胼胝体梗死的康复效果评估:基于功能近红外光谱技术的个案研究  

Assessment of rehabilitation of corpus callosum infarction:a case report based on functional near infrared spectroscopy

作　　者：陈予东[1,3] 杜晓霞 黄富表[2,3] 叶长青[1,3] 马琳 王云雷 吴晓莉 CHEN Yudong;DU Xiaoxia;HUANG Fubiao;YE Changqing;MA Lin;WANG Yunlei;WU Xiaoli(Department of Neurology 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;Capital Medical University School of Rehabilitation Medicine,Beijing 100068,China)

机构地区：[1]中国康复研究中心北京博爱医院神经康复一科,北京市100068 [2]中国康复研究中心北京博爱医院作业疗法科,北京市100068 [3]首都医科大学康复医学院,北京市100068

出　　处：《中国康复理论与实践》2025年第3期365-372,共8页Chinese Journal of Rehabilitation Theory and Practice

基　　金：中国康复研究中心青年课题(No.2023ZX-Q4)。

摘　　要：目的描述1例因脑梗死导致胼胝体损伤(表现为异己手综合征、注意力障碍、空间忽略、步态失用等)患者的个体化康复过程,并探讨功能近红外光谱技术(f NIRS)在评估脑激活中的优势。方法患者男性,54岁,通过简易精神状态检查、蒙特利尔认知评估、洛文斯顿作业治疗用认知功能评定测验和威斯康星卡片分类测验等多种评估工具,为患者制定个性化康复方案。在常规物理治疗、作业治疗、任务导向训练、镜像训练和计算机认知辅助训练的基础上,增加舒尔特方格训练、双侧肢体协同性训练和经颅磁刺激(TMS)治疗。采用f NIRS评估康复前后脑活状态的变化。结果综合康复1个多月后,患者异己手综合征、注意力障碍和空间忽略明显改善,步行恢复正常,运动、认知和日常生活能力均提高,脑部激活状态呈现积极变化。结论针对胼胝体损伤复杂症状,综合康复手段(特别是舒尔特方格、双侧协同训练及TMS)结合f NIRS评估脑激活,展现出显著康复效果。Objective To report the individualized rehabilitation protocol administered to a patient suffering from corpus callosum injury subsequent to cerebral infarction,manifesting clinically as alien hand syndrome,attention deficits,spatial neglect and gait apraxia;and to emphasize the application of functional near infrared spectroscopy(f NIRS) in the assessment of cerebral activation.Methods A 54-year-old male with corpus callosum damage following cerebral infarction was assessed by a comprehensive array of neuropsychological assessments,such as Mini-Mental State Examination,Montreal Cognitive Assessment,Loewenstein Occupational Therapy Cognitive Assessment and Wisconsin Card Sorting Test,etc.Based on these assessments,a personalized rehabilitation program was devised,incorporating physical therapy,occupational therapy,task-oriented training,mirror therapy,computer-assisted cognitive training,as well as Schulte's square attention training,bilateral limb coordination training and transcranial magnetic stimulation(TMS).f NIRS was used to evaluate changes in brain activation before and after rehabilitation.Results After more than a month of comprehensive rehabilitation,the patient experienced significant improvements in Alien hand syndrome,attention deficit and spatial neglect.Gait was normalized,and enhancements were observed in motor function,cognition and activity of daily living.f NIRS analysis revealed favorable alterations in cerebral activation patterns.Conclusion For the intricate symptoms associated with corpus callosum injury,a multidisciplinary rehabilitation approach,particularly the incorporation of Schulte's square attention training,bilateral coordination exercises and TMS,alongside f NIRS for monitoring cerebral activation,showed significant rehabilitation effects.

关 键 词：脑梗死 胼胝体 康复 经颅磁刺激 功能近红外光谱技术 

分 类 号：R743.3[医药卫生—神经病学与精神病学]