运动再学习对缺血性脑卒中患者上肢功能训练前后 - 中国康复.doc

功能性核磁共振成像在计算机辅助的上肢功能训练治疗缺血性脑卒中上肢偏瘫中的应用研究 陈金1 敖丽娟2,4 杨菲菲3 李咏梅2 1天津市人民医院康复医学科（300121） 2昆明医科大学第二附属医院康复医学科(650101) 3 昆明医科大学第二附属医院核磁共振室(650101) 4 通讯作者 项目来源:云南省教育厅科学研究基金项目（07C10295） 摘要: 目的：对10例脑卒中上肢偏瘫患者进行计算机训练，探讨计算机辅助训练上肢对脑可塑性的可能作用。方法：对患者进行6周的计算机辅助训练，每次共约48分钟，每周训练5次，在训练前、训练后分别在患者屈伸腕关节时进行功能核磁共振扫描。结果：1.训练后,患者患侧上肢运动功能显著改善(p0.01)。2.患者健侧手运动脑功能激活区主要位于对侧初级运动皮质区(SMC)及同侧小脑，患者健手在康复训练后脑激活区增多,包括对侧SMC区及同侧小脑、部分边缘系统。3.患者治疗前患侧手运动激活区分布广泛，而对侧SMC激活减少，同侧SMC激活增多，另主要还见辅助运动区激活增多；治疗后可见双侧SMC及辅助运动区激活，对侧SMC激活较治疗前增多,另主要还见对侧顶上小叶激活增多。 结论：计算机训练可以有效改善脑卒中患者上肢运动功能，诱发大脑皮质功能重塑是其机制的重要组成部分。 关键词 缺血性脑卒中; 康复; 计算机训练；功能磁共振 A study of functional MRI in upper-limb stroke hemiplegia treated with computer-assisted exercise Abstract Purpose: To test Computer-assisted technology for ten stroke hemiparesis and investigate the effects of computer-assisted technology intervention on cortical reorganization and associated motor recovery. Materials and Methods: computer-assisted exercise consisted of 48 minutes, 5 times a week for 6 weeks. fMRI with 1.5T scanner was performed at the time of the subjects attemping sequential wrist flexion-extension at pretreatment and posttreatment. Results:1.Computer-assisted therapy showed improvements in affected hand motor function after chronic stroke(p0.01).2.Prior to computer-assisted exercise, contralateral primary sensorimotor cortex (SMC) and ipsilateral cerebellum were activated during the motor task with unaffected hand of patients; After computer-assisted exercise, the actived areas of uninjured side hand of patients were increased in contralateral primary sensorimotor cortex (SMC) and part of the limbic system.3.Before training, the brain maps showed scattered activity in the contralateral primary sensorimotor cortex (SMC) which was weaken, the ipsilateral SMC and SMA which are increased during the affected wrist movement. After six weeks training, during the paretic wrist movement, activated regions were mainly in the contralateral and ipsilateral SMC、SMA、contralateral p