To investigate changes of functional activation areas of the cerebral cortex and the connectivity of motor cortex networks （MCNs） in stroke patients during the recovery, five patients with the infarct in their left ...To investigate changes of functional activation areas of the cerebral cortex and the connectivity of motor cortex networks （MCNs） in stroke patients during the recovery, five patients with the infarct in their left hemispheres are recruited. Functional magnetic resonance imaging （fMRI） is performed in the second, fourth, eighth, and sixteenth weeks after the stroke. Images are analyzed using the professional software SPM5 to obtain the bilateral activation of the motor cortex in left and right handgrip tests. MCN data are extracted from the active areas, and the structural and functional characteristic parameters are computed to indicate the connectivity of the network. Results show that the ipsilesional hemisphere recruits more areas with less active extent during the handgrip test, compared with the contralesional hemisphere. MCN shows a higher overall degree of statistical independence and more statistical dependence among motor areas with the gradual recovery. It can help physicians understand the recovery mechanism.展开更多
BACKGROUND： Functional MRI （fMRI） demonstrates the localization of hand representation in the motor cortex, thereby providing feasible noninvasive mapping of functional activities in the human brain. OBJECTIVE： To...BACKGROUND： Functional MRI （fMRI） demonstrates the localization of hand representation in the motor cortex, thereby providing feasible noninvasive mapping of functional activities in the human brain. OBJECTIVE： To observe cortical activation within different cortical motor regions during repetitive hand movements in healthy subjects through the use of fMRI. DESIGN： An observational study, with each subject acting as his own control. SETTING： Department of Radiology, the First Affiliated Hospital of Nanchang University. PARTICIPANTS： Seven healthy volunteers, 4 males and 3 females, aged 19 to 38 years, participated in the study. All subjects were right-handed, with no neurological or psychological disorders. Informed written consent was obtained from all subjects, and the study was approved by the Institutional Review Board of the First Affiliated Hospital of Nanchang University. METHODS： The study was performed at the Department of Radiology between June-August 2005. A 1.5 Tesla Siemens MRI scanner （Symphony, Germany） was used to acquire T1-weighted structural images, which were oriented parallel to the line running through the anterior and the posterior commissures. Subjects were instructed on a task and were allowed to practice briefly prior to the imaging procedure. The motor activation task consisted of the right hand performing a clenching movement. The T1-W images were acquired from six alternating epochs of rest and activation from all seven healthy subjects. Data were collected with echoplanar imaging of brain oxygen level dependent （BOLD） sequence. Each series comprised six cycles of task performance （30 seconds）, alternating with rest （30 seconds） periods, and 3-second time intervals. The differences between active and baseline fMRI imaging were calculated using the student t-test. Differential maps were overlaid on the high resolution TI-W structural image for neuroanatomical correlation of activation areas. MAIN OUTCOME MEASURES： The omega-shaped hand knobs were recognized on T1-W structural images. Active signal changes in the primary （M1） and secondary motor （M2） areas, as well as the relationship between the hand knobs and M1 area activation, were analyzed. Region of interest was selected for signal change quantitative graphic analysis. RESULTS： All 7 enrolled volunteers were included in the final analysis. In the present study, hand knob structures were recognized on T1-weighted images in all subjects and were omega-shaped in the axial plane. Significant functional activations were observed in the contralateral primary motor area of all subjects. Activation signals were distributed mainly in the central sulcus around the hand knob. The contralateral primary sensory （S1） cortex was activated in most cases, and ipsilateral M1 was activated in 3 subjects. Contralateral or bilateral supplementary motor area （SMA） was also activated in 6 cases. Premotor area, or super parietal lobe, was activated in two subjects. Three-dimensional reconstruction demonstrated that the active signal of M1 was primarily located at the middle-lateral surface of the contralateral precentral gyrus in Brodman＇s area 4, and the signal of SMA activation was located in the mesial surface of the premotor area. CONCLUSION： The knob structure of the precentral gyrus is the representative motor area for hand movement. The cerebral cortical motor network was extensively activated during voluntary hand movements in normal subjects. In alert, conscious human subjects, the activated fMRI signal safely and non-invasively localized and lateralized the motor cortical activity associated with simple voluntary repetitive hand movements. Whether higher cognitive functions, such as perception and speech, can be similarly mapped using the fMRI technique and the BOLD method remains to be determined in future well-designed human studies.展开更多
