健康人和脑卒中患者视觉反馈步行训练后脑激活特征的功能性近红外光谱技术研究

doi:10.3969/j.issn.1006-9771.2024.09.011

《中国康复理论与实践》 ›› 2024, Vol. 30 ›› Issue (9): 1074-1081.doi: 10.3969/j.issn.1006-9771.2024.09.011

健康人和脑卒中患者视觉反馈步行训练后脑激活特征的功能性近红外光谱技术研究

谢丹丹¹, 陈善佳¹, 雷蕾¹, 余果¹, 余佳慧¹, 赵嘉培¹, 何晓阔¹^,²()

1.厦门市第五医院康复医学科，福建厦门市 361101
2.厦门市脑病康复技术转化重点实验室，福建厦门市 361101

收稿日期:2024-06-17 修回日期:2024-07-15 出版日期:2024-09-25 发布日期:2024-10-15
通讯作者: 何晓阔，E-mail： hexk@sohu.com
作者简介:谢丹丹(1978-)，女，汉族，湖北十堰市人，主管护师，主要研究方向：运动康复与内分泌及代谢病。
基金资助:
厦门市医疗卫生重点项目(3502Z20234005);厦门市自然科学基金项目(3502Z202373135);厦门市自然科学基金项目(3502Z20227418);福建省自然科学基金项目(2022D010)

Characteristics of brain activation during treadmill walking with visual feedback in healthy subjects and hemiplegic patients: a functional near infrared spectroscopy study

XIE Dandan¹, CHEN Shanjia¹, LEI Lei¹, YU Guo¹, YU Jiahui¹, ZHAO Jiapei¹, HE Xiaokuo¹^,²()

1. Department of Rehabilitation Medicine, Fifth Hospital of Xiamen, Xiamen, Fujian 361101, China
2. Xiamen Key Laboratory of Rehabilitation Technology Transformation of Encephalopathy, Xiamen, Fujian 361101, China

Received:2024-06-17 Revised:2024-07-15 Published:2024-09-25 Online:2024-10-15
Contact: HE Xiaokuo, E-mail: hexk@sohu.com
Supported by:
Xiamen Key Project of Medical Treatment and Public Health(3502Z20234005);Xiamen Natural Science Foundation(3502Z202373135);Xiamen Natural Science Foundation(3502Z20227418);Fujian Province Natural Science Foundation(2022D010)

摘要/Abstract

摘要：

目的比较健康受试者和脑卒中患者在视觉反馈步行训练(TWVF)时的皮质激活特征。
方法 2021年8月至11月，厦门市第五医院招募8例脑卒中右侧偏瘫住院患者(患者组)和8例健康受试者(健康组)。两组均佩戴功能性近红外光谱帽并完成TWVF任务，范式包括预备期(10 s)和任务期(“迈步30 s-休息30 s”5个循环)。测量两组大脑皮质激活β值，感兴趣区(ROI)包括前运动皮质(PMC)、辅助运动区(SMA)、感觉运动皮质(S1与M1合称SMC)。
结果健康组步行时双侧M1无明显激活，左半球SMA、PMC和S1激活(P < 0.05)；患者组步行时健(右)侧半球M1激活程度高于患(左)侧半球，PMC激活程度低于患侧(P < 0.05)。患者组双侧半球M1、健侧SMA和患侧PMC的激活程度高于健康组(P < 0.05)。
结论脑卒中偏瘫患者在步行时涉及更多的SMC-PMC-SMA运动网络激活。健康受试者步行时无明显M1激活，偏瘫患者健侧M1存在代偿激活现象。

关键词: 脑卒中, 步行, 脑激活模式, 功能性近红外光谱技术

Abstract:

Objective To compare the cortical activation characteristic in the healthy subjects and hemiplegia patients during executing treadmill walking with visual feedback (TWVF).
Methods From August to November, 2021, eight stroke patients with right hemiplegia (patient group) and eight healthy subjects (healthy group) in Fifth Hospital of Xiamen were recruited. Both groups wore functional near-infrared spectroscopy (fNIRS) caps and executed TWVF, respectively. Experimental block design for walking modes included the preparation period (10 s) and task period (five cycles of "step 30 s- rest 30 s"). The cortical activation (β values) were measured. The regions of interest (ROI) included the pre-motor cortex (PMC), supplementary motor area (SMA), primary motor cortex (M1), primary somatosensory cortex (S1) and sensorimotor cortex (SMC, M1+S1).
Results No activation in bilateral M1, and some significant activation (P < 0.05) in the left hemisphere SAM, PMC and S1, were found during walking in the healthy group. M1 was activated more in the unaffected (right) hemisphere than in the affected (left) hemisphere during walking in the patient group (P < 0.05), and less PMC activation was found (P < 0.05). M1 in bilateral hemispheres, SMA in the unaffected hemisphere and PMC in the affected hemisphere were activated more in the patient group than in the healthy group (P < 0.05).
Conclusion The locomotor network of SMC-PMC-SMA are activated more in the hemiplegic patients than in the healthy pepole during walking. M1 are almost not activated in the healthy people during walking, and compensatorily activated in M1 of the unaffected side in the hemiplegic patients.

Key words: stroke, walking, brain activation, functional near infrared spectroscopy

中图分类号:

R743.3

谢丹丹, 陈善佳, 雷蕾, 余果, 余佳慧, 赵嘉培, 何晓阔. 健康人和脑卒中患者视觉反馈步行训练后脑激活特征的功能性近红外光谱技术研究[J]. 《中国康复理论与实践》, 2024, 30(9): 1074-1081.

