痉挛型脑性瘫痪青少年行走时下肢协调及大脑皮质激活特征研究

关键词：脑性瘫痪  行走  关节协调  功能性近红外光谱  脑激活

Keywords:cerebral palsy  walk  joint coordination  functional near-infrared spectroscopy  brain activation

摘要：

      摘要 目的：探究痉挛型脑性瘫痪（脑瘫）青少年行走时大脑皮质的脑激活特征、下肢关节协调特征，为其步态协调性的康复训练提供理论依据。 方法：本研究共纳入8例12—18岁的痉挛型脑瘫青少年，为痉挛型脑瘫组，8例12—18岁的正常青少年为对照组，两组均以0.45m/s的固定速度在跑步机上行走。应用Vicon红外高速动作捕捉系统及功能性近红外光谱系统采集两组人群在跑步机上行走时运动学数据及感觉运动皮质区域的血流动力学信号，计算下肢关节内的平均绝对相对相位（mean absolute value of the continuous relative phase， MACRP）和相对相位标准差的平均值（deviation phase，DP），评价下肢环节的耦合协调特征；计算大脑皮质氧合血红蛋白（oxygenated hemoglobin，HbO2）相对浓度变化，评价大脑皮质激活特征。 结果：①下肢协调能力对比结果：在行走过程中，痉挛型脑瘫组左侧下肢肢体内髋-膝关节的耦合协调性MACRP值显著小于对照组（P=0.043，Cohen’s d=1.113）；痉挛型脑瘫组肢体内髋-膝关节（P=0.003，Cohen’s d=1.755）和膝-踝关节（P=0.009，Cohen’s d=1.503）的耦合变异性DP值均显著大于对照组。②大脑激活水平对比结果：痉挛型脑瘫组行走时辅助运动区的11通道（P=0.025，Cohen’s d=1.258）、12通道（P=0.02，Cohen’s d=2.310），中央前回的6通道（P=0.043，Cohen’s d=1.112）、14通道（P=0.006，Cohen’s d=1.633）和15通道（P=0.002，Cohen’s d=1.886），中央后回的6通道（P=0.043，Cohen’s d=1.112）、7通道（P=0.002，Cohen’s d=1.837）、15通道（P=0.002，Cohen’s d=1.886）和17通道（P=0.002，Cohen’s d=1.933），顶上小叶的9通道（P=0.016，Cohen’s d=1.363）、10通道（P=0.045，Cohen’s d=1.101）和18通道（P=0.001，Cohen’s d=2.221），以上通道的激活水平均显著大于对照组。 结论：痉挛型脑瘫青少年在行走过程中，大脑躯体感觉运动皮质区过度激活，下肢肢体内关节协调模式不稳定，存在较大变异性。

Abstract:

      Abstract Objective： To investigate the activation characteristics of the cerebral cortex and the coordination characteristics of the lower limb joints in adolescents with spastic cerebral palsy during walking， and to provide a theoretical basis for the rehabilitation training of their gait coordination. Method： A total of eight adolescents aged 12—18 years with spastic cerebral palsy were included as the spastic cerebral palsy group and eight normal adolescents aged 12—18 years were included as the control group. Both groups walked on a treadmill at a fixed speed of 0.45 m/s. A Vicon infrared high-speed motion capture system and a functional near-infrared spectroscopy system were applied to collect the kinematic data and hemodynamic signals in the sensory-motor cortical region of the two groups while walking on the treadmill. The mean absolute value of the continuous relative phase （MACRP） and the mean of the standard deviation of the relative phase （DP） were calculated to evaluate the coupling coordination characteristics of the lower limb links. The relative concentration change of oxygenated hemoglobin （HbO2） in the cerebral cortex was calculated to evaluate the activation characteristics of the cerebral cortex. Result： ①Comparison results of lower limb coordination ability： During walking， the MACRP value of coupling coordination of hip-knee joints within the left lower limb of the spastic cerebral palsy group was significantly smaller than that of the control group （P=0.043， Cohen's d=1.113）. The DP value of coupled variability within the limb of the spastic cerebral palsy group was significantly larger than that of the control group for both the hip-knee （P=0.003， Cohen's d=1.755） and knee-ankle （P=0.009， Cohen's d=1.503） joints. ②Comparison results of brain activation levels： Channels 11 （P=0.025， Cohen's d=1.258） and 12 （P=0.02， Cohen's d=2.310） in the supplementary motor area， channels 6 （P=0.043， Cohen's d=1.112）， 14 （P=0.006， Cohen's d=1.633）， and 15 （P=0.002， Cohen's d=1.886） in the precentral gyrus， channels 6 （P=0.043， Cohen's d=1.112）， 7 （P=0.002， Cohen's d=1.837）， 15 （P=0.002， Cohen's d=1.886）， and 17 （P=0.002， Cohen 's d=1.933） in the postcentral gyrus， channels 9 （P=0.016， Cohen's d=1.363）， 10 （P=0.045， Cohen's d=1.101） and 18 （P=0.001， Cohen's d=2.221） in the superior parietal lobule， the activation levels of the above channels of the spastic cerebral palsy group were significantly greater than those of the control group. Conclusion： During walking， adolescents with spastic cerebral palsy had hyperactivation of the somatosensory-motor cortical area of the brain and an unstable pattern of joint coordination within the lower limbs， with a high degree of variability.