《中国康复理论与实践》

《中国康复理论与实践》 ›› 2026, Vol. 32 ›› Issue (10): 1165-1176.doi: 10.3969/j.issn.1006-9771.2026.10.005

• 应用研究 • 上一篇    下一篇

多学科团队管理下多模态调控对1例大面积脑梗死患者动态评估与精准康复

吴晓莉1a,2, 夏小茜2, 叶长青1a,2, 王云雷1a,2, 李星珠1a,2, 刘丽旭1a,2, 黄富表1b, 刘劲松1c, 宋宜川1d, 张悦1e, 杜晓霞1a,2()   

  1. 1 中国康复研究中心北京博爱医院， a. 神经康复科；b. 作业疗法科；c. 假肢矫形部；d. 音乐治疗中心；e. 康复评定科， 北京市 100068
    2 首都医科大学康复医学院， 北京市 100068
  • 收稿日期:2025-09-26 修回日期:2026-01-26 接受日期:2026-01-28 出版日期:2026-10-25 发布日期:2026-10-23
  • 通讯作者: 杜晓霞，女，博士，主任医师，主要研究方向：神经康复。E-mail： duxiaoxia2005@gmail.com
  • 作者简介:吴晓莉(1984-)，女，汉族，四川绵阳市人，博士，副主任医师，主要研究方向：神经康复。
  • 基金资助:
    国家重点研发计划项目(2022YFC3602802)

Application of multimodal neuromodulation guided by multidisciplinary team-based management in dynamic assessment and precision rehabilitation for a case of large-area cerebral infarction

Wu Xiaoli1a,2, Xia Xiaoqian2, Ye Changqing1a,2, Wang Yunlei1a,2, Li Xingzhu1a,2, Liu LiXu1a,2, Huang Fubiao1b, Liu Jingsong1c, Song Yichuan1d, Zhang Yue1e, Du Xiaoxia1a,2()   

  1. 1 a. Department of Neurology Rehabilitation; b. Department of Occupational Therapy; c. Institute of Rehabilitation Engineering; d. Music Therapy Center; e. Department of Rehabilitation Assessment, Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing 100068, China
    2 School of Rehabilitation, Capital Medical University, Beijing 100068, China
  • Received:2025-09-26 Revised:2026-01-26 Accepted:2026-01-28 Published:2026-10-25 Online:2026-10-23
  • Supported by:
    National Key Research and Development Plan(2022YFC3602802)

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摘要：

目的 探讨1例常规康复疗效欠佳的大面积脑梗死患者在多学科团队(MDT)全程动态评估下，结合多模态神经调控技术实施个体化精准康复治疗的有效性及可能的神经变化。

方法 患者为38岁男性，因动脉夹层致左侧额颞顶叶及基底节区大面积脑梗死，表现为右侧偏瘫伴完全性失语。在MDT协作下，开展为期6个月的住院康复及1个月门诊随访。全程采用弥散张量成像(DTI)、功能磁共振成像(fMRI)、三维步态分析、128导联脑电图等技术，联合标准化量表如中国康复研究中心汉语标准失语症检查(CRRCAE)、洛文斯顿作业疗法认知评定量表(LOTCA)、简化版Fugl-Meyer评定量表(FMA)和改良Barthel指数(MBI)等进行多时间点动态评估，并据此调整康复方案。康复方案在常规治疗基础上，整合多靶点经颅磁刺激(TMS)、脑机接口(BCI)器械手训练、任务导向性虚拟现实(VR)上肢训练等组成多模态干预体系。

结果 治疗后，患者LOTCA评分提升16分，CRRCAE各项评分提高60%~90%，FMA总分从20分增至54分，FMA平衡部分提高至12分，MBI由40分增至91分。DTI显示全脑纤维束追踪数量增加，胼胝体及右侧皮质脊髓束各向异性分数增高；fMRI提示特定脑区低频振幅与局部一致性增高；BCI训练中事件相关去同步化呈动态下降趋势；三维步态参数均总体改善。

结论 针对常规康复反应欠佳的大面积脑卒中，基于MDT全程动态评估，融合多模态神经调控技术与常规康复的个体化精准干预体系，可有效促进患者的认知、言语、运动功能及日常生活能力恢复。神经影像及电生理变化提示该方案可能通过促进神经纤维重塑、调节脑区活动等发挥作用。

关键词: 脑卒中, 功能评估, 神经调控, 康复, 功能恢复

Abstract:

Objective To explore the efficacy and potential neural mechanisms of individualized precision rehabilitation combining multimodal neuromodulation technologies under the guidance of multidisciplinary team (MDT)-based whole process dynamic assessment in a patient with large-area cerebral infarction who responded poorly to conventional rehabilitation.

Methods A 38-year-old male patient presented with hemiplegia and complete aphasia following large-area cerebral infarction in the left fronto-temporo-parietal lobe and basal ganglia due to arterial dissection. Under the MDT framework, the patient underwent six months of inpatient rehabilitation and one month of outpatient follow-up. Multimodal assessments were performed at multiple time points using diffusion tensor imaging (DTI), functional magnetic resonance imaging (fMRI), three-dimensional gait analysis and 128-channel electroencephalogram (EEG) monitoring, combined with standardized scales, such as Chinese Rehabilitation Research Center Standard Aphasia Examination (CRRCAE), Loewenstein Occupational Therapy Cognitive Assessment (LOTCA), simplified Fugl-Meyer Assessment (FMA) and modified Barthel Index (MBI). The rehabilitation protocol integrated conventional therapies with multimodal interventions, including multi-target transcranial magnetic stimulation, brain-computer interface (BCI)-driven robotic hand training and task-oriented virtual reality upper limb training.

Results After intervention, the patient showed significant improvements: LOTCA score increased by 16 points, CRRCAE subscale scores improved by 60% to 90%, total FMA score increased from 20 to 54, FMA-Balance reached 12, and MBI improved from 40 to 91. DTI revealed an increase in global fiber tract count, elevated fractional anisotropy in the corpus callosum and right corticospinal tract, and significantly increased amplitude of low-frequency fluctuations and regional homogeneity in specific brain regions on fMRI. Event-related desynchronization dynamically decreased during BCI training, and three-dimensional gait parameters showed overall improvement.

Conclusion For patients with large-area stroke who respond inadequately to conventional rehabilitation, an individualized precision rehabilitation system based on MDT whole-process dynamic assessment and integrating multimodal neuromodulation with conventional therapy can effectively enhance cognitive, language, motor functions and activities of daily living. Neuroimaging and electrophysiological findings suggest that the mechanism may involve promoting neural fiber remodeling and modulating regional brain activity.

Key words: stroke, functional assessment, neuromodulation, rehabilitation, recovery of function

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