运动想象治疗脑卒中患者手部运动功能的功能磁共振研究  

Efficacy of Motor Imagery on Hand Function in Stroke Patients:an fMRI Study

作　　者：张亚菲[1] 刘旸[1] 张通[2] Zhang Yafei;Liu Chang;Zhang Tong(Department of Rehabilitation Medicine, Aerospace Center Hospital, Beijing 100049, China)

机构地区：[1]航天中心医院康复医学科,北京100049 [2]中国康复研究中心北京博爱医院神经康复科,北京100068

出　　处：《中国康复》2020年第11期576-581,共6页Chinese Journal of Rehabilitation

摘　　要：目的:探讨运动想象(MI)治疗对脑卒中后脑功能重塑的影响。方法:将16例脑卒中患者随机分为运动想象组(MI)6例、执行运动(EM)组5例、对照组(CG)5例。3组在常规康复治疗基础上,MI组、EM组分别进行运动想象、实际动作治疗,每次30min,每周5次,为期4周。治疗前、后进行运动功能评价,并使用功能磁共振(fMRI)观察患手对指实际动作、想象时偏瘫对侧感觉运动区的激活情况,定量分析治疗前后cSMC区的激活强度t、LI变化。结果:治疗4周后,MI组及EM组FMA、STEF评分较前均有明显提高(均P<0.05),且MI组上述评分均更高于其它2组(均P<0.05)。治疗后,3组MBI评分均有提高,但组内及组间差异无统计学意义。运动想象与运动执行的激活部位相似:治疗前运动想象激活区主要位于双侧SMC区、双侧SMA区,治疗后,各组双侧SMC区激活强度有增大趋势,MI组对侧SMC区激活显著(P<0.05),且对侧偏侧化优势较CG组显著(P<0.05)。结论:运动想象治疗能够明显改善脑卒中后患者手功能,其机制可能与运动想象促进脑功能重塑有关。Objective:To explore the cortical reorganization induced by motor imagery(MI)in stroke patients with functional magnetic resonance imaging(fMRI).Methods:All 16 patients were randomly divided into the MI group,executive motion(EM)group and control group.The MI group received the motor imagery treatment,and the EM group was given the actual operation,30 min/time,5 times a week,for a period of 4 weeks.The control group only received conventional rehabilitation.The improvement of hand function was assessed,and the fMRI scanning(overt and covert palmar opposition of thumb of the affected side)was done to find out the activated intensity(t value)of contralateral SMC and laterality index(LI).Results:The hand functions were improved in MI group and EM group after training(P<0.05),more significant in MI group than in the rest two groups(P<0.05).The t value caused by overt movement of MI and EM groups in contralateral SMC activation increased(P<0.05),more significantly in MI group than in control group(P<0.05).The activated cortices caused by imagery were similar to that of overt movement.The activation of MI was mainly located in the bilateral SMC and SMA.After training,the t value of bilateral SMC activation in all groups increased,the activation in MI group showed an advantage of the ipsilesional side(P<0.05),and the LI was significantly increased in MI group as compared with that in control group(P<0.05).Conclusion:MI could significantly improve the hand function of stroke patients,which might be related to the reorganization of brain functions.

关 键 词：运动想象 脑卒中 手功能 功能磁共振 脑功能重塑 

分 类 号：R49[医药卫生—康复医学] R743.3[医药卫生—临床医学]