偏瘫康复治疗中不同拇指运动方式的脑机制研究

Brain mechanism of different exercise mode of thumb in the rehabilitative treatment of hemiplegia

目的:探讨不同拇指运动方式在偏瘫康复治疗中的脑机制。方法:使用血氧水平依赖对比成像的功能性磁共振技术,观察了右侧底核区出血致左侧偏瘫患者在进行主动、被动、阻力和交替拇指运动时的脑区激活状况,将健侧与患侧运动时激活的脑区进行比较。结果:主动运动时健侧仅激活了对侧初级运动区(M1)。患侧激活了对侧M1区、辅助运动区、运动前区、同侧M1区、对侧小脑、底核区;被动运动时健侧激活了对侧M1区。患侧激活了对侧底核区、小脑;阻力运动时健侧激活了对侧M1区、同侧小脑、底核和M1区。患侧激活了对侧M1区、底核区及同侧感觉区、小脑;交替运动时双侧M1区不同程度被激活。结论:不同拇指运动方式各有其独特的康复作用。主动运动对于额叶高级皮质运动区的功能康复,是最好的方式,应尽早进行。被动运动方式对于相对低级的皮质下运动区(底核区、小脑),具有与主动运动相似的康复作用。阻力运动方式有助于皮质和皮质下运动区的全面功能康复。健、患侧交替运动时,健侧肢体对患侧肢体有“带领”作用,可以减低患侧肢体重新学习运动的难度,是有助于患侧功能康复的运动方式。

AIM:To explore the brain mechanism of different exercise mode of thumb in the rehabilitative treatment of hemiplegia. METHODS:Blood oxygenation level dependent contrast functional MRI was used to observe brain activation during active,passive,resistant,and alternative thumb movement of a hemiplegic patient of left side caused by bleeding of right basal ganglia,the status of activated brain of the healthy thumb was compared with that of the rehabilitated thumb. RESULTS:During active exercise,the movement of healthy thumb only activated contralateral primary motor area(M1),while the movement of rehabilitated thumb led to activations in the bilateral M1,contralateral premotor area(PMA),supplementary motor area(SMA),cerebellum,and basal ganglia;during passive movement,the healthy thumb activated contralateral M1 area,while the rehabilitated thumb activated contralateral basal ganglia and cerebellum;during resistant movement,the healthy thumb activated contralateral M1,ipsilateral basal ganglia,cerebellum and M1,while the rehabilitated thumb activated contralateral M1,basal ganglia,ipsilateral sensory area and cerebellum;during the alternative thumb movement,bilateral M1 area was activated with different degree. CONCLUSION:Different motor exercises have their unique rehabilitative function.The active exercise is the best method for rehabilitation of senior cortex motor area of frontal lobe,and should be adopted as soon as possible.Passive movement has similar rehabilitative function as active exercise to relatively low subcortex motor area(basal ganglia, cerebellum).Resistant exercise is good for the overall functional rehabilitation of cortex and subcortex motor areas.During the alternative exercise,the healthy thumb acts a role of guidance for the rehabilitative thumb.The alternative thumb movement,which is very good for the functional rehabilitation,may reduce the difficulty of learning to move the sick thumb again.