实时与视频动作观察疗法下脑卒中患者脑区血氧动力学反应比较：一项基于功能性近红外光谱的研究

doi:10.3969/j.issn.1006-9771.2026.09.006

《中国康复理论与实践》 ›› 2026, Vol. 32 ›› Issue (9): 1041-1051.doi: 10.3969/j.issn.1006-9771.2026.09.006

实时与视频动作观察疗法下脑卒中患者脑区血氧动力学反应比较：一项基于功能性近红外光谱的研究

黄旭丽¹^,²^,³, 王萍芝³, 罗天娥¹^,²()

¹ 山西医科大学公共卫生学院卫生统计学教研室，山西晋中市 030600
² 煤炭环境致病与防治教育部重点实验室，山西晋中市 030619
³ 山西白求恩医院/山西医学科学院/山西医科大学第三医院/同济山西医院，山西太原市 030032

收稿日期:2026-01-07 修回日期:2026-04-13 接受日期:2026-04-15 出版日期:2026-09-25 发布日期:2026-09-20
通讯作者: 罗天娥(1977-)，女，汉族，山西大同市人，博士，副教授，硕士研究生导师，主要研究方向：医学纵向数据统计分析方法与应用。E-mail： luotiane1977@163.com
作者简介:黄旭丽(1990-)，女，汉族，山西临汾市人，主管治疗师，主要研究方向：神经康复。
基金资助:
山西省研究生教育创新计划项目(2025xx13);山西医科大学教育教学研究项目(XJ2025176);山西省重点研发计划项目(202302130501014)

Comparison of cortical hemodynamic responses between real-time and video-based action observation therapy in patients with stroke: a functional near-infrared spectroscopy study

Huang Xuli¹^,²^,³, Wang Pingzhi³, Luo Tian'e¹^,²()

¹ Department of Health Statistics, School of Public Health, Shanxi Medical University, Jinzhong, Shanxi 030600, China
² Key Laboratory of Coal Environment-Related Diseases and Prevention and Control, Ministry of Education, Jinzhong, Shanxi 030619, China
³ Shanxi Bethune Hospital/Shanxi Academy of Medical Sciences/the Third Hospital of Shanxi Medical University/Tongji Shanxi Hospital, Taiyuan, Shanxi 030032, China

Received:2026-01-07 Revised:2026-04-13 Accepted:2026-04-15 Published:2026-09-25 Online:2026-09-20
Contact: Luo Tian'e, E-mail: luotiane1977@163.com
Supported by:
Graduate Education Innovation Program Project of Shanxi Province(2025xx13);Shanxi Medical University Educational and Teaching Research Project(XJ2025176);Shanxi Provincial R&D Program (Key)(202302130501014)

摘要/Abstract

摘要：

目的采用功能性近红外光谱技术(fNIRS)，探讨实时动作观察疗法(R-AOT)与视频动作观察疗法(V-AOT)对脑卒中患者观察-模仿过程中脑区激活的血氧动力学差异。

方法选取2025年6月至9月在山西白求恩医院就诊的29例脑卒中患者，采用随机顺序、自身对照的交叉试验设计，先后接受R-AOT与V-AOT干预，中间间隔1 d以避免残留效应。通过fNIRS同步采集两阶段病灶侧和非病灶侧背外侧前额叶皮质(DLPFC)、枕叶皮质(OC)、颞叶皮质(TC)等感兴趣区(ROI)的氧合血红蛋白浓度(Oxy-Hb)变化，比较两种干预方式在不同阶段的脑区激活差异。

结果全部监测皮质ROI经假发现率(FDR)校正后，观察期和模仿期R-AOT与V-AOT条件间无显著性差异(P_FDR > 0.05)。观察期R-AOT条件下病灶侧DLPFC的Oxy-Hb变化高于V-AOT (Z = 2.183, P_FDR = 0.045)；病灶侧OC的Oxy-Hb变化方向与V-AOT不同，但无显著性差异(Z = 2.321, P_FDR = 0.060)。模仿期，R-AOT条件下仅病灶侧TC的Oxy-Hb变化高于V-AOT (Z = 2.724, P_FDR = 0.018)。

结论 R-AOT与V-AOT在脑卒中患者观察和模仿阶段可产生不同的局部皮质血氧动力学反应，其中观察阶段的差异主要见于病灶侧DLPFC，模仿阶段主要见于病灶侧TC。

关键词: 脑卒中, 实时动作观察疗法, 视频动作观察疗法, 功能性近红外光谱, 皮质激活, 镜像神经元系统

Abstract:

Objective To investigate the hemodynamic differences in cortical activation during the observation-imitation process between real-time action observation therapy (R-AOT) and video-based action observation therapy (V-AOT) in patients with stroke using functional near-infrared spectroscopy (fNIRS).