BACKGROUND：Neuro-rehabilitative training has been shown to promote motor function recovery in stroke patients,although the underlying mechanisms have not been fully clarified.OBJECTIVE：To investigate the effects of ...BACKGROUND：Neuro-rehabilitative training has been shown to promote motor function recovery in stroke patients,although the underlying mechanisms have not been fully clarified.OBJECTIVE：To investigate the effects of finger movement training on functional connectivity and information flow direction in cerebral motor areas of healthy people using electroencephalogram （EEG）.DESIGN,TIME AND SETTING：A self-controlled,observational study was performed at the College of Life Science and Bioengineering,Beijing University of Technology between December 2008 and April 2009.PARTICIPANTS：Nineteen healthy adults,who seldom played musical instruments or keyboards,were included in the present study.METHODS：Specific finger movement training was performed,and all subjects were asked to separately press keys with their left or right hand fingers,according to instructions.The task comprised five sessions of test train test train-test.Thirty-six channel EEG signals were recorded in different test sessions prior to and after training.Data were statistically analyzed using one-way analysis of variance.MAIN OUTCOME MEASURES：The number of effective performances,correct ratio,average response time,average movement time,correlation coefficient between pairs of EEG channels,and information flow direction in motor regions were analyzed and compared between different training sessions.RESULTS：Motor function of all subjects was significantly improved in the third test comparedwith the first test （P〈 0.01）.More than 80% of connections were strengthened in the motor-related areas following two training sessions,in particular the primary motor regions under the C4 electrode.Compared to the first test,a greater amount of information flowed from the Cz and Fcz electrodes （corresponding to supplementary motor area） to the C4 electrode in the third test.CONCLUSION：Finger task training increased motor ability in subjects by strengthening connections and changing information flow in the motor areas.These results provided a greater understanding of the mechanisms involved in motor rehabilitation.展开更多
Studies have confirmed that low-frequency repetitive transcranial magnetic stimulation can decrease the activity of cortical neurons, and high-frequency repetitive transcranial magnetic stimulation can increase the ex...Studies have confirmed that low-frequency repetitive transcranial magnetic stimulation can decrease the activity of cortical neurons, and high-frequency repetitive transcranial magnetic stimulation can increase the excitability of cortical neurons. However, there are few studies concerning the use of different frequencies of repetitive transcranial magnetic stimulation on the recovery of upper-limb motor function after cerebral infarction. We hypothesized that different frequencies of repetitive transcranial magnetic stimulation in patients with cerebral infarction would produce different effects on the recovery of upper-limb motor function. This study enrolled 127 patients with upper-limb dysfunction during the subacute phase of cerebral infarction. These patients were randomly assigned to three groups. The low-frequency group comprised 42 patients who were treated with 1 Hz repetitive transcranial magnetic stimulation on the contralateral hemisphere primary motor cortex （M1）. The high-frequency group comprised 43 patients who were treated with 10 Hz repetitive transcranial magnetic stimulation on ipsilateral M1. Finally, the sham group comprised 42 patients who were treated with 10 Hz of false stimulation on ipsilateral M1. A total of 135 seconds of stimulation was applied in the sham group and high-frequency group. At 2 weeks after treatment, cortical latency of motor-evoked potentials and central motor conduction time were significantly lower compared with before treatment. Moreover, motor function scores were significantly improved. The above indices for the low- and high-frequency groups were significantly different compared with the sham group. However, there was no significant difference between the low- and high-frequency groups. The results show that low- and high-frequency repetitive transcranial magnetic stimulation can similarly improve upper-limb motor function in patients with cerebral infarction.展开更多
To understand the connectivity of cerebral cor-tex, especially the spatial and temporal pattern of movement, functional magnetic resonance imaging (fMRI) during subjects performing finger key presses was used to extra...To understand the connectivity of cerebral cor-tex, especially the spatial and temporal pattern of movement, functional magnetic resonance imaging (fMRI) during subjects performing finger key presses was used to extract functional networks and then investigated their character-istics. Motor cortex networks were constructed with activation areas obtained with statistical analysis as vertexes and correlation coefficients of fMRI time series as linking strength. The equivalent non-motor cortex networks were constructed with certain distance rules. The graphic and dynamical measures of motor cor-tex networks and non-motor cortex networks were calculated, which shows the motor cortex networks are more compact, having higher sta-tistical independence and integration than the non-motor cortex networks. It indicates the motor cortex networks are more appropriate for information diffusion.展开更多
