双侧上肢训练影响脑梗死患者脑功能重组的fMRI研究  

Bilateral arm training and cortical reorganization in cerebral infarction： A functional MRI study

作　　者：郑雅丹[1] 胡昔权[1] 李奎[1] 康庄[1] 陈颖蓓[1] 李鑫[1] 

机构地区：[1]中山大学附属第三医院康复科,广州510630

出　　处：《中华物理医学与康复杂志》2017年第5期336-341,共6页Chinese Journal of Physical Medicine and Rehabilitation

基　　金：广州市科技计划资助项目（2011Y200017-2）

摘　　要：目的利用BOLD．fMRI技术探讨双侧上肢训练对脑梗死患者脑功能重组的影响。方法采用随机数字表法将14例患侧上肢功能中度到重度损伤皮质下梗死患者分为双侧训练组及对照组，前者接受双侧上肢训练，后者接受以患侧上肢为主的常规单侧肢体训练。2组患者分别于治疗前、治疗4周后进行上肢功能评定以及BOLD—fMRI扫描，刺激任务为肘关节被动屈伸。结果治疗后2组患者Fugl-Meyer量表上肢部分（FMA-UE）、改良Barthel指数（MBI）评分均明显提高（P〈0．05），但两组间差异无统计学意义（P〉0．05）；治疗后2组患者激活脑区增加，以双侧训练组更明显；治疗后双侧训练组患者出现双侧M1、S1、辅助运动区（SMA）激活；治疗后双侧训练组中度损伤患者呈M1对侧激活趋势，重度损伤患者呈M1同侧激活趋势。结论双侧上肢训练能提高脑梗死患者上肢运动功能及日常生活能力，其机制可能与促进两侧大脑皮质间抑制正常化及同侧皮质脊髓通路开放有关。Objective To study the effect of bilateral arm training on cortical reorganization in cerebral infaretlon patients using blood oxygen level-dependent functional MRI （BOLD-fMRI）. Methods Fourteen cerebral infarction subjects with moderate to severe upper limb impairment participated in this randomized and single-blinded training study. Subjects in the bilateral arm training group （n= 7） practiced bilateral symmetrical or opposite activities, while the control group （n = 7） performed conventional, mainly unilateral, arm training. Those in both groups received fMRI scans before and after the training with passive elbow movement as the task in the imaging. Results Both groups had significant improvements in their average scores on the Fugl-Meyer upper extremity assessment and in their modified Barthel index scores after the treatment, and there were no significant differences between the two groups. Brain activation had increased in both groups after the treatment, especially in the bilateral training group. Af- ter the treatment, the first motor area （M1） , the first somatosensory area and the supplementary motor area on both sides were activated in the bilateral training group. Moreover, for patients in the bilateral training group with injuries of moderate severity, the M1 of the opposite side tended to be activated, while for those more severely injured the same side had a tendency to be activated. Conclusion Convalescing subcortical infarction patients with moderate to severe upper limb impairment benefit from bilateral arm training in terms of motor activity and performing activities in daily life. It may be related to the normalization of inhibition between the hemispheres of the bilateral cerebral cortex and the reconnection of ipsilateral corticospinal pathways.

关 键 词：脑梗死 双侧上肢训练 脑功能重组 功能性核磁共振成像 

分 类 号：R493[医药卫生—康复医学] R743.3[医药卫生—临床医学]