Methods A total of 29 patients with stroke in Shanxi Bethune Hospital from June to September, 2025 were enrolled. A randomized-sequence, self-controlled crossover trial design was employed. Each participant received both R-AOT and V-AOT, with a one-day interval between the two conditions to minimize potential carryover effect. fNIRS was used to simultaneously record changes in oxyhemoglobin (Oxy-Hb) concentration during the observation and imitation phases in regions of interest (ROIs), including the ipsilesional and contralesional dorsolateral prefrontal cortex (DLPFC), occipital cortex (OC), and temporal cortex (TC).

Results After false discovery rate (FDR) correction across all ROIs, no significant difference was observed between R-AOT and V-AOT during either the observation or imitation phase (P_FDR > 0.05). During the observation phase, Oxy-Hb was greater under R-AOT than under V-AOT in the ipsilesional DLPFC (Z= 2.183, P_FDR = 0.045). Oxy-Hb showed an opposite directional pattern between the two conditions in the ipsilesional OC, but the difference was not statistically significant (Z= 2.321, P_FDR = 0.060). During the imitation phase, the ipsilesional TC showed greater Oxy-Hb changes under R-AOT than under V-AOT (Z= 2.724, P_FDR = 0.018).

Conclusion R-AOT and V-AOT may elicit different local cortical hemodynamic responses during the observation and imitation phases in patients with stroke. The between-condition difference during the observation phase was mainly observed in the ipsilesional DLPFC, whereas during the imitation phase it was mainly observed in the ipsilesional TC.

Key words: stroke, real-time action observation therapy, video-based action observation therapy, functional near-infrared spectroscopy, cortical activation, mirror neuron system

中图分类号:

R743.3

黄旭丽, 王萍芝, 罗天娥. 实时与视频动作观察疗法下脑卒中患者脑区血氧动力学反应比较：一项基于功能性近红外光谱的研究[J]. 《中国康复理论与实践》, 2026, 32(9): 1041-1051.

Huang Xuli, Wang Pingzhi, Luo Tian'e. Comparison of cortical hemodynamic responses between real-time and video-based action observation therapy in patients with stroke: a functional near-infrared spectroscopy study[J]. Chinese Journal of Rehabilitation Theory and Practice, 2026, 32(9): 1041-1051.

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指标	统计量
性别(男/女)/n	25/4
年龄/岁	52.86±16.38
身高/cm	169.86±6.16
体质量/kg	72.52±13.77
病程/d	36.62±37.54
利手(右/左)/n	24/5
FMA上肢部分	22.10±15.41
FMA手功能	5.31±5.35
MMSE	28.41±1.12
上肢感觉障碍(有/无)/n	2/27
病灶部位(皮质/皮质下/混合)/n	2/11/16
优势半球受累(是/否)/n	12/17
病灶侧别(左/右)/n	15/14
失语(有/无)/n	2/27
偏侧忽略(有/无)/n	0/29
Brunnstrom上肢分期(Ⅱ/Ⅲ/Ⅳ期及以上)/n	9/11/9
Brunnstrom手分期(Ⅰ/Ⅱ/Ⅲ/Ⅳ/Ⅴ)/n	8/8/2/4/7
脑卒中类型(梗死/出血)/n	23/6
高血压(是/否)/n	18/11
糖尿病(是/否)/n	8/21
高血脂(是/否)/n	5/24

脑区	V-AOT	R-AOT	原始P值	P_FDR(k = 18)	P_FDR(k = 3)	Z值	r值
Broca(非病灶侧脑区)	-0.002(-0.024, 0.018)	0.006(-0.015, 0.041)	0.126	0.454	—	1.530	0.284
Broca(病灶侧脑区)	0.006(-0.017, 0.033)	0.011(-0.009, 0.033)	0.550	0.901	—	0.597	0.111
DLPFC(非病灶侧脑区)	0.004(-0.009, 0.016)	0.008(-0.007, 0.028)	0.550	0.826	—	0.597	0.111
DLPFC(病灶侧脑区)	0.000(-0.006, 0.010)	0.010(-0.005, 0.020)	0.029	0.262	0.045	2.183	0.405
FEF(非病灶侧脑区)	0.004(-0.011, 0.018)	0.000(-0.009, 0.018)	0.949	0.949	—	0.064	0.012
FEF(病灶侧脑区)	0.012(-0.007, 0.023)	0.002(-0.016, 0.017)	0.247	0.635	—	1.158	0.215
FPA(非病灶侧脑区)	-0.003(-0.013, 0.013)	0.007(-0.002, 0.028)	0.162	0.487	—	1.398	0.260
FPA(病灶侧脑区)	-0.001(-0.007, 0.010)	0.009(-0.008, 0.027)	0.092	0.414	—	1.685	0.313
OC(非病灶侧脑区)	0.027(-0.031, 0.066)	0.022(-0.067, 0.123)	0.898	0.951	—	0.128	0.024
OC(病灶侧脑区)	0.046(-0.054, 0.149)	-0.027(-0.044, 0.078)	0.020	0.365	0.060	2.321	0.431
M1 (非病灶侧脑区)	0.011(-0.017, 0.028)	0.011(-0.002, 0.028)	0.594	0.823	—	0.533	0.099
M1 (病灶侧脑区)	0.007(-0.009, 0.019)	0.008(-0.002, 0.024)	0.429	0.966	—	0.790	0.147
PMC&SMC(非病灶侧脑区)	0.010(-0.006, 0.022)	0.012(-0.004, 0.016)	0.701	0.842	—	0.384	0.071
PMC&SMC(病灶侧脑区)	0.000(-0.006, 0.015)	0.004(-0.014, 0.014)	0.522	0.940	—	0.640	0.119
SSC(非病灶侧脑区)	0.004(-0.006, 0.023)	0.014(0.000, 0.027)	0.670	0.861	—	0.426	0.079
SSC(病灶侧脑区)	0.011(-0.011, 0.029)	0.007(-0.005, 0.026)	0.749	0.843	—	0.320	0.059
TC(非病灶侧脑区)	-0.008(-0.024, 0.024)	0.013(-0.003, 0.031)	0.080	0.479	—	1.752	0.325
TC(病灶侧脑区)	0.000(-0.032, 0.037)	0.010(-0.003, 0.029)	0.481	0.962	0.481	0.704	0.131

