基于功能性近红外光谱技术的脑卒中后上肢运动功能障碍患者单侧上肢训练和双侧上肢训练脑网络功能连接对比研究

doi:10.3969/j.issn.1006-9771.2022.05.001

《中国康复理论与实践》 ›› 2022, Vol. 28 ›› Issue (5): 497-501.doi: 10.3969/j.issn.1006-9771.2022.05.001

基于功能性近红外光谱技术的脑卒中后上肢运动功能障碍患者单侧上肢训练和双侧上肢训练脑网络功能连接对比研究

田婧,刘珏,何志杰,范晨雨,李浩正,杨青,吴毅,余克威()

复旦大学附属华山医院康复医学科,上海市 200040

收稿日期:2022-03-31 修回日期:2022-05-05 出版日期:2022-05-25 发布日期:2022-06-10
通讯作者: 余克威 E-mail:yukewei@fudan.edu.cn
作者简介:田婧(1982-),女,汉族,重庆市人,硕士,主管技师,主要研究方向：神经系统疾病的康复治疗
基金资助:
1. 国家重点研发计划项目(2018YFC2001700);2. 上海市科技创新行动计划课题(20412420200);3. 上海市临床重点专科项目(shslczdzk02702)

Brain network functional connectivity as unilateral or bilateral upper limb training for patients with upper limb motor dysfunction after stroke: study with functional near-infrared spectroscopy

TIAN Jing,LIU Jue,HE Zhijie,FAN Chenyu,LI Haozheng,YANG Qing,WU Yi,YU Kewei()

Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China

Received:2022-03-31 Revised:2022-05-05 Published:2022-05-25 Online:2022-06-10
Contact: YU Kewei E-mail:yukewei@fudan.edu.cn
Supported by:
National Key R & D Program of China(2018YFC2001700);Shanghai Science and Technology Innovation Action Plan(20412420200);Shanghai Municipal Key Clinical Specialty(shslczdzk02702)

摘要/Abstract

摘要：

目的采用功能性近红外光谱(fNIRS)比较上肢运动功能障碍脑卒中患者单侧和双侧上肢运动时的脑网络功能连接差异。方法 2021年4月至6月,华山医院康复医学科脑卒中后上肢运动功能障碍患者40例分别行患侧单侧和双侧上肢运动,运动前后各采集fNIRS数据8 min,基于氧合血红蛋白,分析前额叶(PFC)、上肢与手功能区(H)以及初级躯体感觉区(S1)的功能活动和功能连接。结果单侧任务后,患侧H区功能活动较运动前增强(t = -3.135, P < 0.05),患侧H区与患侧S1区、患侧H区与健侧S1区、患侧S1区与健侧S1区间功能连接强度较任务前增强(|t| > 3.218, P < 0.05)。双侧任务后,各区功能强度和各区间功能连接均无显著性差异(|t| < 2.385, P > 0.05)。单侧任务对患侧H区功能连接的增强效应高于双侧任务(t = 2.026, P < 0.05)。结论相比双侧任务,脑卒中患者单侧上肢训练对强化相应功能脑区的即时效果更好,可对脑功能连接产生更明显的调控效应。

关键词: 脑卒中, 上肢, 运动功能障碍, 功能性近红外光谱, 脑功能连接

Abstract:

Objective To compare the functional connectivity of brain networks in stroke patients with upper limb motor dysfunction during unilateral or bilateral upper limb movement using functional near-infrared spectroscopy (fNIRS). Methods From April to June, 2021, 40 stroke patients with upper limb motor dysfunction in Department of Rehabilitation Medicine, Huashan Hospital, finished unilateral (affected) and bilateral upper limb movement. Eight-minute fNIRS data were collected before and after movement, and the functional activities and connectivity of prefrontal cortex (PFC), upper limb and hand functional area (H), primary sensory cortex (S1) were analyzed based on oxygenated hemoglobin. Results Functional activities increased in affected H after unilateral task (t = -3.135, P < 0.05), while the functional connectivity increased between affected H and affected S1, affected H and unaffected S1, and affected S1 and unaffected S1 (|t| > 3.218, P < 0.05). There was no significant difference in the functional activities and connectivity of all the areas after bilateral upper limb task (|t| < 2.385, P > 0.05). The improvement of affected H was more after unilateral task than after bilateral upper limb task (t = 2.026, P < 0.05). Conclusion Unilateral affected upper limb training is more effective on functional activities and connectivity for corresponding brain regions than bilateral task.

Key words: stroke, upper limb, motor dysfunction, functional near-infrared spectroscopy, brain functional connectivity

中图分类号:

R743.3

田婧,刘珏,何志杰,范晨雨,李浩正,杨青,吴毅,余克威. 基于功能性近红外光谱技术的脑卒中后上肢运动功能障碍患者单侧上肢训练和双侧上肢训练脑网络功能连接对比研究[J]. 《中国康复理论与实践》, 2022, 28(5): 497-501.

TIAN Jing,LIU Jue,HE Zhijie,FAN Chenyu,LI Haozheng,YANG Qing,WU Yi,YU Kewei. Brain network functional connectivity as unilateral or bilateral upper limb training for patients with upper limb motor dysfunction after stroke: study with functional near-infrared spectroscopy[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2022, 28(5): 497-501.