Once people have a well-trained motor skill, their performance becomes stabilized and achieving substantial improvement is difficult. Recently, we have shown that even a plateaued hand motor skill can be upgraded with...Once people have a well-trained motor skill, their performance becomes stabilized and achieving substantial improvement is difficult. Recently, we have shown that even a plateaued hand motor skill can be upgraded with short-period electrical stimulation to the hand prior to the task. Here, we identify the neuronal substrates underlying the improvement of the plateaued skill by examining the enhanced functional connectivity in the sensory-motor regions that are associated with motor learning. We measured brain activity using functional magnetic resonance imaging and performed psychophysiological interaction analysis. We recruited seven right-handed very-well trained participants, whose motor performance of continuously rotating two balls with their right hands became stabilized at higher performance levels. We prepared two experiments, in each of which they repeated an experimental run 16 times. In each run, they performed this cyclic rotation as many times as possible in 16 s. In the thenar-stimulation experiment, we applied 60-s stimulation to the thenar muscle before each of the 5th - 12th runs, and the others were preceded by ineffective sham stimulation. In the control experiment, the sham was always provided. Thenar stimulation enabled the participants to perform the movements at higher cycles. In association with this performance improvement, we found enhanced activity couplings between the primary motor cortex and the sensorimotor territory of the putamen and between the cerebellum and the primary sensorimotor cortices, without any quantitative activity increase. Neither behavioral change nor these increased activity couplings were observed in the control.Thus, in contrast to the stable neuronal states in the cortico-subcortical motor circuits when the well-learned task is repeated at the later stages of motor skill learning, plastic changes in the motor circuits seem to be required when the plateaued skill is upgraded, and the stimulation may entail a state of readiness for the plastic change that allows subsequent performance improvement.展开更多
Many studies have examined motor impairments using voxel-based lesion symptom mapping, but few are reported regarding the corresponding relationship between cerebral cortex injury and lower limb motor impairment analy...Many studies have examined motor impairments using voxel-based lesion symptom mapping, but few are reported regarding the corresponding relationship between cerebral cortex injury and lower limb motor impairment analyzed using this technique. This study correlated neuro- nal injury in the cerebral cortex of 16 patients with chronic stroke based on a voxel-based lesion symptom mapping analysis. Neuronal injury in the corona radiata, caudate nucleus and putamen of patients with chronic stroke could predict walking speed. The behavioral measure scores were consistent with motor deficits expected after damage to the cortical motor system due to stroke. These findings suggest that voxel-based lesion symptom mapping may provide a more accurate prognosis of motor recovery from chronic stroke according to neuronal injury in cerebral motor cortex.展开更多
目的:以非受累侧前运动皮质区(premotor cortex,PMC)为刺激靶点,比较不同治疗时程的重复经颅磁刺激(repeated transcranial magnetic stimulation,rTMS)对脑卒中患者上肢运动功能及脑功能连接的影响。方法:将60例缺血性脑卒中后上肢运...目的:以非受累侧前运动皮质区(premotor cortex,PMC)为刺激靶点,比较不同治疗时程的重复经颅磁刺激(repeated transcranial magnetic stimulation,rTMS)对脑卒中患者上肢运动功能及脑功能连接的影响。方法:将60例缺血性脑卒中后上肢运动功能障碍患者随机分到6周rTMS组、4周rTMS组和2周r TMS组以及对照组,每组15例。在治疗前后采用上肢Brunnstrom分期、Fugl-Meyer运动功能评分上肢部分(Fugl-Meyer assessment of upper extremity,FMA-UE)和Wolf运动功能评分(Wolf motor function test,WMFT)进行行为学评定,另外以非受累侧PMC为种子点采用静息态功能磁共振成像(resting state functional magnetic resonance imaging,rs-fMRI)进行功能连接分析。结果:治疗后,2周rTMS组的FMA-UE和WMFT的评分与4周及6周rTMS组间有显著性差异(P<0.05),但4周rTMS组的FMA-UE和WMFT的评分与6周rTMS组间无显著性差异(P>0.05)。非受累侧PMC区为种子点的功能连接分析显示,rTMS治疗后非受累侧PMC与同侧中央前回、对侧颞中回和楔前叶功能连接增强(P<0.05)。结论:研究结果表明,以非受累侧半球PMC为靶点的低频rTMS治疗可有效促进偏瘫上肢运动功能的恢复,其中与2周rTMS干预和6周rTMS干预相比,4周rTMS干预具有最佳的时间-效益比,这可能与其增强双侧半球间、非受累半球内皮质-皮质间的功能连接有关。展开更多
目的:系统评价经颅直流电刺激对帕金森患者运动功能的康复疗效,并比较经颅直流电刺激作用于不同靶点对帕金森患者运动功能的疗效差异,为临床中经颅直流电刺激的靶点选择提供理论依据。方法:计算机检索Cochrane Library、PubMed、Web of ...目的:系统评价经颅直流电刺激对帕金森患者运动功能的康复疗效,并比较经颅直流电刺激作用于不同靶点对帕金森患者运动功能的疗效差异,为临床中经颅直流电刺激的靶点选择提供理论依据。方法:计算机检索Cochrane Library、PubMed、Web of Science、中国知网、维普和万方数据库,以“帕金森、经颅直流电刺激”为中文检索词,以“Parkinson,transcranial direct current stimulation”为英文检索词,收集从各数据库建库至2023年1月发表的关于经颅直流电刺激改善帕金森患者运动功能的随机对照试验。使用Cochrane 5.1.0偏倚风险评估工具和PEDro量表对纳入研究进行质量评价。采用RevMan 5.4和Stata 17.0软件对结局指标进行Meta分析。结果:①最终纳入15项随机对照试验,PEDro量表评估显示均为高质量或极高质量研究。②Meta分析显示,与对照组相比经颅直流电刺激可显著提高UPDRS-Ⅲ评分(MD=-2.49,95%CI:-4.42至-0.55,P<0.05)、步频评分(MD=0.07,95%CI:0.03-0.11,P<0.05)和步速评分(MD=0.02,95%CI:0.00-0.05,P<0.05),但对BBS评分(MD=2.57,95%CI:-0.74-5.87,P>0.05)的提高不明显。③网状Meta分析概率排序结果显示,在UPDRS-Ⅲ评分方面,刺激靶点疗效的概率排序结果为背外侧前额叶皮质(52.4%)>初级皮质运动区(45.8%)>大脑中央点(1.8%)>常规康复治疗(0%);在步频评分方面,刺激靶点疗效的概率排序结果为小脑(50.1%)>大脑中央点(45.8%)>背外侧前额叶皮质(3.9%)>初级皮质运动区(0.2%)>常规康复治疗(0%);在步速评分方面,刺激靶点疗效的概率排序结果为小脑(64.8%)>背外侧前额叶皮质(23.8%)>大脑中央点(9.4%)>初级皮质运动区(1.7%)>常规康复治疗(0.4%);在BBS评分方面,刺激靶点疗效的概率排序结果为:小脑(77.4%)>背外侧前额叶皮质(20.7%)>大脑中央点(0.7%)>常规康复治疗(0.2%)。结论:经颅直流电刺激可显著改善帕金森患者运动功能,其中刺激背外侧前额叶皮质区域对改善帕金森患者运动协调方面疗效更佳,而刺激小脑区域对改善帕金森患者步行和平衡方面疗效更佳。展开更多
