Murayama Takashi, Numata Kenji, Kawakami Takahiro, Tosaka Tomonari, Oga Masaru, Oka Nobuo, Katano Mihoko, Takasugi Jun, Shimizu Eiji
Department of Physical Therapy for Adult, Chiba Rehabilitation Center, Chiba, Japan.
Brain Inj. 2011;25(11):1047-57. doi: 10.3109/02699052.2011.607785. Epub 2011 Aug 31.
This study investigated the longitudinal changes in brain activation balance in motor-related areas after Constraint-Induced Movement Therapy (CIMT).
The subjects included seven ischemic stroke patients with mild right hemiparesis. Eight normal subjects were also included. The patients underwent functional MRI and motor function tests (Fugl-Meyer Assessment; FMA, modified Wolf Motor Function Test; mWMFT) both before and immediately after CIMT and also after a 3-month follow-up.
The motor function test scores improved immediately after CIMT; moreover, these scores were either maintained or improved even at the 3-month follow-up. In a comparison of the chronological data of the contralaterality index of the affected hand movement, the cerebellar activity changed significantly to ipsilateral activation immediately after CIMT and thereafter the cerebellar activity further changed to ipsilateral activation at the 3-month follow-up. A correlation was observed among the contralateral activation, FMA and mWMFT scores in SM1 and the ipsilateral activation and in the mWMFT scores in the cerebellum at the 3-month follow-up examinations.
The participation of the contralateral SM1 and the ipsilateral cerebellum is thus considered to play an important role in the satisfactory recovery of the motor function after CIMT intervention.
本研究调查了强制性运动疗法（CIMT）后运动相关脑区激活平衡的纵向变化。
受试者包括7名患有轻度右侧偏瘫的缺血性中风患者。还纳入了8名正常受试者。患者在CIMT之前、之后即刻以及3个月随访后均接受了功能磁共振成像和运动功能测试（Fugl-Meyer评估；FMA，改良Wolf运动功能测试；mWMFT）。
CIMT后运动功能测试评分即刻改善；此外，即使在3个月随访时这些评分仍保持或有所提高。在患侧手运动对侧性指数的时间顺序数据比较中，CIMT后小脑活动显著变为同侧激活，并且在3个月随访时小脑活动进一步变为同侧激活。在3个月随访检查中，观察到初级运动皮层（SM1）中对侧激活、FMA和mWMFT评分之间以及小脑中同侧激活与mWMFT评分之间存在相关性。
因此，对侧SM1和同侧小脑的参与被认为在CIMT干预后运动功能的良好恢复中起重要作用。