图/表 6

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参考文献 29

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ROI	任务前	任务后	t值	P值
L-PFC	0.615±0.050	0.680±0.054	-1.388	0.208
R-PFC	0.665±0.045	0.697±0.047	-0.933	0.356
L-H	0.918±0.066	1.105±0.071	-3.135	0.020
R-H	0.955±0.061	1.062±0.068	-1.702	0.145
L-S1	0.806±0.059	0.940±0.070	-2.064	0.091
R-S1	0.820±0.059	0.974±0.077	-2.315	0.078

ROI	任务前	任务后	t值	P值
L-PFC/R-PFC	0.487±0.034	0.514±0.043	-0.741	0.496
L-PFC/L-H	0.455±0.033	0.505±0.044	-1.364	0.246
L-PFC/R-H	0.432±0.035	0.517±0.042	-1.990	0.115
L-PFC/L-S1	0.465±0.037	0.522±0.047	-1.395	0.246
L-PFC/R-S1	0.426±0.038	0.495±0.044	-1.837	0.138
R-PFC/L-H	0.431±0.024	0.475±0.036	-1.310	0.247
R-PFC/R-H	0.450±0.026	0.506±0.038	-1.371	0.246
R-PFC/L-S1	0.450±0.033	0.459±0.039	-0.264	0.793
R-PFC/R-S1	0.467±0.31	0.516±0.042	-1.228	0.262
L-H/R-H	0.745±0.048	0.876±0.061	-2.362	0.079
L-H/L-S1	0.684±0.047	0.835±0.056	-3.218	0.031
L-H/R-S1	0.569±0.038	0.703±0.055	-2.894	0.031
R-H/L-S1	0.590±0.041	0.703±0.055	-2.229	0.079
R-H/R-S1	0.704±0.048	0.810±0.060	-2.257	0.079
L-S1/R-S1	0.566±0.041	0.737±0.062	-3.031	0.031

ROI	任务前	任务后	t值	P值
L-PFC	0.688±0.066	0.698±0.060	-0.252	0.889
R-PFC	0.659±0.060	0.708±0.061	-1.008	0.889
L-H	1.020±0.065	1.029±0.067	-0.141	0.889
R-H	1.030±0.066	1.011±0.067	0.290	0.889
L-S1	0.841±0.069	0.978±0.069	-1.848	0.433
R-S1	0.887±0.070	0.931±0.071	-0.770	0.889

ROI	任务前	任务后	t值	P值
L-PFC/R-PFC	0.503±0.048	0.562±0.047	-1.523	0.387
L-PFC/L-H	0.463±0.044	0.509±0.038	-1.214	0.387
L-PFC/R-H	0.464±0.042	0.472±0.039	-0.179	0.859
L-PFC/L-S1	0.448±0.045	0.533±0.043	-2.370	0.129
L-PFC/R-S1	0.430±0.042	0.481±0.041	-1.345	0.387
R-PFC/L-H	0.420±0.035	0.479±0.036	-1.663	0.387
R-PFC/R-H	0.463±0.039	0.486±0.043	-0.602	0.635
R-PFC/L-S1	0.424±0.037	0.506±0.041	-2.385	0.129
R-PFC/R-S1	0.470±0.045	0.555±0.042	-2.317	0.129
L-H/R-H	0.840±0.052	0.862±0.059	-0.379	0.757
L-H/L-S1	0.762±0.053	0.823±0.057	-1.081	0.430
L-H/R-S1	0.633±0.048	0.690±0.049	-1.285	0.387
R-H/L-S1	0.660±0.045	0.700±0.053	-0.805	0.542
R-H/R-S1	0.754±0.058	0.793±0.054	-0.791	0.542
L-S1/R-S1	0.616±0.045	0.678±0.058	-1.302	0.387

ROI	单侧任务	双侧任务	t值	P值
L-PFC	0.066±0.047	0.009±0.042	0.898	0.372
R-PFC	0.032±0.035	0.048±0.049	-0.268	0.789
L-H	0.188±0.060	0.008±0.066	2.026	0.046
R-H	0.107±0.063	-0.026±0.065	1.463	0.147
L-S1	0.135±0.065	0.131±0.074	0.036	0.972
R-S1	0.154±0.066	0.041±0.057	1.296	0.199
L-PFC/R-PFC	0.028±0.038	0.058±0.038	-0.557	0.579
L-PFC/L-H	0.051±0.037	0.046±0.038	0.087	0.931
L-PFC/R-H	0.085±0.042	0.006±0.043	1.302	0.197
L-PFC/L-S1	0.058±0.041	0.083±0.036	-0.459	0.648
L-PFC/R-S1	0.069±0.037	0.050±0.038	0.349	0.728
R-PFC/L-H	0.044±0.034	0.058±0.035	-0.288	0.774
R-PFC/R-H	0.056±0.041	0.022±0.038	0.613	0.542
R-PFC/L-S1	0.010±0.037	0.081±0.034	-1.419	0.160
R-PFC/R-S1	0.049±0.040	0.084±0.037	-0.650	0.518
L-H/R-H	0.131±0.056	0.019±0.059	1.387	0.169
L-H/L-S1	0.152±0.047	0.059±0.057	1.257	0.212
L-H/R-S1	0.133±0.046	0.056±0.044	1.203	0.233
R-H/L-S1	0.113±0.051	0.037±0.050	1.069	0.288
R-H/R-S1	0.107±0.047	0.037±0.049	1.020	0.311
L-S1/R-S1	0.172±0.057	0.061±0.048	1.503	0.137

基于功能性近红外光谱技术的脑卒中后上肢运动功能障碍患者单侧上肢训练和双侧上肢训练脑网络功能连接对比研究

Brain network functional connectivity as unilateral or bilateral upper limb training for patients with upper limb motor dysfunction after stroke: study with functional near-infrared spectroscopy

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