Mental practice is a new rehabilitation method that reters to the mental rehearsal ot motor imagery content with the goal of improving motor performance. However, the relationship between activated regions and motor r...Mental practice is a new rehabilitation method that reters to the mental rehearsal ot motor imagery content with the goal of improving motor performance. However, the relationship between activated regions and motor recovery after mental practice training is not well understood. In this study, 15 patients who suffered a firstever subcortical stroke with neurological deficits affecting the right hand, but no significant cognitive impairment were recruited. 10 patients underwent mental practice combined with physical practice training, and 5 patients only underwent physical practice training. We observed brain activation regions after 4 weeks of training, and explored the correlation of activation changes with functional recovery of the affected hands. The results showed that, after 4 weeks of mental practice combined with physical training, the Fugl-Meyer assessment score for the affected right hand was significantly increased than that after 4 weeks of practice training alone. Functional MRI showed enhanced activation in the left primary somatosensory cortex, attenuated activation intensity in the right primary motor cortex, and enhanced right cerebellar activation observed during the motor imagery task using the affected right hand after mental practice training. The changes in brain cortical activity were related to functional recovery of the hand. Experimental findings indicate that cortical and cerebellar functional reorganization following mental practice contributed to the improvement of hand function.展开更多
目的运用静息态功能磁共振技术探究“手足十二针”对缺血性脑卒中偏瘫患者运动皮质连接组功能连接(functional connectivity,FC)的影响。方法纳入37例缺血性脑卒中偏瘫患者,分为真穴组25例、假穴组12例。真穴组患者给予“手足十二针”组...目的运用静息态功能磁共振技术探究“手足十二针”对缺血性脑卒中偏瘫患者运动皮质连接组功能连接(functional connectivity,FC)的影响。方法纳入37例缺血性脑卒中偏瘫患者,分为真穴组25例、假穴组12例。真穴组患者给予“手足十二针”组穴(双侧合谷、内关、曲池、足三里、阳陵泉、三阴交)针刺干预;假穴组患者给予“手足十二针”经穴旁开1寸针刺干预。采用Fugl-Meyer量表(Fugl-Meyer assessment scale,FMA)评价患者的肢体运动功能,采用美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)评价患者的神经系统缺损程度,并进行静息态功能磁共振成像。选取双侧初级运动区(primary motor area,M1)、辅助运动区(supplementary motor area,SMA)、运动前区(premotor cortex,PMC)为种子点,分析计算各脑区间FC值。比较两组患者治疗前后FMA量表、NIHSS评分及FC值。结果与治疗前比较,真穴组患者治疗后FMA上肢运动功能评分、下肢运动功能评分、总分均显著升高(P<0.05),NIHSS评分显著降低(P<0.05);双侧M1 FC值显著升高(P<0.05),患侧SMA与健侧PMC的FC值显著降低(P<0.05)。与治疗前比较,假穴组患者治疗后下肢运动功能评分、FMA总分均显著升高(P<0.05),NIHSS评分显著降低(P<0.05)。结论“手足十二针”可能通过增强双侧初级运动区的FC以改善缺血性脑卒中偏瘫患者的运动功能及神经功能缺损程度,且具有穴位特异性,而辅助运动区与运动前区FC的改变也是另一可能的机制。展开更多
Cross-training is a phenomenon related to motor learning, where motor performance of the untrained limb shows improvement in strength and skill execution following unilateral training of the homologous contralateral l...Cross-training is a phenomenon related to motor learning, where motor performance of the untrained limb shows improvement in strength and skill execution following unilateral training of the homologous contralateral limb. We used functional MRI to investigate whether motor performance of the untrained limb could be improved using a serial reaction time task according to motor sequential learning of the trained limb, and whether these skill acquisitions led to changes in brain activation patterns. We recruited 20 right-handed healthy subjects, who were randomly allocated into training and control groups. The training group was trained in performance of a serial reaction time task using their non-dominant left hand, 40 minutes per day, for 10 days, over a period of 2 weeks. The control group did not receive training. Measurements of response time and percentile of response accuracy were performed twice during pre- and post-training, while brain functional MRI was scanned during performance of the serial reaction time task using the untrained right hand. In the training group, prominent changes in response time and percentile of response accuracy were observed in both the untrained right hand and the trained left hand between pre- and post-training. The control group showed no significant changes in the untrained hand between pre- and post-training. In the training group, the activated volume of the cortical areas related to motor function （i.e., primary motor cortex, premotor area, posterior parietal cortex） showed a gradual decrease, and enhanced cerebellar activation of the vermis and the newly activated ipsilateral dentate nucleus were observed during performance of the serial reaction time task using the untrained right hand, accompanied by the cross-motor learning effect. However, no significant changes were observed in the control group. Our findings indicate that motor skills learned over the 2-week training using the trained limb were transferred to the opposite homologous limb, and motor skill acquisition of the untrained limb led to changes in brain activation patterns in the cerebral cortex and cerebellum.展开更多
