双侧上肢训练影响脑梗死患者脑功能重组的fMRI研究

被引：28

作者：

郑雅丹

胡昔权

李奎

康庄

陈颖蓓

李鑫

机构：

[1] 广州,中山大学附属第三医院康复科

来源：

中华物理医学与康复杂志 | 2017年 / 39卷 / 05期

关键词：

脑梗死; 双侧上肢训练; 脑功能重组; 功能性核磁共振成像;

D O I：

暂无

中图分类号：

R743.3 [急性脑血管疾病（中风）]; R445.2 [核磁共振成像];

学科分类号：

100204 [神经病学]; 100231 [临床病理学];

摘要：

目的利用BOLD-fMRI技术探讨双侧上肢训练对脑梗死患者脑功能重组的影响。方法采用随机数字表法将14例患侧上肢功能中度到重度损伤皮质下梗死患者分为双侧训练组及对照组, 前者接受双侧上肢训练, 后者接受以患侧上肢为主的常规单侧肢体训练。2组患者分别于治疗前、治疗4周后进行上肢功能评定以及BOLD-fMRI扫描, 刺激任务为肘关节被动屈伸。结果治疗后2组患者Fugl-Meyer量表上肢部分(FMA-UE)、改良Barthel指数(MBI)评分均明显提高(P<0.05), 但两组间差异无统计学意义(P>0.05);治疗后2组患者激活脑区增加, 以双侧训练组更明显;治疗后双侧训练组患者出现双侧M1、S1、辅助运动区(SMA)激活;治疗后双侧训练组中度损伤患者呈M1对侧激活趋势, 重度损伤患者呈M1同侧激活趋势。结论双侧上肢训练能提高脑梗死患者上肢运动功能及日常生活能力, 其机制可能与促进两侧大脑皮质间抑制正常化及同侧皮质脊髓通路开放有关。

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