亚急性脑卒中患者康复过程中优势与非优势脑半球功能变化差异

doi:10.3969/j.issn.1006-9771.2022.11.014

Abstract

Abstract:

Objective To observe the differences of brain functioning between dominant and non-dominant hemispheres during rehabilitation for subacute stroke based on functional near-infrared spectroscopy (fNIRS).

Methods From September, 2019 to June, 2020, ten subacute stroke inpatients with left hemiplegia (non-dominant hemisphere group) and 16 with right hemiplegia (dominant hemisphere group) from Beijing Bo'ai Hospital received the same unilateral task-oriented occupational therapy for upper limbs, for four weeks. They were assessed with Action Research Arm Test, Fugl-Meyer Assessment-Upper Extremities and grip strength before and after treatment, and scanned with fNIRS to the β value of bilateral sensorimotor cortex, premotor cortex and prefrontal cortex according to the changes of oxyhemoglobin concentration.

Results All the indexes of assessment improved in the both groups after treatment (|t| > 3.253, P < 0.05), while the scores of Action Research Arm Test and grip strength improved more in the dominant hemisphere group than in the non-dominant hemisphere group (|t| > 2.154, P < 0.05). For the β value of fNIRS, there was no main effect on time, region and groups (F < 0.542, P> 0.05), and the interactive effect between region and group was significant (F = 4.226, P < 0.01): In the dominant hemisphere group, the β value was higher in the ipsilateral premotor cortex than in the contralateral cortex (P= 0.030), and it was less in the contralateral prefrontal cortex than in the ipsilateral sensorimotor cortex (P= 0.024), ipsilateral premotor cortex (P= 0.003) and ipsilateral prefrontal cortex (P = 0.018).

Conclusion For the subacute stroke patients with right hemiplegia, the activation of brain regions is different between dominant and non-dominant hemispheres during the rehabilitation of upper limb and hand.

Key words: stroke, subacute, upper limb, dominant hemisphere, functional near-infrared spectroscopy, brain plasticity

CLC Number:

R743.3

LI Chaojinzi,HUANG Fubiao,DU Xiaoxia,ZHANG Haojie,ZHANG Tong. Brain functioning between dominant and non-dominant hemispheres during rehabilitation for subacute stroke[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2022, 28(11): 1342-1348.

Figures/Tables 6

References 54

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一般特征	非优势半球组 (n = 10)	优势半球组 (n = 16)	χ²/t值	P值
性别(男/女)/n	8/2	12/4	0.087	0.768
年龄/岁	58.19±11.77	61.30±8.97	-0.715	0.482
病程/d	56.69±22.85	43.30±25.33	1.395	0.176
卒中类型 (出血/梗死)/n	5/5	4/12	1.699	0.192
NIHSS评分	5.13±2.30	4.50±2.92	0.608	0.549

组别	n	治疗前	治疗后	t值	P值
非优势半球组	10	35.81±13.93	45.13±13.21	-5.320	< 0.001
优势半球组	16	29.10±10.20	41.30±11.29	-5.107	0.001
t值		1.315	-0.975
P值		0.201	0.342

组别	n	治疗前	治疗后	t值	P值
非优势半球组	10	22.00±17.23	32.19±19.62	-3.935	0.001
优势半球组	16	19.60±13.59	39.70±14.41	-4.893	0.001
t值		0.373	-2.154
P值		0.712	0.040

组别	n	治疗前	治疗后	t值	P值
非优势半球组	10	6.44±8.68	8.08±8.33	-3.637	0.002
优势半球组	16	4.95±4.47	9.25±6.22	-3.253	0.010
t值		0.501	-2.255
P值		0.621	0.034

组别	脑区	治疗前	治疗后
非优势半球组 (n = 10)	同侧SMC	2.66±2.24	2.67±1.69
	对侧SMC	4.32±3.41	4.60±4.62
	同侧PMC	2.58±2.27	2.46±1.91
	对侧PMC	4.28±3.82	3.77±2.61
	同侧PFC	3.00±1.88	2.91±1.08
	对侧PFC	3.85±2.47	3.77±2.68
优势半球组 (n = 16)	同侧SMC	3.87±3.36	2.45±4.99
	对侧SMC	2.47±1.63	2.48±2.23
	同侧PMC	3.67±3.00	5.05±6.80
	对侧PMC	2.18±1.71	1.79±1.35
	同侧PFC	2.75±3.24	3.69±3.70
	对侧PFC	2.12±2.20	0.98±2.13

Brain functioning between dominant and non-dominant hemispheres during rehabilitation for subacute stroke

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脑区	同侧SMC	对侧SMC	同侧PMC	对侧PMC	同侧PFC
对侧SMC	0.376	-
同侧PMC	0.178	0.058	-
对侧PMC	0.146	0.319	0.030	-
同侧PFC	0.929	0.307	0.073	0.089	-
对侧PFC	0.024	0.073	0.003	0.370	0.018

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