基金Supported by the National Natural Science Foundation of China (30670543)~~
文摘To investigate changes of functional activation areas of the cerebral cortex and the connectivity of motor cortex networks （MCNs） in stroke patients during the recovery, five patients with the infarct in their left hemispheres are recruited. Functional magnetic resonance imaging （fMRI） is performed in the second, fourth, eighth, and sixteenth weeks after the stroke. Images are analyzed using the professional software SPM5 to obtain the bilateral activation of the motor cortex in left and right handgrip tests. MCN data are extracted from the active areas, and the structural and functional characteristic parameters are computed to indicate the connectivity of the network. Results show that the ipsilesional hemisphere recruits more areas with less active extent during the handgrip test, compared with the contralesional hemisphere. MCN shows a higher overall degree of statistical independence and more statistical dependence among motor areas with the gradual recovery. It can help physicians understand the recovery mechanism.
文摘BACKGROUND： Functional MRI （fMRI） demonstrates the localization of hand representation in the motor cortex, thereby providing feasible noninvasive mapping of functional activities in the human brain. OBJECTIVE： To observe cortical activation within different cortical motor regions during repetitive hand movements in healthy subjects through the use of fMRI. DESIGN： An observational study, with each subject acting as his own control. SETTING： Department of Radiology, the First Affiliated Hospital of Nanchang University. PARTICIPANTS： Seven healthy volunteers, 4 males and 3 females, aged 19 to 38 years, participated in the study. All subjects were right-handed, with no neurological or psychological disorders. Informed written consent was obtained from all subjects, and the study was approved by the Institutional Review Board of the First Affiliated Hospital of Nanchang University. METHODS： The study was performed at the Department of Radiology between June-August 2005. A 1.5 Tesla Siemens MRI scanner （Symphony, Germany） was used to acquire T1-weighted structural images, which were oriented parallel to the line running through the anterior and the posterior commissures. Subjects were instructed on a task and were allowed to practice briefly prior to the imaging procedure. The motor activation task consisted of the right hand performing a clenching movement. The T1-W images were acquired from six alternating epochs of rest and activation from all seven healthy subjects. Data were collected with echoplanar imaging of brain oxygen level dependent （BOLD） sequence. Each series comprised six cycles of task performance （30 seconds）, alternating with rest （30 seconds） periods, and 3-second time intervals. The differences between active and baseline fMRI imaging were calculated using the student t-test. Differential maps were overlaid on the high resolution TI-W structural image for neuroanatomical correlation of activation areas. MAIN OUTCOME MEASURES： The omega-shaped hand knobs were recognized on T1-W structural images. Active signal changes in the primary （M1） and secondary motor （M2） areas, as well as the relationship between the hand knobs and M1 area activation, were analyzed. Region of interest was selected for signal change quantitative graphic analysis. RESULTS： All 7 enrolled volunteers were included in the final analysis. In the present study, hand knob structures were recognized on T1-weighted images in all subjects and were omega-shaped in the axial plane. Significant functional activations were observed in the contralateral primary motor area of all subjects. Activation signals were distributed mainly in the central sulcus around the hand knob. The contralateral primary sensory （S1） cortex was activated in most cases, and ipsilateral M1 was activated in 3 subjects. Contralateral or bilateral supplementary motor area （SMA） was also activated in 6 cases. Premotor area, or super parietal lobe, was activated in two subjects. Three-dimensional reconstruction demonstrated that the active signal of M1 was primarily located at the middle-lateral surface of the contralateral precentral gyrus in Brodman＇s area 4, and the signal of SMA activation was located in the mesial surface of the premotor area. CONCLUSION： The knob structure of the precentral gyrus is the representative motor area for hand movement. The cerebral cortical motor network was extensively activated during voluntary hand movements in normal subjects. In alert, conscious human subjects, the activated fMRI signal safely and non-invasively localized and lateralized the motor cortical activity associated with simple voluntary repetitive hand movements. Whether higher cognitive functions, such as perception and speech, can be similarly mapped using the fMRI technique and the BOLD method remains to be determined in future well-designed human studies.
