认知运动双任务训练对亚急性期卒中患者疗效的功能性近红外光谱成像研究

关键词：认知运动双任务  脑卒中  认知功能  运动功能  功能性近红外光谱成像

Keywords:cognitive-motor dual-task  stroke  cognitive function  motor function  functional near-infrared spectroscopy

摘要：

      摘要 目的：观察认知运动双任务训练对卒中后亚急性期患者的疗效并采用功能性近红外光谱成像（functional near-infrared spectroscopy， fNIRS）分析其改善脑功能连接的机制。 方法：40例脑卒中后患者被随机分成对照组和观察组各20例。所有患者均给予常规综合康复治疗，对照组给予步行功能训练与认知功能训练，观察组则给予认知运动双任务模式训练。两组患者分别于治疗前、治疗6周后应用简易智力状态检查量表（mini-mental state examination， MMSE）、Holden步行功能分级（functional ambulation category scale， FAC）、改良Barthel指数（modified Barthel index， MBI）对患者的认知、运动功能与日常生活活动能力进行评估，同时采用fNIRS观察任务态大脑初级运动皮质区（primary motor cortex， M1）、辅助运动皮质区（supplementary motor area， SMA）及前额叶皮质区 （prefrontal cortex， PFC）的功能活动和各脑区间的功能连接。 结果：最终纳入统计的患者共计37例，治疗前两组患者各基线水平相比无差异（P＞0.05）；治疗后两组患者 MMSE、FAC、MBI结果均优于治疗前且观察组更优于对照组，具有显著性差异（P＜0.05）；同时fNIRS观察显示，治疗后两组患者执行任务中除右M1区与右PFC区外，其余M1区、SMA区及PFC区的功能连接强度高于治疗前且观察组SMA区功能连接强度更高于对照组，具有显著性差异（P＜0.05）；治疗后两组患者执行任务中各损伤侧脑区功能连接值高于治疗前且观察组M1区与PFC区、SMA区与PFC区以及双侧SMA区之间的功能连接值更高于对照组，具有显著性差异（P＜0.05）。 结论：认知运动双任务训练比起常规运动与认知功能训练对亚急性期卒中患者认知运动功能的改善更为明显，其机制可能与双任务训练模式可更有效地提高SMA区功能连接强度，以及改善M1区与PFC区、SMA区与PFC区、双侧SMA之间的功能连接有关。

Abstract:

      Abstract Objective： To observe the effect of cognitive-motor dual-task training on patients with subacute stroke and to analyze the mechanism of improvement in brain functional connectivity by functional near-infrared spectroscopy （fNIRS）. Method： Forty patients with subacute stroke were randomly divided into a control group （n=20） and an observation group （n=20）. All patients were given conventional comprehensive rehabilitation treatment. The control group was given walking and cognitive function training separately， while the observation group was given cognitive-motor dual-task training. The cognition， motor function and activities of daily living were evaluated by mini-mental state examination （MMSE）， functional ambulation category scale （FAC） and modified Barthel index （MBI） before and after 6 weeks of treatment. fNIRS was used to compare the functional activity of the primary motor cortex （M1）， supplementary motor area （SMA）， prefrontal cortex （PFC） and the functional connectivity of each brain region under task states. Result： A total of 37 patients were included in the final statistics， and there was no difference in baseline level between the two groups before treatment （P>0.05）. After intervention， the MMSE， FAC and MBI of the two groups were better than those before treatment， and the observation group was better than the control group. The differences were statistically significant （P<0.05）. At the same time， fNIRS observation showed that after treatment， except the right M1 and right PFC， the functional intensity of M1， SMA and PFC in the two groups were higher than those before treatment. The functional intensity of SMA in the observation group was higher than that in the control group， and the difference was statistically significant （P<0.05）. After treatment， the functional connection intensity of brain regions on the injured side in the two groups were higher than those before treatment， and the functional connection intensity between bilateral SMA，M1 and PFC， SMA and PFC in the observation group were higher than those in the control group， and the differences were statistically significant （P<0.05）. Conclusion： Compared with conventional motor and cognitive function training， cognitive-motor dual-task training can more significantly improve cognitive， motor function and independence in patients with subacute stroke. The mechanism may be related to the fact that dual-task training can effectively improve the brain functional intensity of the SMA area， the functional connection intensity between M1 and PFC as well as SMA and PFC.