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

Abstract

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

CLC Number:

R743.3

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.

Figures/Tables 9

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References 35

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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)

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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