMA-UE and BBT had no significant difference between the two groups before the intervention(P>0.05).After the treatment,The above assessments improved significantly within groups(P<0.05),except the FMA-UE for routine OT group.It improved more in the GMI group than those in routine OT group(P<0.05),except the BBT.For GMI group,the ReHo increased mainly in SMA,paracentral lobule,cingulate gyrus,precentral gyrus,middle frontal gyrus,triangular/opercular of the IFG,precuneus and SPL in trouble hemisphere after treatment than that before treatment(P<0.05).However,for the routine OT group,the ReHo increased mainly in paracentral lobule and precuneus,after treatment(P<0.05).Furthermore,in comparison with routine OT group,from the ROI analysis,the signals of ReHo for the IFG and supramarginal gyrus strengthened more significantly in GMI group(P<0.05).Conclusion:Compared with routine occupational therapy,GMI training combined with routine OT could heighten neuron activity of the mirror neuron system(MNS)in affected hemisphere and promote cortical reorganization and repair,which might more favorably improve motor function of the upper extremities of patients with cerebral infarction.