基金the National Natural Science Foundation of China,No. 30670543
文摘BACKGROUND：Neuro-rehabilitative training has been shown to promote motor function recovery in stroke patients,although the underlying mechanisms have not been fully clarified.OBJECTIVE：To investigate the effects of finger movement training on functional connectivity and information flow direction in cerebral motor areas of healthy people using electroencephalogram （EEG）.DESIGN,TIME AND SETTING：A self-controlled,observational study was performed at the College of Life Science and Bioengineering,Beijing University of Technology between December 2008 and April 2009.PARTICIPANTS：Nineteen healthy adults,who seldom played musical instruments or keyboards,were included in the present study.METHODS：Specific finger movement training was performed,and all subjects were asked to separately press keys with their left or right hand fingers,according to instructions.The task comprised five sessions of test train test train-test.Thirty-six channel EEG signals were recorded in different test sessions prior to and after training.Data were statistically analyzed using one-way analysis of variance.MAIN OUTCOME MEASURES：The number of effective performances,correct ratio,average response time,average movement time,correlation coefficient between pairs of EEG channels,and information flow direction in motor regions were analyzed and compared between different training sessions.RESULTS：Motor function of all subjects was significantly improved in the third test comparedwith the first test （P〈 0.01）.More than 80% of connections were strengthened in the motor-related areas following two training sessions,in particular the primary motor regions under the C4 electrode.Compared to the first test,a greater amount of information flowed from the Cz and Fcz electrodes （corresponding to supplementary motor area） to the C4 electrode in the third test.CONCLUSION：Finger task training increased motor ability in subjects by strengthening connections and changing information flow in the motor areas.These results provided a greater understanding of the mechanisms involved in motor rehabilitation.
基金several colleague therapists of the Rehabilitation Medicine Department of the Affiliated Hospital of Qingdao University of China for their support and selfless help
文摘Studies have confirmed that low-frequency repetitive transcranial magnetic stimulation can decrease the activity of cortical neurons, and high-frequency repetitive transcranial magnetic stimulation can increase the excitability of cortical neurons. However, there are few studies concerning the use of different frequencies of repetitive transcranial magnetic stimulation on the recovery of upper-limb motor function after cerebral infarction. We hypothesized that different frequencies of repetitive transcranial magnetic stimulation in patients with cerebral infarction would produce different effects on the recovery of upper-limb motor function. This study enrolled 127 patients with upper-limb dysfunction during the subacute phase of cerebral infarction. These patients were randomly assigned to three groups. The low-frequency group comprised 42 patients who were treated with 1 Hz repetitive transcranial magnetic stimulation on the contralateral hemisphere primary motor cortex （M1）. The high-frequency group comprised 43 patients who were treated with 10 Hz repetitive transcranial magnetic stimulation on ipsilateral M1. Finally, the sham group comprised 42 patients who were treated with 10 Hz of false stimulation on ipsilateral M1. A total of 135 seconds of stimulation was applied in the sham group and high-frequency group. At 2 weeks after treatment, cortical latency of motor-evoked potentials and central motor conduction time were significantly lower compared with before treatment. Moreover, motor function scores were significantly improved. The above indices for the low- and high-frequency groups were significantly different compared with the sham group. However, there was no significant difference between the low- and high-frequency groups. The results show that low- and high-frequency repetitive transcranial magnetic stimulation can similarly improve upper-limb motor function in patients with cerebral infarction.
文摘To understand the connectivity of cerebral cor-tex, especially the spatial and temporal pattern of movement, functional magnetic resonance imaging (fMRI) during subjects performing finger key presses was used to extract functional networks and then investigated their character-istics. Motor cortex networks were constructed with activation areas obtained with statistical analysis as vertexes and correlation coefficients of fMRI time series as linking strength. The equivalent non-motor cortex networks were constructed with certain distance rules. The graphic and dynamical measures of motor cor-tex networks and non-motor cortex networks were calculated, which shows the motor cortex networks are more compact, having higher sta-tistical independence and integration than the non-motor cortex networks. It indicates the motor cortex networks are more appropriate for information diffusion.
文摘Once people have a well-trained motor skill, their performance becomes stabilized and achieving substantial improvement is difficult. Recently, we have shown that even a plateaued hand motor skill can be upgraded with short-period electrical stimulation to the hand prior to the task. Here, we identify the neuronal substrates underlying the improvement of the plateaued skill by examining the enhanced functional connectivity in the sensory-motor regions that are associated with motor learning. We measured brain activity using functional magnetic resonance imaging and performed psychophysiological interaction analysis. We recruited seven right-handed very-well trained participants, whose motor performance of continuously rotating two balls with their right hands became stabilized at higher performance levels. We prepared two experiments, in each of which they repeated an experimental run 16 times. In each run, they performed this cyclic rotation as many times as possible in 16 s. In the thenar-stimulation experiment, we applied 60-s stimulation to the thenar muscle before each of the 5th - 12th runs, and the others were preceded by ineffective sham stimulation. In the control experiment, the sham was always provided. Thenar stimulation enabled the participants to perform the movements at higher cycles. In association with this performance improvement, we found enhanced activity couplings between the primary motor cortex and the sensorimotor territory of the putamen and between the cerebellum and the primary sensorimotor cortices, without any quantitative activity increase. Neither behavioral change nor these increased activity couplings were observed in the control.Thus, in contrast to the stable neuronal states in the cortico-subcortical motor circuits when the well-learned task is repeated at the later stages of motor skill learning, plastic changes in the motor circuits seem to be required when the plateaued skill is upgraded, and the stimulation may entail a state of readiness for the plastic change that allows subsequent performance improvement.