脑区	V-AOT	R-AOT	原始P值	P_FDR (k = 18)	P_FDR (k = 3)	Z值	r值
Broca(非病灶侧脑区)	-0.011(-0.039, 0.008)	-0.003(-0.036, 0.018)	0.325	0.731	—	0.984	0.183
Broca(病灶侧脑区)	0.000(-0.024, 0.037)	0.001(-0.044, 0.031)	0.156	0.702	—	1.420	0.264
DLPFC(非病灶侧脑区)	-0.004(-0.018, 0.009)	0.008(-0.004, 0.038)	0.053	0.477	—	1.932	0.359
DLPFC(病灶侧脑区)	0.003(-0.010, 0.026)	0.014(-0.008, 0.033)	0.247	0.741	0.375	1.158	0.215
FEF(非病灶侧脑区)	0.007(-0.002, 0.025)	0.007(-0.004, 0.060)	0.284	0.730	—	1.071	0.199
FEF(病灶侧脑区)	0.004(-0.014, 0.025)	-0.001(-0.021, 0.011)	0.686	0.882	—	0.405	0.075
FPA(非病灶侧脑区)	-0.010(-0.031, 0.011)	-0.001(-0.017, 0.029)	0.053	0.318	—	1.932	0.359
FPA(病灶侧脑区)	0.001(-0.013, 0.018)	0.006(-0.007, 0.025)	0.405	0.729	—	0.833	0.155
OC(非病灶侧脑区)	-0.018(-0.199, 0.020)	0.002(-0.109, 0.086)	0.405	0.663	—	0.833	0.155
OC(病灶侧脑区)	0.018(-0.070, 0.082)	0.020(-0.030, 0.084)	0.639	0.959	0.639	0.469	0.087
M1 (非病灶侧脑区)	-0.001(-0.022, 0.025)	0.008(-0.012, 0.034)	0.654	0.906	—	0.448	0.083
M1 (病灶侧脑区)	0.005(-0.012, 0.016)	0.013(-0.016, 0.040)	0.198	0.713	—	1.288	0.239
PMC&SMC(非病灶侧脑区)	0.006(-0.013, 0.027)	0.015(-0.001, 0.027)	0.798	0.898	—	0.256	0.047
PMC&SMC(病灶侧脑区)	-0.001(-0.016, 0.017)	0.002(-0.010, 0.021)	0.325	0.650	—	0.984	0.183
SSC(非病灶侧脑区)	0.006(-0.013, 0.028)	0.005(-0.006, 0.020)	0.882	0.882	—	0.149	0.028
SSC(病灶侧脑区)	0.005(-0.012, 0.025)	0.002(-0.024, 0.045)	0.733	0.880	—	0.341	0.063
TC(非病灶侧脑区)	-0.005(-0.020, 0.028)	0.006(-0.022, 0.042)	0.848	0.897	—	0.192	0.036
TC(病灶侧脑区)	-0.025(-0.040, 0.016)	0.030(-0.012, 0.056)	0.006	0.108	0.018	2.724	0.506

脑区	阶段	Z值	原始P值	P_FDR值	r值	激活特征(R-AOT vs. V-AOT)
DLPFC	观察期	2.183	0.029	0.045	0.405	显著激活(R-AOT更高)
OC	观察期	2.321	0.020	0.060	0.431	未达统计学显著性但呈趋势(R-AOT反向激活)
TC	观察期	0.704	0.480	0.480	0.131	无显著性差异
DLPFC	模仿期	1.158	0.247	0.375	0.215	无显著性差异
OC	模仿期	0.469	0.639	0.640	0.087	无显著性差异
TC	模仿期	2.724	0.006	0.018	0.506	显著激活(R-AOT更高)

实时与视频动作观察疗法下脑卒中患者脑区血氧动力学反应比较：一项基于功能性近红外光谱的研究

Comparison of cortical hemodynamic responses between real-time and video-based action observation therapy in patients with stroke: a functional near-infrared spectroscopy study

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