应用BOLD-fMRI探讨推拿对缺血性卒中后运动皮质功能重组影响的研究

关键词：血氧水平依赖性  功能磁共振成像  推拿疗法  缺血性卒中  脑可塑性  功能重组

Keywords:blood oxygenation level dependent-functional MR  Tuina  ischemic stroke  brain plasticity  functional reorganization

摘要：

      摘要 目的：研究推拿治疗前后缺血性卒中患者完成对指运动时脑功能磁共振成像（BOLD-fMRI）激活特点与肢体运动功能恢复的相关性，探讨推拿对卒中后大脑运动功能区重塑可能存在的影响。 方法：5例急性期缺血性卒中患者，均为右侧肢体瘫痪，分别在推拿治疗前、推拿治疗30次后应用3.0T磁共振仪进行fMRI数据采集，fMRI试验采用组块设计，受试者完成拇指与食指的对指运动。功能磁共振数据使用SPM5软件包进行处理，受试者功能评分使用SPSS软件统计。 结果：fMRI显示，与对照组相比，推拿治疗前右侧（患侧）对指运动以右脑激活为主，激活脑区较少，激活体素低；推拿治疗后患者右侧（患侧）对指运动时右侧中央前回手部支配区域激活强度明显增加，左脑SMC区呈小簇状激活，运动前区和辅助运动区激活较前显著，双侧后顶叶皮质激活。 结论：推拿治疗可能通过调节中枢的张力反馈通路，对中枢的运动协调整合功能产生影响，改善初期运动功能障碍状态和运动协调性、灵活性，促进脑皮质运动区功能重组。

Abstract:

      Abstract Objective: To investigate the effects of Tuina on functional reorganization of cerebral motor cortex by studying the correlation between rehabilitation of limb motor function and the activation presentation with blood oxygenation level dependent-functional MR imaging (BOLD-fMRI) of ischemic stroke patients treated with Tuina. Method: Five patients in acute stage of cerebral infarction participated in the experiments. All of the patients had functional disturbance of right upper-limb and the volunteers were normal. The evaluation of functional disturbance of upper-limb was performed to the subjects prior to the experiment. All of the patients were required to finish the thumb-to-other fingers tapping task and underwent 3.0T functional magnetic resonance imaging twice, before Tuina in resting state and after 30 times Tuina. A block design was used for the inspection. Result: The fMRI showed that before Tuina the activated brain regions were mainly in the right side(affected side) during the right thumb-to-other fingers tapping task, and only in a lower activation level and rarely areas were activated to the task. After Tuina， the patients' scores increased in active research arm test(ARAT), which indicated the affected arm function improved. These subjects also displayed cortical reorganization on fMRI. The area responsible for the right hand movement showed activation increased obviously in the precentral gyrus. The left SMC region was significantly activated in the left premotor area, posterior parietal cortex and supplementary motor area. Conclusion: Tuina can regulate tension feedback path of central nervous system (CNS) and affect CNS's motor coordination integration which can improve movement function obstacle in early states and enhance sports coordination and flexibility. Tuina may play an role in enhancing brain plasticity and functional reorganization.