基金supported by intramural funding from the University of South Carolina McCausland Center for Brain Imaging
文摘Many studies have examined motor impairments using voxel-based lesion symptom mapping, but few are reported regarding the corresponding relationship between cerebral cortex injury and lower limb motor impairment analyzed using this technique. This study correlated neuro- nal injury in the cerebral cortex of 16 patients with chronic stroke based on a voxel-based lesion symptom mapping analysis. Neuronal injury in the corona radiata, caudate nucleus and putamen of patients with chronic stroke could predict walking speed. The behavioral measure scores were consistent with motor deficits expected after damage to the cortical motor system due to stroke. These findings suggest that voxel-based lesion symptom mapping may provide a more accurate prognosis of motor recovery from chronic stroke according to neuronal injury in cerebral motor cortex.
文摘目的:以非受累侧前运动皮质区(premotor cortex,PMC)为刺激靶点,比较不同治疗时程的重复经颅磁刺激(repeated transcranial magnetic stimulation,rTMS)对脑卒中患者上肢运动功能及脑功能连接的影响。方法:将60例缺血性脑卒中后上肢运动功能障碍患者随机分到6周rTMS组、4周rTMS组和2周r TMS组以及对照组,每组15例。在治疗前后采用上肢Brunnstrom分期、Fugl-Meyer运动功能评分上肢部分(Fugl-Meyer assessment of upper extremity,FMA-UE)和Wolf运动功能评分(Wolf motor function test,WMFT)进行行为学评定,另外以非受累侧PMC为种子点采用静息态功能磁共振成像(resting state functional magnetic resonance imaging,rs-fMRI)进行功能连接分析。结果:治疗后,2周rTMS组的FMA-UE和WMFT的评分与4周及6周rTMS组间有显著性差异(P<0.05),但4周rTMS组的FMA-UE和WMFT的评分与6周rTMS组间无显著性差异(P>0.05)。非受累侧PMC区为种子点的功能连接分析显示,rTMS治疗后非受累侧PMC与同侧中央前回、对侧颞中回和楔前叶功能连接增强(P<0.05)。结论:研究结果表明,以非受累侧半球PMC为靶点的低频rTMS治疗可有效促进偏瘫上肢运动功能的恢复,其中与2周rTMS干预和6周rTMS干预相比,4周rTMS干预具有最佳的时间-效益比,这可能与其增强双侧半球间、非受累半球内皮质-皮质间的功能连接有关。
文摘目的:系统评价经颅直流电刺激对帕金森患者运动功能的康复疗效,并比较经颅直流电刺激作用于不同靶点对帕金森患者运动功能的疗效差异,为临床中经颅直流电刺激的靶点选择提供理论依据。方法:计算机检索Cochrane Library、PubMed、Web of Science、中国知网、维普和万方数据库,以“帕金森、经颅直流电刺激”为中文检索词,以“Parkinson,transcranial direct current stimulation”为英文检索词,收集从各数据库建库至2023年1月发表的关于经颅直流电刺激改善帕金森患者运动功能的随机对照试验。使用Cochrane 5.1.0偏倚风险评估工具和PEDro量表对纳入研究进行质量评价。采用RevMan 5.4和Stata 17.0软件对结局指标进行Meta分析。结果:①最终纳入15项随机对照试验,PEDro量表评估显示均为高质量或极高质量研究。②Meta分析显示,与对照组相比经颅直流电刺激可显著提高UPDRS-Ⅲ评分(MD=-2.49,95%CI:-4.42至-0.55,P<0.05)、步频评分(MD=0.07,95%CI:0.03-0.11,P<0.05)和步速评分(MD=0.02,95%CI:0.00-0.05,P<0.05),但对BBS评分(MD=2.57,95%CI:-0.74-5.87,P>0.05)的提高不明显。③网状Meta分析概率排序结果显示,在UPDRS-Ⅲ评分方面,刺激靶点疗效的概率排序结果为背外侧前额叶皮质(52.4%)>初级皮质运动区(45.8%)>大脑中央点(1.8%)>常规康复治疗(0%);在步频评分方面,刺激靶点疗效的概率排序结果为小脑(50.1%)>大脑中央点(45.8%)>背外侧前额叶皮质(3.9%)>初级皮质运动区(0.2%)>常规康复治疗(0%);在步速评分方面,刺激靶点疗效的概率排序结果为小脑(64.8%)>背外侧前额叶皮质(23.8%)>大脑中央点(9.4%)>初级皮质运动区(1.7%)>常规康复治疗(0.4%);在BBS评分方面,刺激靶点疗效的概率排序结果为:小脑(77.4%)>背外侧前额叶皮质(20.7%)>大脑中央点(0.7%)>常规康复治疗(0.2%)。结论:经颅直流电刺激可显著改善帕金森患者运动功能,其中刺激背外侧前额叶皮质区域对改善帕金森患者运动协调方面疗效更佳,而刺激小脑区域对改善帕金森患者步行和平衡方面疗效更佳。
文摘Mental practice is a new rehabilitation method that reters to the mental rehearsal ot motor imagery content with the goal of improving motor performance. However, the relationship between activated regions and motor recovery after mental practice training is not well understood. In this study, 15 patients who suffered a firstever subcortical stroke with neurological deficits affecting the right hand, but no significant cognitive impairment were recruited. 