运动想象在脑卒中康复中的应用  

Application of Motor Imagery in Stroke Rehabilitation

作　　者：王嘉雨 王杰宁 齐瑞[2] WANG Jiayu;WANG Jiening;QI Rui(The Seventh Clinical Medical College,Shanghai University of Traditional Chinese Medicine,Shanghai 200137,China;Affiliated Yueyang Hospital of Integrated Traditional Chinese and Western Medicine,Shanghai University of Traditional Chinese Medi-cine,Shanghai 200437,China)

机构地区：[1]上海中医药大学附属第七人民医院,上海200137 [2]上海中医药大学附属岳阳中西医结合医院,上海200437

出　　处：《康复学报》2025年第2期205-211,220,共8页Rehabilitation Medicine

基　　金：国家中医药管理局高水平中医药重点学科建设项目(ZYYZDXK-2023065);国家重点研发计划“中医药现代化研究”重点专项课题(2019YFC1711805);上海市临床重点专科项目(shslczdzk04601)。

摘　　要：运动想象(MI)是指对某一动作的实际运动过程有意识地在脑中重复排练但不产生任何运动的主动中枢干预方式,以激活与实际运动执行相似的神经网络,实现脑功能重组。MI具有应用安全性高、实施过程简易及治疗成本低等优点,可辅助脑卒中患者进行康复训练。本研究综述MI的概念及其发展、运动想象脑机接口(MI-BCI)技术、MI能力的评估方式、MI在脑卒中康复中的应用和作用机制,以期为MI在脑卒中康复领域的规范化应用提供参考。其中MI能力的评估方式包括问卷评估[运动想象问卷(MIQ)、运动想象清晰度问卷(VMIQ)和运动觉-视觉想象问卷(KVIQ)]、心理测量学(心理计时和心理旋转试验)和其他方式(时间一致性评估及自主神经功能指标)。MI在脑卒中康复中的应用主要包括MI在脑卒中后上肢运动功能障碍、脑卒中后下肢运动功能障碍、脑卒中后吞咽及言语功能障碍和脑卒中后抑郁中的应用;MI作用机制研究主要包括基于功能性近红外光谱成像技术(fNIRS)探究MI训练时脑区激活情况;基于功能性磁共振成像(fMRI)探究MI训练时大脑皮层区域活跃情况;基于神经电生理方法探究MI训练时大脑局部皮质神经元兴奋性和基于静息态脑功能连接(rs-FC)探究MI训练时大脑连接基线特征。但MI在脑卒中康复领域的应用还存在一些不足之处,如MI的作用机制尚未完全明确;开展MI康复训练前,需要评估患者的MI能力;临床上对MI辅助康复治疗尚无统一标准,如在治疗时间、操作指令及具体流程等方面还存在诸多差异。Motor imagery(MI)refers to an active central nervous system intervention involving conscious mental rehearsal of specific motor actions without producing physical movement,in order to activate neural networks analogous to those engaged during actual movement performance to achieve cerebral functional reorganization.Characterized by high operational safety,procedural simplicity,and cost-effectiveness,MI serves as an effective adjunctive approach for rehabilitation training in stroke patients.This review systematically examines five critical aspects,including concept and development of MI,motor imagery-based brain-computer interface(MI-BCI)technologies,MI capability assessment methods,clinical applications of MI in stroke rehabilitation,and neurophysiological mechanisms of MI,aiming to establish standardized implementation guidelines for MI interventions in stroke recovery.MI capability assessment incorporates three primary approaches,including standardized questionnaires[Motor Imagery Questionnaire(MIQ),Vividness of Movement Imagery Questionnaire(VMIQ),Kinesthetic-Visual Imagery Questionnaire(KVIQ)],psychometric evaluations(mental chronometry and psychomotor rotation tasks),and supplementary measures(temporal consistency analysis and autonomic nervous system parameters).Clinical applications of MI in stroke rehabilitation encompass four domains,including upper extremity motor dysfunction after stroke,lower extremity motor dysfunction after stroke,swallowing/speech impairments after stroke,and depression after stroke.Neurophysiological mechanisms of MI included functional near-infrared spectroscopy(fNIRS)for cortical activation mapping during MI training,functional magnetic resonance imaging(fMRI)for neural circuit analysis,neuroelectrophysiological recordings for cortical excitability assessment,and resting-state functional connectivity(rs-FC)for baseline neural network characterization during MI.However,there are still some limitations in the application of MI in stroke rehabilitation,such as incomplete elucidati

关 键 词：脑卒中 功能障碍 运动想象 运动想象脑机接口 康复治疗 

分 类 号：R743.3[医药卫生—神经病学与精神病学]