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胡昔权,蒋瑞姝,邹 艳,康 庄,郑雅丹,陈颖蓓.康复训练对脑梗死患者脑功能重组影响的纵向fMRI研究[J].中国康复医学杂志,2009,24(10):887~892
康复训练对脑梗死患者脑功能重组影响的纵向fMRI研究    点此下载全文
胡昔权  蒋瑞姝  邹 艳  康 庄  郑雅丹  陈颖蓓
中山大学附属第三医院康复医学科,广州,510630
基金项目:广东省科技计划项目(2006B36004014)
DOI:
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摘要:
      目的:利用BOLD-fMRI技术探讨脑梗死患者运动功能恢复过程中脑功能重组的发生及康复训练对脑梗死患者脑功能重组的影响。方法:16例病程1—3个月初发的皮质下脑梗死患者基本随机分为康复训练组(n=10)和对照组(n=6),分别接受、不接受康复训练。两组患者分别于入组时(第1次)、入组4周后(第2次)进行FMA、MAS和MBI等运动功能评定和BOLD-fMRI扫描。fMRI扫描时运动模式依次为患手、健手被动腕关节背伸运动,比较两组患者fMRI扫描结果的异同点,计算患手运动时对侧M1激活的体积、强度和LI值,观察LI值与患手功能恢复的关系。 结果:①康复训练组患者运动功能改善程度明显高于对照组(P<0.05)。②第1次fMRI扫描时,两组患者都出现双侧大脑皮质广泛、散在的激活,表现为M1激活的缺失、双侧PMC、SMA、CMA、IPL、PFC、CRB等的明显激活。第2次fMRI扫描时,康复训练组患手运动时以对侧M1激活为主,并有双侧SMA、PMC的激活;对照组患者前、后两次fMRI扫描出现的皮质激活情况改变不大。③康复训练组患手被动运动时,M1区的LI值第1、2次fMRI扫描分别为负数、正数;不论是对侧M1激活的体积,还是强度,均是第2次fMRI检查优于第1次fMRI(P<0.05)。④康复训练组患者前后两次FMA、MAS评分的改善程度与M1区LI的改变呈正相关(r=0.917,r=0.949)。结论: 脑卒中偏瘫患者的运动功能恢复,其机制与大脑发生的功能重组有关。康复训练可使患手运动时对侧M1区出现更多、更强的激活。
关键词:脑梗死  功能重组  康复训练  功能磁共振成像
The effect of rehabilitative training on brain functional reorganization in patients with cerebral infarction by fMRI: a longitudinal study    Download Fulltext
The Third Affiliated Hospital of Sun Yat-sen University,Guangzhou, 510630
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Abstract:
      Objective: To explore the effect of rehabilitative training on brain functional reorganization in patients with cerebral infarction. Method: Sixteen patients within 3 months after subcortical infarct were assigned to rehabilitation group(n=10) or control group(n=6).The rehabilitation group received 4 weeks rehabilitative training and the control group did not in this research. All patients were assessed by fMRI scanning and Fugl-Meyer motor assessment(FMA),Modified Barthel Index(MBI) and the Motor assessment scale (MAS) prior to and following the training. All patients received fMRI scanning during passive movement at both affected and unaffected wrested clenching separately. Brain functional mapping was acquired with SPM2, and different activation patterns of brain were compared between the two groups. The volume and intension of M1 activation were calculated, and the relationship between laterality index(LI) and motor function was examined. Result: The scores of motor function assessment in the rehabilitative training group were significantly better than the control group. The first fMRI before rehabilitative training showed an early general hyperactivation when the affected wrest was moved in bilateral brain. M1 activation moved from an early contralesional hyperactivation to a later ipilesional hyperactivation.There were positive correlation between LI (M1) and FMA、MAS changes.(r=0.917,r=0.949). Conclusion: The rehabilitative training can promote the motor function recovery and induce brain functional reorganization. Activation of M1 regions are associated with motor function recovery.
Keywords:cerebral infarction  functional reorganization  rehabilitative training  BOLD-fMRI
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