10 patients underwent mental practice combined with physical practice training, and 5 patients only underwent physical practice training. We observed brain activation regions after 4 weeks of training, and explored the correlation of activation changes with functional recovery of the affected hands. The results showed that, after 4 weeks of mental practice combined with physical training, the Fugl-Meyer assessment score for the affected right hand was significantly increased than that after 4 weeks of practice training alone. Functional MRI showed enhanced activation in the left primary somatosensory cortex, attenuated activation intensity in the right primary motor cortex, and enhanced right cerebellar activation observed during the motor imagery task using the affected right hand after mental practice training. The changes in brain cortical activity were related to functional recovery of the hand. Experimental findings indicate that cortical and cerebellar functional reorganization following mental practice contributed to the improvement of hand function.
文摘目的运用静息态功能磁共振技术探究“手足十二针”对缺血性脑卒中偏瘫患者运动皮质连接组功能连接(functional connectivity,FC)的影响。方法纳入37例缺血性脑卒中偏瘫患者,分为真穴组25例、假穴组12例。真穴组患者给予“手足十二针”组穴(双侧合谷、内关、曲池、足三里、阳陵泉、三阴交)针刺干预;假穴组患者给予“手足十二针”经穴旁开1寸针刺干预。采用Fugl-Meyer量表(Fugl-Meyer assessment scale,FMA)评价患者的肢体运动功能,采用美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)评价患者的神经系统缺损程度,并进行静息态功能磁共振成像。选取双侧初级运动区(primary motor area,M1)、辅助运动区(supplementary motor area,SMA)、运动前区(premotor cortex,PMC)为种子点,分析计算各脑区间FC值。比较两组患者治疗前后FMA量表、NIHSS评分及FC值。结果与治疗前比较,真穴组患者治疗后FMA上肢运动功能评分、下肢运动功能评分、总分均显著升高(P<0.05),NIHSS评分显著降低(P<0.05);双侧M1 FC值显著升高(P<0.05),患侧SMA与健侧PMC的FC值显著降低(P<0.05)。与治疗前比较,假穴组患者治疗后下肢运动功能评分、FMA总分均显著升高(P<0.05),NIHSS评分显著降低(P<0.05)。结论“手足十二针”可能通过增强双侧初级运动区的FC以改善缺血性脑卒中偏瘫患者的运动功能及神经功能缺损程度,且具有穴位特异性,而辅助运动区与运动前区FC的改变也是另一可能的机制。
基金supported by the Yeungnam College of Science & Technology Research Grants in 2012
文摘Cross-training is a phenomenon related to motor learning, where motor performance of the untrained limb shows improvement in strength and skill execution following unilateral training of the homologous contralateral limb. We used functional MRI to investigate whether motor performance of the untrained limb could be improved using a serial reaction time task according to motor sequential learning of the trained limb, and whether these skill acquisitions led to changes in brain activation patterns. We recruited 20 right-handed healthy subjects, who were randomly allocated into training and control groups. The training group was trained in performance of a serial reaction time task using their non-dominant left hand, 40 minutes per day, for 10 days, over a period of 2 weeks. The control group did not receive training. Measurements of response time and percentile of response accuracy were performed twice during pre- and post-training, while brain functional MRI was scanned during performance of the serial reaction time task using the untrained right hand. In the training group, prominent changes in response time and percentile of response accuracy were observed in both the untrained right hand and the trained left hand between pre- and post-training. The control group showed no significant changes in the untrained hand between pre- and post-training. In the training group, the activated volume of the cortical areas related to motor function （i.e., primary motor cortex, premotor area, posterior parietal cortex） showed a gradual decrease, and enhanced cerebellar activation of the vermis and the newly activated ipsilateral dentate nucleus were observed during performance of the serial reaction time task using the untrained right hand, accompanied by the cross-motor learning effect. However, no significant changes were observed in the control group. Our findings indicate that motor skills learned over the 2-week training using the trained limb were transferred to the opposite homologous limb, and motor skill acquisition of the untrained limb led to changes in brain activation patterns in the cerebral cortex and cerebellum.
