运动想象疗法治疗脊髓损伤的机制及应用前景

Mechanism and application prospects of motor imagery in spinal cord injury

背景:脊髓损伤是常见的中枢神经系统疾病,表现为损伤平面以下功能障碍,严重影响患者生活和危害人类生命。运动想象疗法治疗脊髓损伤是近年来新兴的康复领域,是一种具有很大发展潜力的康复治疗技术。目的:文章拟对运动想象基本原理、运动想象应用于脊髓损伤的可能机制及其研究进展作进行综述。方法:检索PubMed、Web of Science、中国知网和万方数据库收录的相关文献,英文检索词为“spinal cord injury,motor imagery”,中文检索词为“脊髓损伤、运动想象”,检索从各数据库建库至2021年9月,排除研究目标与该综述不相关、重复研究以及可信度较低的文献,对最终符合纳入标准的94篇文献进行综述。结果与结论:①运动想象最早在20世纪50年代提出,随后明确提出运动想象是一种特殊的运动功能状态,是患者反复模拟和排练某种运动的一种心理状态,它存在于运动记忆中,可激活运动记忆中枢,而没有任何明显的运动输出,并遵循中枢运动控制原则。②运动想象疗法的理论模式比较公认的是心理神经肌肉理论,认为运动想象与运动执行所诱发的神经肌肉活动是相似的。③运动想象疗法治疗脊髓损伤的机制尚不明确,对于脊髓损伤患者而言,由于大脑结构没有被破坏,患者运动想象能力应当被适度保留,目前的研究表明其机制可能是脊髓损伤患者能激活与健康人相似的脑区,且脊髓损伤患者进行运动想象与运动执行也能激活相似的脑区,患者可通过不断的运动想象训练诱导中枢神经可塑性发展和功能重组,促进功能的恢复。④目前临床研究表明,脊髓损伤患者进行运动想象训练后可减轻神经性疼痛和提高运动功能、膀胱功能,运动想象疗法作为辅助治疗应当被纳入脊髓损伤患者的常规康复方案中,但临床疗效存在较大的异质性,进一步研究是有必要的。⑤脑机接口可将患者运动想象期间产生的信号转换成驱动信号来控制外在设备从而实现瘫痪肢体再运动,运动想象-脑机接口的发展被认为是脊髓损伤后康复的革命性改变,具有非常好的发展前景。

BACKGROUND:Spinal cord injury is a kind of common central nervous system disease,causing dysfunction below the injury plane,which affects patient’s living quality and endangering human’s life seriously.The use of motor imagery therapy in the treatment of spinal cord injury is a new rehabilitation field in recent years,and it is a kind of rehabilitation treatment technology with a great development potential.OBJECTIVE:To review the basic principles of motor imagery,the possible mechanism of motor imagery applied to spinal cord injury and the research progress.METHODS:“Spinal cord injury,motor imagery”were used as search terms to retrieve articles on PubMed,Web of Science,CNKI,and Wanfang databases from inception to September 2021.The author excluded the articles that were not correlated with the research purpose,were repetitive,and had low credibility,and summarized the 94 articles that finally met the standard.RESULTS AND CONCLUSION:(1)Motor imagery first was put forward in the 1950s,and then it is identified that motor imagery is a special kind of movement function status,and is repeatedly simulation and rehearse some movement of patients with a mental state.It exists in memory,activates the motor memory center,and without any obvious motor output,and follows the principle of central motion control.(2)The theoretical model of motor imagery therapy is generally recognized as psycho-neuromuscular theory,which holds that motor imagery is similar to the neuromuscular activity induced by motor execution.(3)The mechanism of motor imagery therapy for spinal cord injury is unclear.For patients with spinal cord injury,because brain structure is not damaged,the patient’s ability of motor imagery should be properly preserved.The current studies show that the mechanism may be that spinal cord injury patients and healthy people could activate similar brain regions.In patients with spinal cord injury,similar brain regions are activated by motor imagery and motor execution.Patients can induce the development of central nerve plasticity and functional reorganization through continuous motor imagery training,which can promote the recovery of function.(4)Clinically,current studies have shown that motor imagery training can relieve neuropathic pain,improve motor and bladder function in patients with spinal cord injury.Motor imagery therapy as an adjuvant therapy should be adopted in conventional rehabilitation programs for patients with spinal cord injury.However,there is high heterogeneity in clinical efficacy,and further research is necessary.(5)Brain computer interface can convert the signals generated during the patient’s motor imagery into driving signals to control external devices to achieve the re-movement of paralyzed limbs.The development of motor imagery with brain computer interface is considered to be a revolutionary change in rehabilitation after spinal cord injury and has a very good development prospect.