亚急性脑卒中患者康复过程中优势与非优势脑半球功能变化差异  

Brain functioning between dominant and non-dominant hemispheres during rehabilitation for subacute stroke

作　　者：李晁金子[1,2] 黄富表[1,3] 杜晓霞[1,2] 张豪杰 张通[1,2] LI Chaojinzi;HUANG Fubiao;DU Xiaoxia;ZHANG Haojie;ZHANG Tong(Capital Medical University School of Rehabilitation Medicine,Beijing 100068,China;Department of Neurological Rehabilitation,Beijing Bo'ai Hospital,China Rehabilitation Research Center,Beijing 100068,China;Department of Occupational Therapy,Beijing Bo'ai Hospital,China Rehabilitation Research Center,Beijing 100068,China)

机构地区：[1]首都医科大学康复医学院,北京市100068 [2]中国康复研究中心北京博爱医院神经康复科,北京市100068 [3]中国康复研究中心北京博爱医院作业疗法科,北京市100068

出　　处：《中国康复理论与实践》2022年第11期1342-1348,共7页Chinese Journal of Rehabilitation Theory and Practice

基　　金：中国康复研究中心项目(No.2020-Q4)。

摘　　要：目的基于功能性近红外光谱技术探讨亚急性脑卒中患者康复过程中优势与非优势大脑半球功能变化的差异。方法2019年9月至2020年6月,北京博爱医院亚急性脑卒中住院患者26例,其中左侧偏瘫患者10例(非优势半球组),右侧偏瘫患者16例(优势半球组),均行相同的单侧上肢任务导向作业治疗,共4周。训练前后,采用上肢动作研究量表、Fugl-Meyer评定量表上肢部分和握力进行评定,采用功能近红外光谱氧合血红蛋白浓度计算双侧感觉运动皮质、运动前皮质、前额叶皮质的平均β值。结果治疗后,两组各项临床评定均改善(|t|>3.253,P<0.05)。优势半球组上肢动作研究量表评分和握力改善程度大于非优势半球组(|t|>2.154,P<0.05)。时间、脑区、组别主效应均不显著(F<0.542,P>0.05),脑区与组别交互效应显著(F=4.226,P<0.01)。优势半球组,病灶同侧运动前皮质β值大于病灶对侧(P=0.030),对侧前额叶皮质β值低于同侧感觉运动皮质β值(P=0.024)、同侧运动前皮质(P=0.003)和同侧前额叶皮质β值(P=0.018)。结论脑卒中右侧偏瘫患者在亚急性期,随着上肢和手功能的恢复,优势半球与非优势半球脑区激活存在差异。Objective To observe the differences of brain functioning between dominant and non-dominant hemispheres during rehabilitation for subacute stroke based on functional near-infrared spectroscopy(fNIRS).Methods From September,2019 to June,2020,ten subacute stroke inpatients with left hemiplegia(non-dominant hemisphere group)and 16 with right hemiplegia(dominant hemisphere group)from Beijing Bo'ai Hospital received the same unilateral task-oriented occupational therapy for upper limbs,for four weeks.They were assessed with Action Research Arm Test,Fugl-Meyer Assessment-Upper Extremities and grip strength before and after treatment,and scanned with fNIRS to theβvalue of bilateral sensorimotor cortex,premotor cortex and prefrontal cortex according to the changes of oxyhemoglobin concentration.Results All the indexes of assessment improved in the both groups after treatment(|t|>3.253,P<0.05),while the scores of Action Research Arm Test and grip strength improved more in the dominant hemisphere group than in the non-dominant hemisphere group(|t|>2.154,P<0.05).For theβvalue of fNIRS,there was no main effect on time,region and groups(F<0.542,P>0.05),and the interactive effect between region and group was significant(F=4.226,P<0.01):In the dominant hemisphere group,theβvalue was higher in the ipsilateral premotor cortex than in the contralateral cortex(P=0.030),and it was less in the contralateral prefrontal cortex than in the ipsilateral sensorimotor cortex(P=0.024),ipsilateral premotor cortex(P=0.003)and ipsilateral prefrontal cortex(P=0.018).Conclusion For the subacute stroke patients with right hemiplegia,the activation of brain regions is different between dominant and non-dominant hemispheres during the rehabilitation of upper limb and hand.

关 键 词：脑卒中 亚急性 上肢 优势半球 功能性近红外光谱 脑可塑性 

分 类 号：R743.3[医药卫生—神经病学与精神病学]