《中国康复理论与实践》

《中国康复理论与实践》 ›› 2020, Vol. 26 ›› Issue (1): 77-84.doi: 10.3969/j.issn.1006-9771.2020.01.014

• 临床研究 • 上一篇    下一篇

脑机接口综合康复训练对亚急性期脑卒中疗效的静息态功能磁共振研究

吴琼1a,任诗媛2,乐赞2,葛云祥3,马迪1a,赵红亮1b,刘刚2,王晶2,潘钰1a(),窦维蓓3,4()   

  1. 1.清华大学附属北京清华长庚医院,清华大学临床医学院,a.康复医学科; b.放射科,北京市 102218
    2.西安交通大学机械学院机器人与智能系统研究所,陕西西安市 710049
    3.清华大学电子工程系,北京市 100084
    4.北京信息科学与技术国家研究中心,北京市 100084
  • 收稿日期:2019-10-09 修回日期:2019-11-04 出版日期:2020-01-25 发布日期:2020-02-07
  • 通讯作者: 潘钰,窦维蓓 E-mail:py10335@163.com;douwb@tsinghua.edu.cn
  • 作者简介:吴琼(1982-),女,满族,山西晋中市人,硕士,主治医师,主要研究方向：神经康复、脑机接口技术。
  • 基金资助:
    1.北京市科技计划课题(Z181100003118004);2.北京市自然科学基金项目(L182028)

Brain-computer Interface and Comprehensive Training for Stroke: A Resting State Functional Magnetic Resonance Imaging Study

WU Qiong1a,REN Shi-yuan2,YUE Zan2,GE Yun-xiang3,MA Di1a,ZHAO Hong-liang1b,LIU Gang2,WANG Jing2,PAN Yu1a(),DOU Wei-bei3,4()   

  1. 1. a. Department of Rehabilitation Medicine; b. Department of Radiology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, China
    2. Institute of Robotics and Intelligent Systems, School of Mechanical Engineering, Xi'an Jiaotong University, Xi'an, Shaanxi 710049, China
    3. Department of Electronic Engineering, Tsinghua University, Beijing 100084, China
    4. Beijing National Research Center for Information Science and Technology, Beijing 100084, China
  • Received:2019-10-09 Revised:2019-11-04 Published:2020-01-25 Online:2020-02-07
  • Contact: PAN Yu,DOU Wei-bei E-mail:py10335@163.com;douwb@tsinghua.edu.cn
  • Supported by:
    Beijing Science and Technology Commission Plan(Z181100003118004);Beijing Natural Science Foundation(L182028)

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摘要：

目的 探索亚急性期脑卒中患者接受基于运动想象的脑机接口(BCI)综合康复训练后,上肢运动功能和神经可塑性变化。
方法 2018年1月至2019年6月,中重度上肢功能障碍的亚急性期脑卒中患者14例,接受综合康复训练4周,内容包括基于运动想象的BCI训练、常规运动疗法和作业疗法。训练前后,采用Fugl-Meyer评定量表上肢部分(FMA-UE)、手臂动作调查测试(ARAT)和Wolf运动功能测试(WMFT)进行评定;以感觉运动区及额叶内侧为种子点,行静息态功能磁共振扫描,比较种子点功能连接。
结果训练后,患者FMA-UE、ARAT和WMFT评分均明显升高(|t| > 5.298, Z = -3.297, P < 0.01);颞、额、枕、顶叶多个脑区间功能连接增强。其中左侧顶叶前梨状皮质区(BA5L)与右侧额叶下脚后区(BA48R)之间的连接、左侧中央前回背侧(BA4L)和右侧前颞横回(BA41R)之间的连接与上肢运动功能评分正相关( r > 0.416, P < 0.05)。
结论 基于运动想象的BCI综合康复训练能改善亚急性期脑卒中患者上肢运动功能,促进脑功能网络活动。

关键词: 脑卒中, 脑机接口, 运动想象, 静息态功能磁共振, 神经可塑性, 功能连接

Abstract:

Objective To investigate the topological alterations in brain functional networks following comprehensive treatment including brain-computer interface (BCI) training in subacute stroke subjects.
Methods From January, 2018 to June, 2019, 14 subacute stroke patients with moderate to severe upper limbs paralysis accepted routine physical therapy, occupational therapy and BCI training based on motor imagery, for four weeks. They were assessed with Fugl-Meyer Assessment-Upper Extremities (FMA-UE), Action Research Arm Test (ARAT) and Wolf Motor Function Test (WMFT) before and after treatment, while the functional connectivity (FC) was investigated with resting state functional magnetic resonance imaging.
Results The scores of FMA-UE, ARAT and WMFT increased after treatment (|t| > 5.298, Z = -3.297, P < 0.01). The FC also increased across the whole brain, including temporal, parietal, occipital lobes and subcortical regions. The FC between left piriform cortex of parietal lobule (BA5L) and right medial surface of temporal lobe (BA48R), as well as those between left precentral gyrus (BA4L) and right anterior transverse temporal gyrus (BA41R) ( r > 0.416, P < 0.05).
Conclusion Comprehensive rehabilitation including BCI training may promote recovery of motor function and activities of FC in brain in subacute stroke patients.

Key words: stroke, brain-computer interface, motor imagery, resting state functional magnetic resonance imaging, neural plasticity, functional connectivity

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