XIE Dandan, CHEN Shanjia, LEI Lei, YU Guo, YU Jiahui, ZHAO Jiapei, HE Xiaokuo. Characteristics of brain activation during treadmill walking with visual feedback in healthy subjects and hemiplegic patients: a functional near infrared spectroscopy study[J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(9): 1074-1081.

图/表 4

表1

图1

表2

群组水平的脑区通道激活列表(β值)"

CH	健康组	患者组	健康组内比较		患者组内比较		两组间对比
CH	健康组	患者组	t值	P值	t值	P值	t值	P值
1	-0.020±0.026	-0.171±0.113	-0.773	0.465	-1.514	0.190	-1.487	0.163
2	-0.041±0.033	-0.012±0.036	-1.238	0.256	-0.338	0.749	0.582	0.571
3	0.052±0.074	-0.173±0.105	0.700	0.507	-1.646	0.161	-1.805	0.096
4	0.053±0.075	-0.219±0.091	0.705	0.504	-2.424	0.060	-2.334	0.038
5	0.018±0.022	-0.094±0.046	0.819	0.440	-2.036	0.097	-2.379	0.035
6	0.017±0.023	-0.173±0.085	0.744	0.481	-2.029	0.098	-2.449	0.031
7	0.017±0.016	-0.140±0.069	1.045	0.331	-2.023	0.099	-2.529	0.026
8	0.013±0.052	0.254±0.067	0.257	0.805	3.800	0.013	2.879	0.014
9	-0.119±0.132	-0.152±0.051	-0.903	0.396	-2.989	0.030	-0.203	0.842
10	0.107±0.080	0.114±0.008	1.333	0.224	14.052	< 0.001	0.075	0.941
11	0.020±0.037	0.014±0.005	0.538	0.607	2.900	0.034	-0.134	0.896
12	-0.150±0.134	-0.014±0.087	-1.120	0.300	-0.165	0.875	0.785	0.448
13	0.033±0.051	0.128±0.063	0.633	0.547	2.041	0.097	1.191	0.257
14	0.048±0.074	0.150±0.076	0.651	0.536	1.982	0.104	0.944	0.364
15	0.004±0.026	0.281±0.088	0.167	0.872	3.188	0.024	3.402	0.005
16	0.042±0.030	0.243±0.117	1.387	0.208	2.078	0.092	1.904	0.081
17	-0.119±0.090	0.233±0.108	-1.318	0.229	2.154	0.084	2.515	0.027
18	-0.039±0.044	-0.012±0.033	-0.894	0.401	-0.368	0.728	0.470	0.647
19	-0.009±0.022	0.098±0.051	-0.421	0.686	1.922	0.113	2.120	0.056
20	0.081±0.047	0.124±0.065	1.733	0.127	1.911	0.114	0.562	0.585
21	-0.008±0.013	-0.163±0.107	-0.656	0.532	-1.526	0.188	-1.675	0.120
22	0.165±0.081	-0.096±0.062	2.036	0.081	-1.549	0.182	-2.409	0.033
23	0.070±0.030	0.091±0.045	2.351	0.051	2.029	0.098	0.409	0.690
24	0.059±0.031	0.063±0.049	1.890	0.101	1.307	0.248	0.079	0.939
25	0.013±0.079	0.123±0.046	0.164	0.875	2.678	0.044	1.101	0.293
26	-0.007±0.017	0.084±0.026	-0.376	0.718	3.267	0.022	3.030	0.010
27	0.061±0.038	0.138±0.035	1.597	0.154	3.983	0.010	1.455	0.171
28	0.029±0.020	0.116±0.032	1.481	0.182	3.670	0.014	2.457	0.030
29	0.017±0.010	-0.214±0.112	1.673	0.138	-1.917	0.113	-2.406	0.033
30	0.014±0.017	0.091±0.036	0.780	0.461	2.522	0.053	2.102	0.057
31	0.019±0.024	0.015±0.011	0.813	0.443	1.318	0.245	-0.152	0.882
32	0.035±0.021	-0.008±0.036	1.718	0.129	-0.216	0.838	1.112	0.288
33	0.039±0.015	0.067±0.041	2.496	0.041	1.648	0.160	0.735	0.476
34	0.034±0.010	0.135±0.050	3.424	0.011	2.726	0.041	2.294	0.041
35	0.040±0.025	0.113±0.040	1.635	0.146	2.843	0.036	1.626	0.130
36	0.029±0.017	0.006±0.011	1.697	0.134	0.536	0.615	1.033	0.322
37	0.066±0.026	0.173±0.052	2.514	0.040	3.334	0.021	1.977	0.071

表2

图2

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Brodmann分区法	通道序号
S1：BA 1,2,3 Wernicke区：BA40 Subcentral area中央下区：BA43	CH03/05/06/09/11、CH21/29/30/35/37、CH01/36 CH02/31 CH3/37
M1：BA4	CH08/10/15/16/19/20/25/26/28
PMC和SMA：BA6	CH04/07/12/13/14/17/18/22/23/24/27/32/33/34

健康人和脑卒中患者视觉反馈步行训练后脑激活特征的功能性近红外光谱技术研究

Characteristics of brain activation during treadmill walking with visual feedback in healthy subjects and hemiplegic patients: a functional near infrared spectroscopy study

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