运动想象脑机接口技术在脑卒中后运动功能康复中的应用

Application of Motor Imagery Brain-Computer Interface on Patients with Motor Dysfunction after Stroke

运动想象脑机接口(MI-BCI)技术通过识别运动想象产生的脑电信号来判断其运动意图,进而实现人脑与外部设备之间的通信与控制。MI-BCI技术在脑卒中后患者的运动功能康复应用中取得肯定疗效,对中、重度肢体运动功能障碍患者的康复也具有很大潜力。本研究总结了国内外MI-BCI技术在脑卒中后运动功能康复中的应用现状(MI-BCI技术的神经调控机制、临床康复应用及存在的问题和可能的解决途径3个方面),以期为MI-BCI技术的临床应用和相关设备研发提供理论支持。MI-BCI技术的神经调控机制主要包括“中枢-外周-中枢”闭环理论[“中枢-外周”自上而下的中枢刺激模式(运动想象)与“外周-中枢”自下而上的感觉运动反馈(外置设备带动肢体运动)模式]、神经反馈和赫布理论;临床康复应用主要集中在脑卒中后上肢/下肢运动功能康复、大脑功能网络变化等方面。但MI-BCI技术在临床康复应用中仍存在表现力不佳、治疗剂量不明确、采集信号质量亟待提高、运动想象模式的类别较少和训练周期长等问题。下一步仍需开展MI-BCI技术联合其他中枢神经干预方式相关研究,增加运动想象模式类别等方式以改善MIBCI技术的康复效果,并开发适用于各个时期脑卒中患者MI-BCI技术训练方案,为中枢神经系统疾病患者的肢体运动康复提供参考。

Motor imagery brain-computer interface(MI-BCI)technology determines the motor intention by recognizing the electroencephalogram(EEG)signals generated by motor imagery and then realizes the communication and control between the human brain and external devices.MI-BCI technology had achieved a positive effect in the application of motor function rehabilitation of patients after stroke,which has excellent potential for rehabilitating patients with moderate and severe limb motor dysfunctions.This paper summarizes the domestic and international research status evidence(neuroregulatory mechanism,clinical rehabilitation application,existing problems and possible solutions)of MI-BCI technology in motor function rehabilitation after stroke to provide theoretical support for the clinical application of MI-BCI technology and the development of related equipment.The neural regulation mechanisms of MI-BCI technology mainly include the"central-peripheral-central"closed-loop theory[the top-down central stimulation mode of"central-periphery"(motor imagery)and the down-top sensorimotor feedback mode of"peripheral-central"(limb movement driven by external devices)],neurofeedback and Hebb theory.The clinical rehabilitation application mainly focuses on rehabilitating upper/lower limb motor function and the changes in brain functional networks after stroke.However,there are still some problems in applying MI-BCI technology in clinical rehabilitation,such as poor performance,unclear treatment dose,the quality of collected signals needing to be improved,few categories of motor imagery,and long training cycle.The future study is needed to conduct research on MI-BCI technology combined with other central nervous system intervention,improve the rehabilitation effect of MI-BCI technology by increasing the categories of motor imagery modalities,develop MI-BCI training programs for stroke patients in all periods,and provide a reference for limb movement rehabilitation of patients with central nervous system diseases.